Abstracts of the 8th World Congress of Psycho ...

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PSYCHO-ONCOLOGY

Psycho-Oncology 15: S1–S478 (2006) Published online in Wiley InterScience (www.interscience.wiley.com) DOI: 10.1002/pon.1092

ABSTRACTS

ABSTRACTS OF THE 8TH WORLD CONGRESS OF PSYCHO-ONCOLOGY 16TH–21ST OCTOBER 2006 Ferrara}Venice, Italy

1 Global Psychosocial Oncology: 2006 Holland JC Wayne E. Chapman Chair in Psychiatric Oncology, Department of Psychiatry & Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA Psychosocial oncology began in the early 1980s and the International Psycho-Oncology Society was founded in 1984 to link the small groups of clinicians and investigators studying the psychological, social and behavioral aspects of cancer care. Over the past twenty years, they have developed valid tools to measure patient-reported outcomes (QOL) and they have developed, with the WHO, standards and guidelines for psychosocial care, modified to reflect the resources available in countries with limited means. There are key psychosocial issues at each point in the cancer trajectory: changing lifestyle and behaviors to reduce cancer risk; psychological factors altering participation in early detection and screening; control of physical and psychological symptoms during treatment (management of side effects, pain, anxiety, depression, delirium, fatigue); psychosocial sequelae in cancer survivors; and, significant psychological support in palliative and end of life care. Psycho-oncology today has a broad research agenda which is being carried out by investigators from many countries and different disciplines (psychology, psychiatry, nursing, social work). They collaborate with all the clinical specialties of oncology, epidemiology, prevention, palliative care, and bioethics. The addition of Copyright # 2006 John Wiley & Sons, Ltd.

psycho-oncology to the oncologic specialties has enhanced the understanding of the human experience of cancer and has led to evidence-based treatment guidelines which are being applied to patient care.

2 Methods of Assessment of Depression in Cancer Patients Breitbart W Psychiatry Service, Memorial Sloan-Kettering Cancer Center, Department of Psychiatry and Behavioral Sciences, New York, NY, USA Depression is highly prevalent in cancer patients, however, it is frequently under-diagnosed, misdiagnosed and under-treated. One of the obstacles to the accurate diagnosis and treatment of depression in cancer patients has been the lack of methods of assessment of depression that has been specific to medically ill populations such as cancer patients. Recent advances have been made in the assessment of depression in cancer patients that have helped improve the accuracy and specificity of such a diagnosis beyond the utilization of diagnostic criteria (DSM IV, RDC) that had originally been established and validated in physically healthy populations. The problem of the ‘somatic’ symptoms of depression have been dealt with in several ways. This presentation will describe two approaches to increased accuracy of diagnosis of depression in cancer patients: the substitutive approach, and the high threshold approach. In addition, this lecture will review the currently available research/clinical methods and

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instruments for diagnosing depression in cancer patients, including novel brief single item screening tools. Finally, new data on the relationship between pro-inflammatory cytokines and depression in cancer patients and the potential for the use of cytokines in the assessment of depression in cancer will be presented.

3 Psychotherapeutic Intervention for Depression in Cancer Patients Spiegel D Stanford University School of Medicine, Stanford, CA, USA As advances in medical treatment extend life with cancer, converting it in many cases from a terminal to a chronic illness, problems in coping with the disease and its treatment become more important. Depression is three times as common (11%) among medical inpatients, and twice as common (6%) among medical outpatients, than in the general population (3%), and affects some 25% of cancer patients. Half of all cancer patients have a psychiatric disorder, the most common of which are adjustment disorders with depression. Anxiety about illness such as cancer leads to delay in diagnosis which has been estimated to reduce prospects of long-term cancer survival by 10–20%. Depression is often underdiagnosed in the medically ill due to: (1) focus on somatic signs and symptoms; (2) misattribution of depressive symptoms such as energy loss, appetite disturbance and sleep difficulties as necessarily resulting from cancer or its treatment; (3) therapeutic nihilism regarding psychiatric conditions. Psychosocial problems that can exacerbate depression include fears of recurrence or death, family stresses, social isolation, energy reduction, alterations in body image, unanticipated demands on time, and financial burden. Finding means of helping people live with a chronic life threat, cope with the side effects of arduous treatments, and manage the personal, social and vocational consequences of disease-related disability is of growing importance. In addition there is evidence that depression contributes to risk of breast cancer progression, so it requires vigorous treatment to ameliorate quality of life and potentially to improve survival time. There is a growing body of evidence that suggests that psychotherapeutic interventions for cancer patients, along with appropriate psychopharmacological treatment, can reduce symptoms

Copyright # 2006 John Wiley & Sons, Ltd.

of depression and anxiety, as well as improving coping, enhancing interaction with family and friends, and improving interactions with health care professionals and adherence to treatment. These interventions are safe and inexpensive. Supportive-Expressive Group Therapy is designed to help cancer patients build bonds of social support, express and manage emotion, deal with fears of dying and death, alter life priorities, adjust to changes in body image, improve relationships with their family and friends, enhance communication with physicians, and develop cognitive and experiential skills to manage information and symptoms such as pain and nausea. Principles of psychotherapeutic intervention for depression among cancer patients will be reviewed, along with videotapes examples of the intervention. Additionally, there is some evidence that such interventions may have effects on disease course as well. Studies of these outcome effects will be reviewed. Possible mechanisms linking psychosocial intervention with effects on disease course will be described. Such therapeutic techniques have shown themselves to be humane, effective, and cost-efficient.

4 Depression as Systemic Disease: The Antidepressants Spectrum of Action Torta R Psychoncology Unit, University of Turin, Turin, Italy Mood depression is a systemic disease, not only related to the neurotransmission imbalance, but also to other neurotrophic, neurosteroidal, hormonal CNS modifications and diffuse autonomic, immunological, metabolic somatic changes. Antidepressants (ADs) induce systemic serotonergic, noradrenergic or dopaminergic modifications, according to the somatic activity of these drugs. Stress circuits are activated during mood depression: the hypothalamic paraventricolar nucleus (PVN) increases the release of the corticotrophinreleasing hormone (CRH) and, consequently, of ACTH and cortisol (Barden, 2004). ADs act not only in retoring neurotransmitters; level, but also in exerting a direct activity in the modulation of the receptor expression in hypothalamus, that normalizes the hyperactivity of hypothalamicpituitary-adrenal (HPA) axis observed in depressed patients. Recent findings demonstrate the involvement of neurotrophic factors, particularly

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

ABSTRACTS OF THE 8TH WORLD CONGRESS OF PSYCHO-ONCOLOGY

the Brain Derived Neurotrophic Factor (BDNF), in the pathophysiology of mood disorders (Hashimoto et al., 2004). BDNF protects against stress-induced neuronal damage: chronic administration of antidepressants increases the expression of BDNF mRNA in limbic structures. Proinflammatory cytokines within the central nervous system play a role in the pathophysiology of mood disorders and a modulation of these cytokines by chronic antidepressant treatment contributes to improve depression. Several of the aforementioned antidepressant mechanisms of action, represent the basis of the broad activity of AD in medical pathologies, such as pain, cardiovascular, metabolic and oncological diseases (Torta and Berra, 2002). This broad spectrum of ADs clinical activities suggest that term antidepressants is limited and that it would be better to define these drugs as noradrenergic or serotonergic drugs.

5 The Assessment and Management in Patients with Advanced Cancer Bruera E Department of Palliative Care & Rehabilitation Medicine (Unit 8), UTM. D. Anderson Cancer Center, Houston, TX, USA Approximately 50% of patients in developed countries and more than 80% of patients in developing countries will die of advanced disease. These patients will develop a number of devastating physical and psychosocial symptoms. In recent years there have been major developments in the state-of-the-art in the assessment and management of many of these syndromes. A number of very effective tools have been developed for the assessment of the intensity of physical and psychosocial symptoms. These tools have now moved from the research to the clinical setting. Multidimensional assessment of symptoms includes not just the intensity but also those major associated factors that can be appropriately corrected as part of the management of the different symptom complexes. Interdisciplinary care of difficult symptoms in patients with advanced cancer requires comprehensive multidimensional assessment and integrated pathways between different healthcare professionals. This presentation will discuss some of the areas where interdisciplinary care has been highly effective in controlling symptom distress.

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6 Delirium in Cancer Patients: Assessment and Intervention Caraceni A Palliative Care Unit, Hospice Floriani, National Cancer Institute, Milan, Italy The diagnosis of delirium is a significant clinical task in oncology for both psychiatrists and neurologists called to see patient with changes in mental status, cognitive impairment or neuropsychiatric symptoms. Delirium is a syndrome with a number of potential etiologies and its diagnosis and treatment can have a major impact on patient quality and quantity of life. Early recognition is fundamental to prevent more complicated courses and lack of recovery. Among the risk factors age, cognitive impairment and advanced disease play an important role. The context of care will influence the outcome, as delirium can alternatively characterize the terminal evolution of an advanced illness or compromise the course of a patient that instead has still potential for recovery. For the elderly in particular delirium can herald a long and incomplete recovery and lack of autonomy. Interventions range from prevention that has a potential in changing the care for the hospitalized elderly to palliative pharmacological treatment. Palliation of symptoms is however required as delirium causes suffering and although haloperidol is the first line of therapy optimal management would benefit of more trials and individualized pharmacological strategies, including the observation that delirium is one of the most frequent indications to palliative or terminal sedation. The impact of delirium on the patient and his or her family still awaits for more research as the social domain of care is certainly relevant to this complex and fascinating syndrome and therefore the attention to contextual, communication and nursing aspects of care should be also emphasized.

7 Dying with Dignity: Rhetoric, Data and Therapeutic Opportunities Chochinov HM Family Medicine and Community Health Sciences at the University of Manitoba, and Director of the Manitoba Palliative Care Research Unit at CancerCare Manitoba, Winnipeg, Canada

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Over the past decade, our research group has conducted a number of studies addressing the issue of dying with dignity. Dignity is a highly politicized term, which has been used to support various approaches for care of the dying. While most palliative care providers attending to patients would espouse dignity as an overarching value or goal of end-of-life care, few empirical studies have provided guidance or direction on how this might be operationalized or systematically achieved. Without such information, how are we to ensure that dying patients maintain their sense of dignity until the very end? To begin, one must appreciate how the terminally ill understand the notion of dignity, and what factors undermine or maintain dignity for those nearing death. This talk will address these issues, using clinical illustrations and research data, highlighting therapeutic considerations for patients near the end of life. An empirical model of dignity will be presented, along with the rational for a ‘dignity model’ based therapy. This novel, individualize, brief psychotherapy has been designed specifically to maintain the dignity of dying patients and their families. Results from one hundred patients who have completed this protocol will be presented, including data on the extent to which this intervention influenced their sense of dignity, hope, meaning, preparedness for death, and will to live. Results will also be presented regarding the reactions this intervention has garnered from family participants.

8 Cancer Survival and Supportive Care: From Diagnosis, Through Therapy to Follow-up Aapro MS Dean, IMO Clinique de Genolier, Genolier, Switzerland Even if one does not look at pediatric oncology, survival in cancer patients has improved. There are two main reasons for this result: earlier detection and better treatment. This presentation will briefly address the needs for support of cancer patients who survive the various forms of this, still today, demonized disease. Helping excellence in this support, through all stages of the cancer experience, is part of the definition of tasks of the Multinational Association for Supportive Care in Cancer (MASCC). At the diagnostic stage it is more and more recognized that society cannot offer early detection without immediate support in

Copyright # 2006 John Wiley & Sons, Ltd.

case of a suspicious lesion, let alone a confirmed diagnosis. And once treatment starts, the needs for support of our patients can be immense. In some cases the oncology community has responded well, and considerable progress has been made, among other areas, in psycho-social support, help to cope with consequences of surgery or radiation therapy, antiemetic treatment, control of infections, treatment of fatigue and anemia. In other instances, progress is slow to come, and mucositis, hair-loss, skin toxicity, diarrhea, are some of the areas which have not been given enough attention, even if some advances have been made. Patients who were often the center of the attention will find themselves suddenly very much alone once the end of a successful treatment is announced. The need for support at this stage has not received wide attention in most cancer centers.

9 Cancer and the Family: Paradigms and Quandaries Within a Cultural Context Baider L Head Psycho-Oncology Unit, Department of Radiation and Clinical Oncology, Hadassah University Hospital, Jerusalem, Israel More than 75 million people in the United States alone will be diagnosed with cancer, affecting approximately three out of four families. Chronic illness, such as cancer, places unexpected demands on family resources and creates changes over time and during the illness trajectory. Cancer has become a regular feature of family life, ceasing to be an isolated calamity of private individuals. Awareness and perception of illness based on socio-cultural understandings include norms regarding how family members are expected to relate and care for one another in the event of illness. They become part of family legacies, which are passed down from one generation to the next. Notwithstanding the considerable number of studies and clinical research that has been focused on the subject of families and chronic disease, we are only now beginning to identify some of the factors that come into play. What basic aspects of the family context might serve as a basic framework to identify risks of poor disease management? Why do some families fare relatively well in managing a chronic medical condition over an extended period of time, while others fare relatively poorly? Furthermore, despite the recognition that different chronic diseases place different

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demands for care on family members and that different developmental stages can cause families to respond differently to similar chronic conditions, we still know relatively little about how to design, implement and assess family care programs over various periods of time. If we succeed in distinguishing between families that do well and families that do poorly, then we can identify patients and families at risk of poor disease management and more appropriately redirect clinical resources.

10 The Implications of Neurosciences in Communication and Doctor–Patient Relationship Biondi M Department of Psychiatric Sciences and Psychological Medicine; University ‘La Sapienza’, Rome, Italy The scientific literature traditionally treats the therapist–patient communication in oncology according to a predominant psychological and/or humanistic approach. This communication often involves intense emotional distress, with patient’s anxiety, fear and preoccupation, sadness or despair, or outbursts of anger. The communication process is accompanied by intense distress, although not overt, for doctors and psychooncologists, too. Caring for cancer patients has a high emotional cost, resulting in a high rate of personnel burnout. Cynicism, scarce communication with patients, avoidance and emotional flattening are often psychological defence against distress. I suggest that doctor–patient communication and relationship have a hidden biological dimension which can help to explain the burden of caring for severely ill persons, with its emotional and physical/psychosomatic costs. Studies suggested that distress of oncologists and psychooncologists after stressful communications with patient also appears in dream content (Costantini, 1998). Psychosomatic and neuroscience research strongly evidenced the biological correlates of affects and cognitive processes. This evidence can be applied to suggest a ‘psychobiology of the doctor–patient communication’: it ranges from brain neurotransmitter circuits (5HT, NA, GABA, DA), to psychoneuroendocrine (PNE) and autonomic nervous systems (ANS) modifications, and, at a final level, to peripheral visceral and somatic responses which accompany arousing and distressing communications and interactions. Fear, anxiety and emotional arousal during

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communication involve limbic activation both for the patient and the doctor, with a role played by amygdala circuits, hypothalamic–pituitary axes, and brainstem nuclei, while descending pathways finally result in peripheral somatic ANS and PNE stress responses. The simple registration of doctor’s electrodermal activity (such as skin conductance level and skin conductance responses) during communication shows its ANS correlates. Phases of distress}while discussing bad news or preoccupation for a cancer recurrence, issues of bad prognosis, complications of treatment, participating in episodes of patient despair and crying, all elicit significant SCL changes in the therapist (personal observations). As brain imaging studies have shown, peripheral skin responses follow the activation of controlateral brain frontal circuits. The distress of difficult physician communication also displays moderate, transient heart rate increase, similarly related to emotional arousal and ANS central activation. Emotional stress results in several PNE changes, such as ACTH, cortisol, prolactin and catecholamines transient increases. To my knowledge, there are few PNE studies about the doctor–patient relationship. However, we can hypothesize that relevant anxiety and distress interactions can elicit PNE activation while social support in an experimental frustrating situation can prevent stress and cortisol increases (Biondi et al., 1986). A recent brain imaging study shows specific circuits activation while viewing the suffering of one’s own partner, suggesting a ‘psychobiology of empathy’ and give us the evidence that emotional suffering is also a biological, not only a psychological, matter. Caring for suffering persons implies an inner suffering of the caregiver, together with its psychobiological correlates. Courses in communication skills, training and support personnel groups, can both improve caring skills and reduce the psychobiology of distress of therapists in oncology and psychooncology.

11 Seven Characters in Search of a Disease: The Social Construction of People with Cancer in the Mass Media Burfoot A Department of Sociology, Queen’s University, Kingston, ON, Canada This paper examines seven common and public manifestations of the cancer patient in popular

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culture: The tragic victim; the doomed patient with a cancer diagnosis; the courageous survivor; the infantilized breast cancer patient; the asexual cancer patient; the childless cancer patient; the miracle. This analysis is based on literature that cites popular culture and mass media as a place where meaning is both constructed and contested. In this paper, it is argued that cancer is much more than a medical diagnosis and that the disease is also culturally produced with serious psychosocial outcomes. With the public framing of the cancer patient in terms of the characterizations above, the person becomes identified as the disease and in ways that diminish the full human potential typically awarded to the healthy person or even people with other illnesses or injuries. The material examined comes from popular films and television, as well as from cancer research fundraising campaigns.

12 Journey in Cancer Experience: A Journalist Changes his Life Terzani Staude A Writer, Florence, Italy T.T., a journalist and acclaimed foreign correspondent, is diagnosed with cancer. His immediate reaction is to go to the best cancer center he knows in order to submit to the classical cure: chemotherapy and radiotherapy. He is well taken care of, but when he is told to go back to his normal life he is puzzled: wasn’t it precisely his ‘normal life’ that made him ill? To this question his American doctors have no answer. But he knows that it is his depression in Japan in front of a horrifying society and a horrifying prospect of life for the whole of mankind that made him ill. Therefore, he certainly does not go back to his old life. Instead, he gives up his job as a journalist and withdraws to India and finally into the Himalayas. There, with the help of several teachers, and particularly one ‘old man’, he starts to reflect upon the meaning of life and death. In the end he finds his answer and dies peacefully at his home in Italy, surrounded by his family, after having confided the lesson he learned to two books. One appeared in the last months of his life, the other is posthumous, both are now helping a huge number of readers to make sense of their own troubles and sorrows and to accept the fact that all of us have to face illness and death.

Copyright # 2006 John Wiley & Sons, Ltd.

13 Communication Competency in Oncology: Legal, Ethical and Humanistic Imperatives Baile WF Professor and Chief, Section of Psychiatry, University of Texas, M.D. Anderson Cancer Center, Houston, USA The relationship with the patient has been called the ‘cornerstone of comprehensive cancer care’. This phrase acknowledges that the clinician can influence, through their interpersonal and communication skills, outcomes critical to the mission of cancer care. Legal, ethical and humanistic issues in the relationship with the patient transcend and augment the technical and medically-oriented care which every oncologist and oncology clinician is focused on: the ability to diagnosis the illness and apply appropriate biological anti-cancer interventions. However, this latter goal falls drastically short of the idea of comprehensive cancer care. Instead we can argue that issues related to informed consent, shared decision-making and other communication issues such as discussing prognosis and transitioning patients to palliative care have important medico-legal and ethical implications and obligations for the cancer caregiver. Moreover in this era when cancer has become a ‘survivable’ disease patients desire a relationship with their caregivers that is empathic and provides support to them across the trajectory of the illness. Competency in communication has also been shown to lessen the likelihood of burnout acknowledging the benefits of competent communication for clinician well-being. Despite these imperatives very few oncology trainees receive meaningful communication skills preparation during their training or afterwards. This presentation will review the ethical legal and humanistic imperatives for communication competency among cancer caregivers, review several studies which show that communication skills can be taught and learned, discuss several psychodynamic principles which characterize the therapeutic aspects of the oncologist–patient relationship and identify barriers to teaching and learning communication skills.

14 Psychosocial Oncology: A Real Necessity? Cavalli F

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FRCP Director, Oncology Institute of Southern Switzerland (IOSI), President, International Union Against Cancer (UICC) There are different possibilities to demonstrate the necessity of psychosocial oncology. One might be the ‘definition’. If the only duty of health professionals is to carry out technical acts, then psycho-oncology might be regarded as somewhat of a luxury. Although this might be the opinion of some healthcare-managers, I believe that the majority of health professionals currently have a more holistic approach to disease, which includes also the necessity to help the patient solve his/her social, psychological, familial, etc. problems, in order to create the best conditions to fully allow the healing process. Another way of demonstrating this necessity, is more empirical: if I consider, e.g. the weekly rounds of my in-patients wards, I must conclude that at least in 30–40% of the cases I will encourage my co-workers either to seek help by a psycho-oncologist or at least to discuss the case within a psycho-social discussion group. But is that just something which might be helpful in the affluent world? My 20 years experience with all developing projects in paediatric oncology in Managua, Nicaragua tells me that psycho-oncology was one of the most important elements which led to the success of the sustainability of this endeavour: this will be discussed in detail. PsychoOncology or psychosocial Oncology are a key element in the process of ‘humanisation’ of cancer: i.e. to allow patients to cope in a human way with this disease, which represents always an existent deadly danger. As such, psycho-oncology is a corner stone of palliative care which inturn presents an absolute necessity for a modern approach to cancer. Since cancer is a global problem, the UICC-policy concerning psychooncology and particularly palliative care will be presented in detail.

15 Psychological and Ethical Implications of Medical Errors Surbone A European School of Oncology, Milan, Italy; Department of Medicine, New York University, New York, USA While many aspects of patient safety are common across diseases, errors and adverse events have important specialty-specific dimensions. Special

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issues arise related to errors in clinical oncology such as the severity, pain and uncertainty of the cancer patient’s condition; the tension inherent in patient–doctor communication about cancer; the complexity of cancer diagnosis and treatment; and the toxicity of many cancer therapies, coupled with the prominent role of experimental treatments. By understanding the problem of medical errors within their specific context, specialty societies can contribute to change the culture of medicine and to develop effective strategies for reducing medical errors (e.g. by improvement of communication with patients and proper counselling for patients, family and physicians involved in medical errors). Psycho-oncology may act as the fundamental liaison between patients and physicians when an error has occurred and the tendency is to avoid any confrontation or to resort to legal measures. Silence in particular spoils the trust necessary to the patient–doctor relationship and it negatively affects the physician’s inner life and moral integrity and the psycho-oncologist may greatly contribute to the process of healing and repair. After reviewing the ongoing empirical research on patients’ and doctors’ attitudes regarding error disclosure, I will present excerpts from patient and doctor’s narratives, with special focus on the emotional reactions of physicians to errors that they have committed or observed. I will conclude with an analysis of the ethical implications of medical errors in oncology, including team errors, errors in clinical trials, improper communication and individual and institutional arrogance.

16 E-learning: the On-line IPOS/ESO Multilingual Core Curriculum on Psychosocial Aspects of Cancer Care Grassi La, Johansen Cb a Section of Psychiatry, Department of Medical Sciences of Behaviour and Communication, University of Ferrara, Italy; bInstitute of Cancer Epidemiology, The Danish Cancer Society, Copenhagen, Denmark In 2004 the International Psycho-Oncology Society (IPOS) in cooperation with the European Society of Medical Oncology (ESO), developed a multilingual core-curriculum on Psychosocial Aspects of Cancer Care to be delivered on line. The core-curriculum consists of 10 presentations (of which 5 are available at the moment) aimed at

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sensitizing and updating oncologists, GPs, nurses and health professionals in cancer care on the main psychosocial oncology issues. Each presentation was prepared in English and then translated and adapted into French, German, Hungarian, Italian, and Spanish. Key thought leaders and experts in the field were contacted to devise onehour lectures on five important subjects: Communication Skill in Cancer Care, Distress Management, Anxiety and Adjustment Disorders, Depression and depressive disorders, and Psychosocial Assessment. The translations, in each instance, have been modified to be culturally specific. An evaluation form accompanies each lecture in order to have a feedback on the quality, characteristics and learning objective of each lecture. Some strength points of the lecture are the internal structure and rationale, its specificity of being multilingual (with possible more translation), the evaluation form (with possible feedback for the improvement of the lecture) and the easy process of updating (peculiar elements in comparison with similar program in English taken from congresses or seminars). 789 people completed the evaluations by June 2006, with 222 regarding Communication, 161 regarding Anxiety, 151 regarding Distress, 149 regarding Depression and 106 regarding Psychosocial Assessment. The analysis of data showed that the lecture were considered generally good with indications of usefulness in clinical terms.

and continue learning. Graduates need to be able to conduct comprehensive psychiatric evaluations and both diagnose and treat effectively, including cancer-site and treatment-specific problems. Psychotherapy needs to be delivered to individuals, couples, groups and families and draw from the full range of therapy models, complemented by psychopharmacology. The liaison role invites support of staff and community education. Curricula are enriched by the Humanities, while the nurturance of a reflective style promotes quality assurance and life-long learning. Supervision is vital in developing psychotherapy skills; peergroup supervision is a hallmark of maturity. Communication skills training focusing on the clinician–patient encounter becomes a prime method for the psycho-oncologist to optimize psychosocial care by their whole treatment team. A basic curriculum covers breaking bad news, discussing prognosis, responding to distress, shared treatment decision-making, transition to palliative care and preparation for death and dying. Attendance at multi-disciplinary meetings within their oncology service provides opportunities for continued education. Finally, research is the source of new knowledge and refined treatments. Future psycho-oncologists need excellent scholarship to expand the evidence-base of the discipline and inform teaching and training of the next generation.

18 17 Education and Training in Psycho-Oncology: the Creation of the Psycho-Oncologist Kissane D Alfred P. Sloan Chair, Chairman, Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center Department of Psychiatry, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, USA New specialties mature through the establishment of dedicated training programs, not only teaching an agreed curriculum, but assessing and certifying clinical competence. Fellowship programs in Psychosomatic Medicine, Consultation-Liaison Psychiatry or Post-doctoral Research Fellowships are examples. Some universities have established Diploma/Masters Programs in Psycho-Oncology. Competencies include knowledge, skills and attitudes, but also the ability to problem-solve and think critically, work in a team, conduct research

Copyright # 2006 John Wiley & Sons, Ltd.

Psychosocial Aspects in Global Cancer Control: A WHO Perspective Sepulveda C WHO Cancer Control Programme The number of people living with cancer is increasing worldwide, and represents a tremendous burden on patients, families and societies. The World Health Organization estimates that 84 million people will die in the next 10 years if action is not taken. Cancer does not only have a physical impact on those affected by cancer, but also has a psychosocial impact on patients, family members and care givers. Hence the need to address the psychosocial aspect of the disease, which is often neglected. WHO’s cancer prevention and control policy emphasizes the need for providing routine psychosocial services for cancer patients, family members and health care providers when necessary. These services include the assessment of patients for anxiety and depression; support to

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ABSTRACTS OF THE 8TH WORLD CONGRESS OF PSYCHO-ONCOLOGY

help patients adhere to treatment plans; skill building for coping with cancer; information and basic emotional support to patients and families; and continuous training and support to health care providers and family care givers. WHO strongly supports self-care and home-care provided by trained family care givers, to ensure wide coverage of supportive care and end-of-life care including psychosocial support particularly in low-resource settings where health professionals are very scarce. A resolution on cancer prevention and control was adopted by the World Health Assembly in May 2005 which focuses particularly on the development of comprehensive cancer control programmes. The cancer resolution is the reflection of the strong support from governments to intensify action against cancer and provides new opportunities to foster policies and programmes, which include the psychosocial aspects.

19 From Cancer Patient to Cancer Survivor: Advocacy, Action, Access and Accountability: Using Public Policy to Advance the Delivery of Quality Cancer Care Stovall E President & CEO, National Coalition for Cancer Survivorship, USA The advocacy continuum begins with self-advocacy and progresses to a level of empowerment that allows individuals to advocate for many others. This presentation highlights how one national survivor-led nonprofit cancer advocacy organization is influencing nationwide policy changes to advance the delivery of quality, comprehensive cancer care. NCCS describes comprehensive care to include the integration of psychosocial services and palliative care from diagnosis and for the remainder of life.

20 The Wellness Community Twenty-five Years Later: The Role of Community-based Organizations in Psychosocial Oncology Thiboldeaux K President & CEO, The Wellness Community, Washington, DC, USA The Wellness Community (TWC) is an international non-profit organization dedicated to providing support, education and hope for people

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with cancer and their loved ones. TWC’s program is based on the Patient Active Concept, where people with cancer are empowered to make active choices throughout the continuum of the cancer experience and reduce the three most significant psychosocial stressors that people with cancer face}loss of control, loss of hope and unwanted aloneness. The Wellness Community has 21 centers in the United States, two centers abroad in Tel Aviv and Tokyo, The Virtual Wellness Community on the Internet at www.thewellnesscommunity.org and five new centers in development. TWC reaches more than 150 000 people affected by cancer each year. Celebrating its 25th anniversary in 2007, The Wellness Community has established a unique community-based cancer support model grounded in evidence-based psychosocial oncology. TWC offers a wide range of direct services to cancer patients including support groups, educational seminars, nutrition programs, exercise and stress reduction. In addition, the organization participates in and conducts peerreviewed research with academic, government and non-profit partners and serves as a seamless delivery mechanism for the positive findings of such research. This blend of ongoing research and direct community-based services makes TWC a distinctive model in the field of psychosocial oncology and underscores the importance of community-based organizations in the continuum of cancer care.

21 Joining Voices for Best Cancer Care: The Role of Patients’ Associations Faulds Wood L President European Cancer Patient Coalition, Twickenham, UK How do patients in your countries feel after a diagnosis of cancer? Is the emotional impact of cancer harder to cope with than the physical or practical aspects of the disease? A recent UK report (2006 Macmillan Cancer Support) found 6 in 10 people with cancer felt their emotional needs suffered in comparison to their physical and practical needs. Four in ten said they were unable to get information, advice or support for the emotional aspects. Reports across Europe reflect the same lack of awareness of and emphasis on patients’ emotional needs. The European Cancer Patient Coalition, launched in 2003, is an umbrella organisation for European cancer patient organi-

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sations, with over 200 member groups representing the major and rarer cancers. With our slogan ‘Nothing About Us Without Us!’, ECPC aims to be the unique voice of European cancer patients. Surveys of our members have revealed the lack of good information available to patients. Care and quality of life is an important focus for ECPC and we hold annual Masterclasses/Summits bringing together hundreds of patients groups to campaign for better treatment. We see National Cancer Plans as a key target to encourage more emphasis on quality of life as cancer increasingly becomes a chronic rather than a lethal condition. We are promoting the French Cancer Plan, with its emphasis on psychological aspects and encouraging national health ministries to include psychological assistance with example of patient lobbying as a powerful tool.

22 Life After Prostate Cancer: What To Tell Couples about Sex and Intimacy Lyon Howe D, Howe D American Medical Systems, MD Anderson Cancer Center Board, Houston, USA; American Porphyria Foundation, USA Prostate Cancer is the most prevalent cancer in men in the United States, with 235 000 men being diagnosed this year. The primary detection vehicle is the PSA test, which remains controversial in providing a guideline for treatment pending more data. Plus, the optimum treatment for a given diagnosis has not been clearly defined. Thus, men face more complex treatment decisions than people diagnosed with other types of cancer. Also, the fear of having the potential side effects, namely, urinary incontinence (UI) and erectile dysfunction (ED), often leads men to avoid having PSA tests or making timely treatment decisions. Most men are often hesitant to openly discuss these two side effects, even with their own partners or physicians. Since many physicians are equally uncertain as to the most recent treatments for these side effects or may also be uncomfortable discussing the subject, many men are left unaware of available treatments or remain under-treated for ED and UI. The partners are also greatly affected by these side effects, particularly ED. Often a conspiracy of silence results because couples do not have the comfort level or skills to broach this issue. Their relationships may become strained and their physical intimacy further

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jeopardized, which affects their overall sexual function. In this discussion, we will review the side effects of prostate cancer treatment and the common problems in communication between couples affected by this problem. We will discuss up-to-date treatments, including medication, mechanical devices and alternative techniques for enhancing psychological and sexual intimacy.

23 Depression and Pain: Coincidence or Connection? Demyttenaere K Department of Psychiatry, University Hospital Gasthuisberg, Belgium There is a growing interest in better defining the role of chronic painful physical symptoms in major depressive disorder. The presentation will first focus on the available epidemiological evidence for a close link between painful physical and depressive symptoms. Depressive symptoms are predictive for the development of painful physical symptoms and vice versa. Moreover, both add independently to the work loss days. However, the presence of somatic disorders (e.g. cancer) and of painful physical symptoms results in poorer recognition rates of depression. There are multiple models for understanding the relationship between painful physical and depressive symptoms with pathophysiological and psychopathological mechanisms. Painful physical symptoms do predict a higher severity of depression and a poorer outcome. Both serotonin and epinephrine play a role in pain perception and this could explain the higher efficacy of dual acting agents in the treatment of painful physical symptoms in depressed as well as in non-depressed patients. ACKNOWLEDGEMENTS: This Meeting of the expert session has been supported by Eli-Lilly and Boehringer-Ingelheim.

24 Psychosocial Oncology in China: Present Status and Future Directions. Challenges and Opportunities Zhang ZWa, Tang Lb, Grout Jc, Bultz Bc a Secretary-General of Chinese Anti-Cancer Association (CACA), Beijing, China; bDepartment of Psycho-Oncology, Beijing Cancer Hospital, Beijing, China; cDepartment of Psychosocial Resources, Tom Baker Cancer Centre, and Faculty of Medicine, University of Calgary, Calgary, Canada

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PURPOSE: To enhance awareness of the current status of psychosocial oncology in China with attention to its unique cultural concerns, obstacles, and opportunities. METHOD: A selected literature review of academic papers in Chinese and English language journals and web sites was analyzed for the current status, challenges, and opportunities for psychosocial oncology in China. RESULTS: China’s enormous population (1.3 billion), its booming economy, trends to urbanization, improved standard of living, increased lifespan and ‘one child’ policy has increased the focus on public health. In this regard, cancer has become China’s most important public health concern. China’s national cancer strategy (2004– 2010), based on WHO guidelines, focuses on cancer prevention and treatment, as well as quality of life among cancer patients and their families. The Chinese Anti-Cancer Society is now funding research, training an international collaboration in psychosocial oncology. The newly organized Chinese Psychosocial Oncology Society aims to provide a national forum for psychosocial oncology research Cultural and systemic challenges to establishing psychosocial oncology as a core discipline in China include: (1) the family’s desire to ‘protect’ cancer patients by withholding cancerrelated information; (2) stigma and privacy regarding mental health issues; (3) biomedical practitioners’ claims that psychosocial oncology is not sufficiently evidence-based; and (4) limited funding for psychosocial oncology care and research. CONCLUSION: In China, psychosocial oncology has emerged as a new program over the past decade. IPOS is considered a valuable resource towards China’s interest in partnering with the international psychosocial oncology community to enhance the discipline globally.

25 Partners in Survival: Men Helping to Improve Survivorship for Minority Women Loscalzo Ma, Zabora JRb, Heyison Mc, Crews Cd a University of California-San Diego, CA, USA; b Dean, National Catholic School of Social Service, The Catholic University of America, Washington, DC, USA; cMen Against Breast Cancer, Adamstown, MD, USA; dEastern Virginia Medical School, Norfolk, VA, USA A number of studies have found a lack of information and targeted educational materials that engage minority women during their survi-

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vorship of cancer. Unmet needs in the areas of socioeconomic, cultural, and language continue to persist. Minority women are at particular risk because of a lack of access to overall health care overall, and to any types of health promotion and prevention programs. Committed spouses, partners, fathers, brothers, sons, and close friends comprise the vast majority of relationships that women with cancer share with men. Almost all women have men in their lives on whom they expect varying degrees of support. Men are excellent problem-solvers, and are most comfortable undertaking clearly defined activities in which they see a positive outcome. Men Against Breast Cancer (MABC) has partnered with leading survivorship experts from Johns Hopkins University, University of California-San Diego, and Catholic University to develop a health program which addresses this lack of psychosocial support and quality care for underserved survivor populations. The Partners in Survival program utilizes problem-solving education which has been proven to reduce depression, stress, and to improve the overall mental health of the survivor.

26 Psycho-oncology Development Nationwide: A Japanese Perspective Uchitomi Y Psycho-oncology Division, Research Center for Innovative Oncology, National Cancer Center Hospital East, Kashiwa, Japan With encouragement from the IPOS, the Japan Psycho-Oncology Society (JPOS) was established in 1986. Dr Hiroomi Kawano, a founding President, enlightened the importance of psychospiritual care for cancer patients, incorporating palliative care. In 1990s, the move towards truthtelling in cancer care was advancing slowly in Japan. But a dramatic increase of truth-telling practice in cancer care resulted from strict regulation of hospital stay in 2000s. There is an emergent need to establish psycho-oncology service with the aim of ameliorating psychological distress after cancer disclosure and supporting communication between medical professionals and cancer patients and their families. Our Psycho-Oncology Division, established in 1995 under auspice of the Japanese Ministry of Health and Welfare (JMHW), and the JPOS have been providing psycho-oncology post-graduate residency program and workshops. The JMHW has supported several nationwide

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palliative and psycho-oncology research groups; one by a Grant for Second-Term Comprehensive 10-Year Strategy for Cancer Control, focusing on management of distress, especially depression after cancer disclosure since 1994. The research opens new avenues for communication, psychobiology and neuro-imaging research in the field of psycho-oncology in Japan. The Law on Measures for Cancer will come into operation in April 2007. The 30 Cancer Centers and 135 affiliated hospitals in Japan are expected to have a palliative care team including psycho-oncologist as an essential member. The team were also to provide training program of psycho-oncology with supportive and end-of-life care in the community, in cooperation with medical schools where such training in clinical oncology has not yet been established. Intersociety Symposium: American Psychosomatic Society (APS)}Biobehavioral Oncology: IPOSAmerican Psychosomatic Medicine Inter-Society Exchange

27 Cognitive Behavioral Stress Management Facilitates Adaptation During Breast Cancer Treatment: Examining Biobehavioral Mechanisms Antoni Ma, Carver Ca, Lechner Sb, Blomberg Bc a Psychology University of Miami, Coral Gables, FL, USA; bPsychiatry University of Miami, Miller School of Medicine, Miami, FL, USA; cMicrobiology/Immunology, University of Miami, Miller School of Medicine, Miami, FL, USA PURPOSE: We developed a Cognitive Behavioral Stress Management (CBSM) intervention based on a biobehavioral model of adaptation to cancer treatment. We tested effects of CBSM on multiple indicators of adaptation, and neuroendocrine and immunological functioning in women being treated for early-stage breast cancer. METHODS: In two randomized clinical trials (Study 1, N ¼ 99; Study 2, N ¼ 199), women with Stage 1–3 disease were randomized 2–8 weeks after surgery to either a 10-week CBSM group or a one-day informational seminar and followed up to 15 months to test whether CBSM can facilitate adaptation and biological indices after adjuvant therapy. CBSM provides training in relaxation, coping skills, and other stress management techniques, in a supportive group. RESULTS: CBSM improved adaptation as indicated by decreased depression, negative affect, intrusive thoughts and interviewer-rated

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anxiety symptoms; and increased optimism, benefit finding, positive affect, and improved physical quality of life (p’s 50.05–0.001). Latent Growth Modeling analyses demonstrated that increases in emotional processing and perceived relaxation skills during the intervention explained its effects on adaptation. CBSM participants also showed decreased evening serum cortisol levels, and increased lymphocyte proliferation and Th1 cytokine production, p’s 50.05). Women showing larger improvement in psychological adaptation during CBSM revealed greater changes in endocrine and immunologic functioning. CONCLUSIONS: Future work examines whether CBSM-related changes in biobehavioral factors can explain its effects on longer-term quality of life and health outcomes in these women. ACKNOWLEDGEMENTS: This work was supported by grants from the National Cancer Institute.

28 Randomized Trial of Yoga in Women with Breast Cancer Undergoing Radiation Treatment Cohen La, Chandwani Kb, Thornton Ba, Perkins Ga, Rivera Ea a Department of Palliative Care & Rehabilitation Medicine, MD Anderson Cancer Center, Houston, TX, USA; bSwami Vivekananda Yoga Anusandhana Samsthana, Bangalore, India PURPOSE: We tested a yoga program for breast cancer patients undergoing radiotherapy. METHODS: Sixty-one women with breast cancer were randomly assigned to either a yoga program or to a waitlist group. Bi-weekly classes were taught during the 6 weeks of radiotherapy. Patients completed measures of intrusive thoughts and avoidance behaviors, depression, sleep, fatigue, and QOL at baseline, and 1, 4, and 12 weeks after the last treatment. Women also collected saliva samples 5 times/day for 3 days to measure cortisol and blood samples were obtained to assess immune function at baseline and 1 week after the last radiotherapy. We report on the 1-week assessment point. Immune assays are still pending. RESULTS: ANCOVA revealed that the yoga group had significantly better physical functioning (means adjusted for baseline: yoga 81.8; control 68.6, P50:01), significantly higher general health (yoga 78.3; control 67.9, P50:03), marginally better social functioning (yoga 85.3; control 76.0, P ¼ 0:1), significantly lower levels of sleep-related

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daytime dysfunction (yoga 0.5; control 1.2, P50:04), and marginally lower levels of fatigue (yoga 1.9; control 3.1, P50:06). Slope analyses of cortisol revealed no group differences. There was a positive correlation between cortisol slope and sleep-related daytime dysfunction (P ¼ 0:02) and fatigue (P ¼ 0:1), and a negative correlation between cortisol slope and social functioning (P ¼ 0:08). As sleep-related daytime dysfunction and fatigue increased cortisol slope was less steep, and as social functioning increased cortisol slope was steeper. CONCLUSIONS: The yoga program was associated with statistically and clinical significant improvements in aspects of QOL.

Greater distress was also related to lower PMA/I stimulated TH1/TH2 ratios across all 3 compartments. Greater distress was related to elevated peripheral IL-8 and VEGF (p’s 50.05) whereas higher levels of perceived stress were related to elevations of IL-8 and IL-6 in ascites. CONCLUSIONS: These findings demonstrate psychosocial–immune relationships in the tumor microenvironment and suggest that psychosocial factors may play a role in impaired host resistance to ovarian carcinoma. ACKNOWLEDGEMENTS: Grants # 1R21 CA88293-01 and #RO1-CA1045-25-01 to Susan Lutgendorf from the National Cancer Institute.

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Extending Psychoneuroimmunology To The Tumor Microenvironment Lutgendorf Sa, Sood Ab, DeGeest Kc, Anderson Bc, Penedo Fd a Psychology University of Iowa, Iowa City, IA, USA; bGynecologic Oncology, MD Anderson Cancer Center Houston, TX, USA; cGynecologic Oncology, University of Iowa, Iowa City, IA, USA; d Psychology University of Miami Coral Gables, FL, USA

Psychosocial Correlates Of Natural Killer Cell Cytotoxicity (NKCC) In Men Treated For Early Stage Prostate Cancer (CaP) Penedo Fa,b, Siegel Sa, Kinsinger Da, Traeger La, Rasheed Ma a Psychology, University of Miami, Coral Gables, Florida, USA; bBiobehavioral Oncology & Cancer Control, Sylvester Comprehensive Cancer Center, Miami, FL, USA

PURPOSE: Our ongoing work addresses links between psychosocial factors, cellular immunity, and tumor progression in peripheral blood and in the tumor microenvironment of ovarian cancer patients. METHODS: Patients awaiting surgery for suspected ovarian cancer completed psychological measures and gave pre-surgical peripheral blood (PBL). Samples of tumor and ascites were taken during surgery. We examined relationships among social support, distress, and natural killer cell activity (NKCC), TH1, TH2, TC1, and TC2 lymphocytes isolated from 3 compartments (PBL, ascites, and tumor [TIL]). Unstimulated, tumorstimulated, and PMA/Ionomycin stimulated Interferon-? and interleukin-4 producing T cell populations were determined by intracellular stain. Production of the angiogenic cytokines interleukin-6 (IL-6), interleukin-8 (IL-8) and vascular endothelial growth factor (VEGF) was also examined. RESULTS: Social support was related to significantly higher NKCC in PBL and in TIL, adjusting for stage (p50:05) whereas distress was related to lower NKCC in TIL (p ¼ 0:018). Multivariate modeling indicated independent contributions of distress and social support to NKCC in TIL (p values 50.02).

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PURPOSE: NKCC is associated with disease severity and progression, presence of tumor cells in circulation and tumor response to treatment in CaP. Studies have documented associations among psychosocial factors (e.g. distress) and NKCC across various cancer populations, but not in men treated for CaP. This was the focus of the present study. METHODS: Participants (N ¼ 190) were men treated (i.e. radical prostatectomy or radiation) for stage I/II Cap, with no history of other cancer and older than 50 years. All participants completed a psychosocial battery that included measures of distress, depression, social support, sociability and quality of life (QoL) using the POMS, BDI, ESSI, IIP and FACT-P, respectively. Peripheral morning blood was collected via venipuncture. NKCC (CD56+CD3) was assessed using a 51Cr release assay in triplicate at 4:1 effector-to-target cell ratio. RESULTS: The average age of participants was 64 years. (SD ¼ 7:4), 77% were married. Men had been diagnosed and treated for CaP 15.1 (SD ¼ 4:6) and 10.1 (SD ¼ 7:1) months, respectively. Greater levels of social support, optimism, sociability and QoL were significantly associated with greater NKCC (all r’s>0.17, p’s50.05). Greater levels of distress, depression and anxiety

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were significantly associated with lower NKCC (all r’s>0.18, p’s50.05). CONCLUSIONS: Several modifiable psychosocial factors are associated with a marker of immunocompetence in CaP. Future work should assess the efficacy of psychosocial interventions in modifying these factors and possible immune and physical health benefits of such changes.

31 Coping with Lung Cancer: Biological Pathways and Quality of Life Sephton Sa,b, Weissbecker Ia a Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA; b James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA PURPOSE: Lung cancer patients often experience a loss of physical function and quality of life (QOL) related to rapid disease progression. Shapiro (1994) identified two dimensions of the coping response to such losses: positive versus negative, and assertive versus yielding. Studies suggest cancer patients who balance positive yielding (e.g. acceptance) and positive assertive (e.g. active) coping efforts experience better QOL. We investigated potential endocrine and immune pathways by which coping may be related to lung cancer outcomes. METHODS: Non-small cell lung cancer patients (n ¼ 56) provided self-reports of coping, functional status, and quality of life. Overnight urinary catecholamines, diurnal salivary cortisol, and pro-inflammatory cytokine levels were assessed. Bivariate correlations identified relevant medical and demographic control variables. Subsequent hierarchical regressions examined relationships between variables of interest. RESULTS: Active coping was significantly associated with functional well-being and lower endocrine activation. Acceptance predicted lower proinflammatory cytokines. Cortisol elevation was related to poor functional well-being and overall QOL. The effect of active coping on functional well-being was reduced (beta 0.389 versus 0.297) and lost significance when cortisol was entered (Baron and Kenny, 1986; Holmbeck, 1997). CONCLUSIONS: Results demonstrate interrelationships between coping, endocrine and immune function and quality of life. The cross-sectional design and multicollinearity issues preclude directional conclusions. However, these data suggest future longitudinal research should examine

Copyright # 2006 John Wiley & Sons, Ltd.

glucocorticoids and inflammatory mediators as potential biological pathways by which coping might affect lung cancer outcomes. ACKNOWLEDGEMENTS: This research was supported by the Kentucky Lung Cancer Research Board. Intersociety Symposium: European Association of Consultation Liaison Psychiatry and Psychosomatics (EACLPP)}Randomised controlled trials of psychotherapeutic interventions in cancer patients

32 A Brief Psychological Intervention to Prevent Affective Disorders in Cancer Patients}Methodological Considerations and Overview of Results Pitceathly Ca, Maguire Pa, Fletcher Ia, Parle Ma, Creed Fb a CRC Psychological Medicine Group, University of Manchester, Manchester, UK; bDivision of Psychiatry, University of Manchester, Manchester, UK A brief psychological intervention to prevent affective disorders in cancer patients}methodological considerations and overview of results. PURPOSE: Affective disorders are common in the year following a diagnosis of cancer. We tested whether a 3-session, concerns’ focused intervention based on cognitive-behavioural principles could prevent these disorders developing amongst newly diagnosed cancer patients. METHOD: Patients beginning cancer treatment who did not have an affective disorder were randomised to receive immediate intervention (at the start of their treatment), delayed intervention (8 weeks after starting treatment) or usual care. The groups were stratified according to patients’ risk of developing affective disorders (high risk was poor coping or previous psychiatric history). Assessments were completed 2, 4, 6 and 12 months after recruitment. Primary outcome was any affective disorder in the year following the cancer diagnosis measured by standardised psychiatric interview (SCID). Secondary outcomes were a checklist of Concerns and the Hospital Anxiety and Depression Scale (HADS). Data were analysed using ANCOVA and conditional odds logistic regression models. RESULTS: 465 patients were recruited. 313 (79%) of the 397 well enough to be interviewed completed the study. During the 12-month study period significantly fewer highrisk patients who received intervention developed

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affective disorders compared to those who received usual care (OR ¼ 0:29; 95% CI: 0.10–0.91 p ¼ 0:034). At the 4-month assessment, HADS and Concerns scores were significantly lower amongst high-risk patients who had received intervention (p50.05). CONCLUSION: A brief intervention, delivered by non-specialists, promoted adjustment amongst newly diagnosed cancer patients at high risk of developing affective disorders. There were no benefits for low-risk patients.

33 Expressive-supportive Group Psychotherapy vs Sports Therapy in Breast Cancer Patients}Feasibility and Preliminary Results of a 3-armed RCT Maislinger Sa, Drobil-Unterberger Aa, Essmann Ia, Lukas Pb, Ninkovic Mc, So¨llner Wd a Department of Medical Psychology & Psychotherapy, bRadiooncology, and cSurgery, Medical University Innsbruck; dDepartment of Psychosomatics, General Hospital, Nuremberg, Germany INTRODUCTION: 20–40% of breast cancer patients suffer from anxiety, depression, body image disturbances, and marital problems. Previous research shows that psychotherapy as well as sports therapy may lead to better quality of life in these patients. However, in most studies effect sizes are low. It is unknown which patients gain more profit from psychotherapy or sports therapy. METHODS: Within the framework of a RCT, 12-session group psychotherapy was compared to sports therapy and to a control group receiving standard treatment. We used standardised instruments measuring psychological symptoms (HADS), QoL (FACT), and adaptation to illness (MAC) at the beginning and at the end of the intervention and after 1 year. RESULTS: From 313 eligible consecutive patients undergoing radiotherapy 55 took part in the RCT (17.6%). Main reasons not to participate were ‘no distress’, ‘sufficient support from family’, ‘wish to dissociate from hospital’, ‘wish to go back to work’ and ‘no interest in participation in a group’. We included 20 patients in the psychotherapy group, 15 in the sports therapy group, and 20 in the control group by now. Numbers of drop outs were 3 patients in the sports therapy group and 2 in the control group. Compared to controls, reduction of anxiety could be shown in both intervention groups at 1-year follow-up (F ¼ 4:11; P ¼ 0:026; ESpsth ¼ 0:46; ESsport ¼ 0:13). CONCLUSION: Participa-

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tion in the RCT in consecutive patients during oncological treatment was low. Further trials should include only patients with higher levels of distress and use a stepped-care approach including individual psychotherapy.

34 Preventing Affective Disorders in Partners of Depressed Cancer Patients: A Randomised Controlled Intervention Study Pitceathly Ca, Fletcher Ib, Creed Fc a Maguire Communication Skills Training Unit, Christie Hospital, Manchester, UK; bDivision of Clinical Psychology, University of Liverpool, Liverpool, UK; cDepartment of Psychiatry, University of Manchester, Manchester, UK PURPOSE: To evaluate a brief psychological intervention to prevent affective disorders amongst partners of depressed cancer patients. METHODS: Partners of patients diagnosed with an affective disorder as well as cancer were randomised to receive one-to-one psychological intervention or usual care. The six-session intervention was based on cognitive–behavioural methods and delivered by a social worker or psychiatric registrar. Study arms were stratified for partners’ risk of developing an affective disorder (high or low), gender and social class. Assessments were completed at recruitment; 6 months and 12 months later. Primary outcome was measured using a standardised psychiatric interview (SCID) to detect cases of affective disorder that developed during the study. Secondary outcome measures were a checklist of Partners’ Concerns and the General Health Questionnaire (GHQ). Data were analysed using ANCOVA and conditional odds logistic regression models. RESULTS: 323 partners were recruited, 232 (72%) were male. 241 (75%) partners completed the study. 132 (81%) of the 163 partners randomised to intervention attended at least one session. 57 partners were diagnosed with affective disorders at recruitment. 42 partners developed disorders during the 12-month study period. Partners in the intervention arm recorded lower concerns’ scores (p50.07) at the 6-month assessment than partners who received usual care. CONCLUSIONS: Psychological morbidity is high amongst partners of depressed cancer patients. The intervention is acceptable to partners and appears to accelerate a reduction in partners’ concerns levels. The presentation will discuss the

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challenges in delivering a preventative intervention to this group of careers. ACKNOWLEDGEMENTS: This work was funded by Cancer Research UK.

35 Development of a Method Investigating Meaning in Life in Cancer Patients Stagno Da, Krenz Sa, Zdrojewski Ca, Luthi Fb, Leyvraz Sb, Stiefel Fa a Service de Psychiatrie de Liaison, De´partement Universitaire de Psychiatrie Adulte, CHUV, Lausanne, Switzerland; bCentre Pluridisciplinaire d’Oncologie, CHUV, Lausanne, Switzerland Meaning in life is an important source of adaptation to somatic diseases. AIM OF THE STUDY: The goal of this study is to validate the Schedule for the Meaning in Life Evaluation (SMiLE), a qualitative and quantitative instrument evaluating the meaning in life perceived by patients suffering from advanced cancers. The first step of this project is to develop and evaluate psychotherapeutic interventions centered on the meaning in life. METHODS: Cancer out patients in a palliative phase of disease were approached and possibly included. The SMiLE is an instrument, which helps patients to identify a maximum of seven fields which produces or could produce meaning in life. The relative importance of each field is weightened by means of a visual scale. The overall meaning in life is scored by a visual analogue scale (VAS) ranging from 3 to 3. Patients are then asked to rate their satisfaction for each field and to define its importance on VAS ranging from 0 to 5. Face validity, feasibility and acceptability is also evaluated by VAS. Reliability has been assessed by test/retest at a three days interval in a sample of medical students. External validity will be evaluated by means of a comparison with the under-scale MEANING of the questionnaire Functional Assessment of Chronic Illness Therapy (FACIT-Sp) and a VAS measuring the perception of the total meaning given in life. With the index of Karnofsky, VAS of physical symptoms and the Edmonton Symptom Assessment Scale (ESAS) potential sources of confounding variables are identified. Generalisation, comparison with a healthy population and crosscultural differences will be evaluated by means of research centres (Lausanne, Munich, Dublin).

Copyright # 2006 John Wiley & Sons, Ltd.

RESULTS: After 4 months of study, 35 patients are included in the study. So far, results indicate satisfying face validity, feasibility and acceptability. The study will be completed before June 2006. CONCLUSIONS: Preliminary results indicate that the SMiLE is an adequate instrument to identify and evaluate fields that produce or could produce meaning in life in patients with advanced cancer.

36 Depression Among Cancer Patients: A Randomised Controlled Trial Comparing Standard Care With a Short Psychodynamic Psychotherapy Stiefel Fa, Krenz Sa, Zdrojewski Ca, Luthi Fb, Leyvraz Sb, Stagno Da a Service de Psychiatrie de Liaison, De´partement Universitaire de Psychiatrie Adulte, CHUV, Lausanne, Switzerland; bCentre Pluridisciplinaire d’Oncologie, CHUV, Lausanne, Switzerland About 40% of the cancer patients suffer from depressive disorders which are seldom identified and even more rarely treated. Depression leads to a reduction in quality of life, diminished medical treatment compliance, prolonged hospital stays, and a reduction of global functioning. AIM OF THE STUDY: The purpose of the study is to compare the effectiveness of a standard treatment based on the guidelines for the management of major depression in the medically ill (1) with a short psychodynamic psychotherapy for major depression (MD) and adjustment disorders (AD) with depressive symptoms in an oncology population (2). METHODS: Cancer patients fulfilling the DSM-IV criteria for a MD and AD are randomly assigned to two groups. The first group receives standard treatment (pharmacotherapy, regular consultations by an oncologist) and the second a short psychodynamic psychotherapy of 16 sessions. Evaluation of effectiveness consists of pre and post intervention results, as well as intermediary and follow-up out-comes. RESULTS: Up to now, a total of 30 patients were included in the study. Results indicate a decrease of depressive symptoms in both groups. DISCUSSION: different questions are raised by this study, such as the difficulties with recruitment in psycho-oncology studies, with randomisation and with drop out [(1) Voellinger R et al. 2003. Major depressive disorder in the general hospital: adaptation of clinical practice guidelines. Gen Hosp Psychiatry 25(3):

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185–193. (2) Stiefel F, Stagno D. Intervention psychothe´rapeutique aupre`s des patients cance´reux souffrant d’une symptomatologie de´pressive; une e´tude clinique randomise´e. Fondation Kisane 2005–2006]. Intersociety Symposium European Association of Palliative Care (EAPC)}‘Pain’ at the End of Life: The Response is not only Medication

37 Pain at the End of Life. Resilience in Palliative Care Patients with Pain Oliviere D St Christopher’s Hospice, London, UK Resilience is a concept that is attracting growing interest (Bluglass, 2003; Huppert, Baylis and Keverne, 2005; Newman, 2005). Vanistendael (2003) has defined it as ‘the capacity to do well when faced with difficult circumstances’ and the International Resilience Project which collected data from thirty countries described resilience as a ‘universal capacity which allows a person, group or community to prevent, minimise or overcome damaging effects with adversity’ (Newman and Blackburn, 2002). The concept has considerable relevance to palliative care. A focus on resilience can assist practitioners to hold on to the increasingly important balance between a medical model that assesses for risk of health problems within individuals and the founding ethos of the hospice and palliative care movement in empowering individuals and promoting their strengths and resources and those of their families and communities (Monroe and Oliviere, 2005). This paper offers an introduction to a resilience-promoting approach to patients with pain; overviews methods of working with patients’ strengths; and critiques aspects of assessment and intervention. An improved focus that emphasises ‘resilience’ rather than ‘risk’ or ‘vulnerability’ in the social, spiritual and psychological dimensions of pain, is the major theme.

38 Opioids for Advanced Cancer Pain: Is Morphine Enough? Kaasa S Department of Cancer Research and Molecular Medicine, Faculty of Medicine, The Norwegian

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University of Science and Technology, Trondheim, Norway Pain at the end of life is a clinical challenge in many patients due to the possible changes in the pathophysiology of the patient, as well as changes of social and psychological nature. Many patients have reduced cognitive function, which makes the diagnosis of pain a challenge, as well as the followup of the effect of the interventions. Pain treatment should be based upon an understanding of the disease, the pain and the patients’ conceptualisation of the complex multiple symptomatology. Observer ratings in the cognitively impaired are often necessary to perform. However, there is no consensus on which instrument to use and the one developed seems to have some limitations. Morphine and other opioids will often be the drug of choice. Many patients will be in the need of opioid rotation and/or combined modality treatment. Analgesics need often to be supplemented by treatment modalities that have an effect on the cancer, such as bisfosphanates, cytotoxic agents, new targeted chemotherapy, as well as radiotherapy. Different patients may respond different to various opioids due to genetically inter-individual variability. New data within this field of translational research may in the near future shed new light on the inter-individual opioid (and pain) treatment.

39 Psychological Aspects of Pain in Advanced Illness Lloyd-Williams M Academic Palliative and Supportive Care Studies Group, School of Population, Community and Behavioural Sciences, University of Liverpool, UK There are many aspects to the management of pain in advanced illness and true holistic care should include an assessment not only of the physical pain experienced by a patient but also explore the psychological, social and spiritual issues which may be contributing to the total pain experienced. This paper will explore how such issues can be addressed in the context of advanced disease and will focus on the complex symptom of depression in advanced illness. This paper will also introduce new research carried out by our research group which allows a deeper insight into the meaning of depression in patients with advanced illness and how depression can influence the

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symptom management of patients in the latter stages of illness. Intersociety Symposium Italian League Against Cancer (LILT) and European Cancer League (ECL)}Understanding and Supporting

40 Effects of Living with an Increased Risk of Breast Cancer Caruso Aa, Vigna Ca, Sega FMb, Cognetti Fc, Savarese Ac a Department of Prevention and Formation in Psycho-Oncology, Regina Elena Cancer Institute, Rome, Italy; bDepartment of Surgery, Regina Elena Cancer Institute, Rome, Italy; cDepartment of Medical Oncology, Regina Elena Cancer Institute, Rome, Italy PURPOSE: Evaluate psychosocial variables of individuals who approach genetic counseling in order to: modulate intervention of team on patients needs; survey psychosocial impact of counselling and surveillance program; survey possible correlation between psychosocial variables and development of cancer. METHODS: Subjects recruited: April 2002–March 2006. Psychological assessment performed at: collection family history}eligibility communication (T0); blood-withdrawal (T1); communication test outcome (T2). Assessment follows surveillance program. Instruments: MMPI-2 annually performed; FACES-III; HADs; Genetic Risk Perception (GRP). RESULTS: Data are preliminary. T0: N ¼ 210 subjects; cancer affected 115/210; eligible135/210; median age 49. MMPI-2: significant differences between affected/unaffected women in the scales: K (13.43/15.80); PA (10.00/11.29); HS(12.15/9.76). HADs. Anxiety: Normal 48%, Borderline 26%, Disturb 26%. Depression: Normal 78%, Borderline 12%, Disturb 10%. FACESIII: Real Cohesion (40.75), Ideal Cohesion (43.82), Real Adaptability (31,92) Ideal Adaptability (34.70). GRP: I don’t know=6%; Lowrisk=34%; Average-risk=45%; High-risk=15%; affected=48.33%; unaffected=35.94%; eligible= 48.43%; not eligible=29.92%. CONCLUSION: Respect unaffected subjects, affected are more hypochondriacs, they have less emotional control and disclose fewer of their doubts. The anxiety is higher than depression. Cohesion is higher than adaptability. Only 6% of subjects answer I don’t know about their genetic risk, affected and eligible

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women perceived higher risk of being mutation carrier than non eligible unaffected. That seems to show that information provided by physicians is adequate.

41 End-of-life Care in Italy: Understanding Family Dynamics. A Qualitative Study From the Italian Survey of the Dying of Cancer (ISDOC) Morasso Ga, Costantini Mb, Di Leo Sa, Roma Sa, Miccinesi Gc a Unit of Psycho-Oncology, National Cancer Institute, Genoa, Italy; bUnit of Clinical Epidemiology, National Cancer Institute, Genoa, Italy; cClinical Epidemiology, CSPO, Florence, Italy PURPOSE: This is a qualitative study aimed at describing and analysing the emotional and practical experience of a representative sample of Italian non-professional caregivers when caring for a terminally ill family member. METHODS: This is a secondary analysis from the Italian Survey of the Dying of Cancer. ISDOC is a mortality follow-back survey of 2000 adult cancer deaths, identified with a 2-stage probability sample representative of the whole country. Information on patients’ experience was gathered from non-professional caregivers with an interview conducted by trained professionals. A specific question of the interview asked about the caregivers’ emotional and practical experience of assisting a terminally ill relative. DATA ANALYSIS: The answers to the specific question about the caregivers’ experience were transcripted and analysed using the constant comparative method according to the grounded theory. Three researchers independently generated categories. Subsequently, areas where they differed were reconsidered and an interpretation was agreed upon. Descriptive coding was used to explore emotional experiences, practical needs and difficulties perceived by caregivers. RESULTS: Valid interviews were obtained from 1.289 caregivers (64.5%), but this qualitative analysis was carried out on 1158 non-professional caregivers. Answers were classified according to the perception of the experience as positive (33.1%), negative (65.1%) or neutral (1.8%). Then we identified subcategories detailing the emotional impact of the caregiving experience, and we tried to connect the perception of the caregivers’ experience (positive, negative or neutral) with some characteristics of the patients and the caregivers:

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previous experiences of loss, the social and family network, unresolved conflicts with the patient, provision of palliative care services.

42 Changing Perspectives}From Micro Wishes to Macro Plans Vollmer TC Division of Psycho-Oncology, Department of Internal Medicine III, University of Munic Grosshadern, Munich, Germany What do we see, when we listen carefully to patients’ stories and needs? Do Metaphors help us, understanding patients’ needs? Could we develop supportive structures by understanding patients’ metaphors? The presentation will question the current offers and possibilities of Psycho-Oncology using a new approach in Bibliotherapy. This approach tries to illuminate cancer patients’ psychological core questions and needs by working with graphical metaphors. The presentation will introduce this new way of understanding and supporting cancer patients and their families. It will provide the first results of a small qualitative study that enables therapists to categorise cancer patients’ psychological needs and compare them with current psychooncological offers. Within the talk the audience will graphically be guided through the psychological journey of the five categories of patients’ needs, their micro wishes, and psychological perspectives, the macro plans. For instance, anxiety increases and decreases at different stages of the cancer journey from the worry of thinking something is wrong to the anxiety of awaiting test results, to a state of shock at diagnosis. Becoming actively involved in dealing with cancer can help decrease anxiety, as can support from all those around the person with cancer, from family and friends to the whole medical team. The very clear micro wish is to exterminate the anxiety, which is an unrealistic goal. Only psychological support can help the person with cancer to learn living with anxiety by changing the perspective. But do we have the right supportive tools already? Intersociety Symposium European Federation of Psycho-Oncology Societies (EFPOS)}A European perspective on psycho-oncological services and guidelines

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43 Psycho-Oncology Services and Guidelines in the United Kingdom Sharp DMa, Cox Kb, Walker Mc, Walker LGa a Postgraduate Medical Institute, University of Hull, Hull, UK; bSchool of Nursing, University of Nottingham, Nottingham, UK; cOncology Health Centres, Hull & East Yorkshire Hospitals, NHS Trust, Hull, UK There are several models for the design of psychooncology services which provide ongoing psychological support and intervention for cancer patients and their relatives. Across Europe the design of such services is also influenced by national political and economic considerations. This presentation will discuss the variety of psychooncology services available in the United Kingdom. A number of differing models of service delivery are described highlighting issues such as multidisciplinary working and degree of functional integration with wider oncology services. The national policy documents which influence the development of psycho-oncology services in the UK such as the National Institute for Clinical Excellence guidance Improving Supportive and Palliative Care for Adults with Cancer, will also be discussed. The current issues of importance in the development of psycho-oncology services in the UK will also be discussed as will possible templates for the further development of such services in the future.

44 A European Perspective on Psycho-oncological Services and Guidelines Schumacher Aa, De Walden-Galuszko Kb, Keller Mc, Monteiro Ld, Remie Me, Sharp DMf a Medizinische Klinik A, Universita¨tsklinikum Mu¨nster, Mu¨nster, Deutschland; bDepartment of Palliative Medicine, Medical University, Gdan´sk, D˛ebinki 2, Poland; cKlinik fu¨r Psychosomatische Medizin, Psychoonkologie, Heidelberg, Deutschland; dUnidade de Psiquiatria, Instituto Portugueˆs de Oncologia, Lisboa, Portugal; eDe Vruchtenburg, Straatweg 171, Rotterdam, NL; fOncology Health Centres, University of Hull, Postgraduate Medical Institute, Institute of Rehabilitation, Hull, UK An overview will be given about the latest psychooncological developments in Europe. Speakers from different European countries will present

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a talk about the design of the clinical services in their countries: how they work, how they are organized, which professions are involved, about the most important issues as well as the major obstacles in their work. To promote high standards of psychological and social support for cancer patients and their families and to improve the quality of psychosocial care, psycho-oncological guidelines need to be established and implemented into clinical oncology across Europe. To influence policies on psychosocial care within Europe collaboration must be fostered and maintained. European psychooncological societies and working groups should exchange ideas and experiences and could thus benefit from each other. Ways to achieve this goal will be elaborated. Psycho-oncologists from all over Europe are invited to attend and to join the discussion. Intersociety Symposium European Oncology Nursing Society (EONS) and International Society of Nurses in Cancer Care (ISNCC)}Psychosocial Issues in Cancer Care: Nursing Roles and Practice Implications

45 Living After Cancer: Challenges in Being a Survivor Fitch MI Psychosocial and Behavioral Research Unit, Sunnybrook Regional Cancer Centre, Toronto, Ontario, Canada The cadre of individuals who are living after a diagnosis of cancer is growing steadily. Therapeutic successes are common today with the overall 5year survival rate for all types of cancer at 64% (ACS, 2005). But this survival often comes with a cost. Cancer and its treatment have more than a physical impact. In addition to late physical effects of cancer treatment, there can be psychological, social, spiritual, and existential long-term effects. These issues can be present for those who may never experience clinical evidence of disease again or for those who may eventually face recurrence and disseminating disease. This growing cadre of survivors possesses an incredible expertise and wisdom regarding what it means to experience cancer and what it means to cope with, and adjust to, the aftermath of its impact. Health care professionals need to look to this group to gain insight about how help can be provided in appropriate and meaningful ways. Achieving a

Copyright # 2006 John Wiley & Sons, Ltd.

person-centered perspective within our cancer services and programs is more likely to be achieved through collaboration with survivors in our midst. This presentation will highlight current thinking about the needs of cancer survivors and the role that health care professionals, particularly nurses and psychosocial experts, can play in working together to improve the cancer care delivery system.

46 Psychoeducational Interventions: Rationale, Structure, and Nursing Sensitive Outcomes Fawzy NW UCLA School of Nursing, CA, USA The United States National Cancer Center Network (NCCN) defines DISTRESS is a multifactorial unpleasant emotional experience of a psychological (cognitive, behavioral, emotional), social &/or spiritual nature that may interfere with the ability to cope effectively with cancer, its physical symptoms, and its treatment. DISTRESS extends along a continuum, ranging from common normal feelings of vulnerability, sadness and fears to problems that can become disabling such as depression, anxiety, panic, social isolation, and existential and spiritual crisis. The term ‘distress’ is more acceptable and less stigmatizing than ‘psychiatric’, ‘psychosocial’, or ‘emotional.’ It sounds ‘normal’ and is less embarrassing. The possible manifestations of this distress that can occur in the diagnostic and initial treatment phases of cancer may have significant impact on affective state, quality of life, treatment decision making, compliance, and long term outcome. Comprehensive psychoeducational interventions encompassing health education, stress management techniques, coping and problem solving skills, as well as individual and group emotional support have been shown to be effective dealing with this distress. It is within the scope of nursing practice for nurses, independently as well as in collaboration with other health care team members, to provide such psychoeducational interventions. Such a structured intervention lends itself to nursing intervention and the measurement of nursing sensitive outcomes.

47 Being There: Nursing Interventions at the End of Life Porock D

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University of Nottingham, Queen’s Medical Centre, Nottingham, UK The role of the nurse in the care of dying people is probably the longest established role in the health professions. Why is it then, when you ask a nurse what she/he is doing, that a clear, description or definition is so difficult to articulate? Finding words to describe caring, the human response to suffering and the emotional labour that is involved in providing end of life care is difficult. However, the nursing literature is gradually giving voice to the exceptional experience of nursing the dying and their families. The concept of ‘being there’ and what that means for the nurse and the interdisciplinary team is explored in this presentation. ‘Being there’ is considered here as an intervention based on the fundamentals of nursing philosophy. Elements of ‘being there’ include creating a healing environment, communicating, promoting trust, touching, listening. Providing physical care and symptom management are expressions of ‘being there’ which are familiar to other health professionals but they do not represent the total range of therapeutic intervention that nursing brings. ‘Being there’ requires the nurse to be present and available to build a caring relationship with the patient and family. It takes time to provide this high level of intensive care. Examples of the impact on the integrity and dignity of dying patients and the health and wellbeing of grieving families will be presented to illustrate the role of nursing at the end of life. Intersociety Symposium Italian Society of Family Therapy (SITF)}Family System Therapy: a Biopsychosocial Approach to Cancer Treatments

48 Practical Aspects Engaging Families for Psychology Therapy When They are Used to a Biomedical Context Hardwick PJ Child, Adolescent & Family Mental Health, Dorset HealthCare, NHS Trust, Poole, UK Psycho-social functioning affects and is affected by the course and experience of physical illness. Yet physicians wishing to refer families for psychological help may find they are resistant to the idea, especially if they associate such help with shame and stigma. Medical explanations and interventions are often perceived as more respectable. This

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talk is based on the clinical experience of a general child and adolescent psychiatrist with a longstanding interest in paediatric liaison and systemic therapy. It gives an overview of practical approaches found useful in engaging families with strong medical views. These include: joining with medicalising families; education re. mind/body relationships; tackling unhelpful beliefs about illness; developing curiosity and experimentation; developing emotional language; ‘practical philosophy’, e.g. using conditions to review lifestyle and beliefs; symptoms as messages; learning to live with symptoms so they impact less on daily functioning; rehabilitation and recovery; paediatricians and child psychiatrists offering joint appointments; interventions in professional network. In the broader context Child and Adolescent Mental Health and Paediatric departments need to work more closely together so they can promote a united mind/body approach as essential to modern medicine. Psycho-social assessment should be routine early in the medical encounter. Better psychosomatic education is required at all levels.

49 The Family Focused Grief Therapy Model of Family-centered Care Kissane DW Department of Psychiatry & Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA Meta-analyses have failed to demonstrate significant benefits for careers and the bereaved from many of the traditional psychosocial and grief interventions. Yet the family is a key source of support when a relative is dying. Family Focused Grief Therapy (FFGT) was developed as a preventive intervention for palliative care families viewed at greater risk of psychosocial morbidity. To identify those at risk, families are classified into well functioning, intermediate and dysfunctional (sullen and hostile) types using the Family Relationships Index (FRI). In the Melbourne RCT of FFGT, 81 families were randomized in a 2:1 ratio, 53 families (233 members) received FFGT; 28 families (130 members) were notreatment controls. Outcome measures, 6 and 13 months post-death, included the Brief Symptom Inventory (BSI) and Beck Depression Inventory (BDI). Analyses used the Generalized Estimating

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Equation (GEE) method to allow for correlated family data, clusters and to control for sites. FFGT achieved a significant global reduction in distress (BSI) over 13 months [difference in change scores ¼ 0:11 (95%CI 0.01, 0.22), p ¼ 0:02] and reduced depression significantly for the 10% with highest baseline BDI scores. FFGT appears able to prevent pathological grief and is a useful method of support during palliative care. Challenges in delivery of therapy and style of therapists’ questions will be discussed.

50 Personal and Interpersonal Dynamics in Families with a Cancer Patient Onnis L Department of Psychiatry, School of Medicine, University of Rome, Italy In this lecture, the author underlines the complex problem of the impact of cancer illness not only with the individual patient and his/her intrapsychic reactions, but also with the family, with its way to organize itself around the illness, with the influence on its life cycle. Circularly the impact of family dynamics on cancer evolution is also analysed in the light of many clear research data. The author moreover evaluates the implications that the illness and the connected themes, particularly the ‘anticipatory loss’, have on the emotions of therapists with respect to their personal experience. Finally the author underlines the importance of integrative interventions, considering the correlation between biological, psychological and relational aspects and connecting the medical treatment with the psychotherapeutic one. In this integration, in the problem interpretation as well as in the intervention, resides the real sense of a ‘systemic approach’ open to complexity.

51 Family System Therapy: A Biopsychosocial Approach to Cancer Treatments Gritti P Department of Psychiatry, School of Medicine, SUN University of Naples, Italy A cancer diagnosis affects not only a patient but his interpersonal network. Literature points out that some psychosocial dimensions of course and prognosis of cancer are influenced by interperso-

Copyright # 2006 John Wiley & Sons, Ltd.

nal factors, mainly family dynamics. Therefore family support programs are considered part of psychosocial treatments in oncology. Family issues in oncology concerns family roles and feelings, coping strategies as well as communication styles. Within a biopsychosocial framework, family systemic interventions are suggested to support patient’s family as well as to enhance psychological resources of the family system to cope with the illness. Family counselling and family psychotherapy may help patient’s relatives to become expert caregivers sharing feelings and improve communication. This IPOS 2006 intersociety symposium, in cooperation with Italian Society of Family Therapy (SITF), is focused on three main topics: how can we describe family dynamics in cancer [Onnis, 1994]; how can we engage family of cancer patient in a psychological treatment in a biomedical context [Hardwick, 2005], how can we help families to cope with the end of life experiences [Block & Kissane, 2000]. Intersociety Symposium International Association for Hospice and Palliative Care (IAHPC)}Palliative Care: Cross-Cultural Experiences

52 Commission of Psycho-oncology for Latin America: A Novel Proposal to Develop the Psycho-Oncology Discipline Krikorian A Director of the Psycho-Oncology, Commission for the Latin American Association of Palliative Care, Colombia The Latin American Association of Palliative Care created this year it’s first commission: the commission of psycho-oncology, which was officially presented in the 3rd Latin American Congress of Palliative Care held in Isla Margarita, Venezuela in March 2006. The mission of the commission is to help in the development of psycho-oncology discipline in palliative care in Latin American countries. Conformed by four members (Dr Jimmie Holland as an honor member, Dr Mauricio Murillo as advisor from the IPOS, Dr Alicia Krikorian as director and Dr Carolina Monti as coordinator), the philosophy of the commission rests in three main principles: participation, cooperation and innovation. The most important objectives are: (1) To create a structured plan for developing the psycho-oncology

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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discipline in palliative care in Latin America, (2) To promote the education of Latin American mental health professionals in psycho-oncology, (3) to generate a space of active participation of Latin American mental health practitioners in palliative care (in research, assessment and intervention protocols, education, scientific psychooncology networks and exchange). In order to accomplish these objectives, the members along with 4 leaders of different regions of Latin American, have established goals in the short, medium and long term. These goals will be described in detail during the presentation, and also accomplishments and barriers will be discussed.

53 Neighbourhood Network in Palliative Care Kumar S Institute of Palliative Medicine, Medical College, Calicut, Kerala, India Psycho-oncology services are not available for the vast majority of the needy in this world. Lack of awareness among the policy makers, professionals and general public, lack of resources including non-availability of trained professionals, and absence of models of care appropriate to the local social ecology are some of the important reasons for this. A similar situation is faced also by many of the palliative care services. Exchange of ideas between different initiatives in the field of health care is absolutely vital for the development of services appropriate to regional needs. Success in development of services depends to a great extent on the willingness to explore and learn from the successes and failures of other initiatives. The philosophy, strategies and evolution of a palliative care movement with community participation in the South Indian state of Kerala are explained in this presentation. This network of palliative care initiatives called Neighbourhood Network in Palliative Care (NNPC) caters to a population of more than 12 million and has achieved the best coverage in palliative care anywhere in the Developing World. The local community plays a major role in the initiation and development of NNPC units. Trained non professionals supported by professionals act as the main delivery points for psycho social support in NNPC. The possible relevance of this successful initiative involving trained

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volunteers to Psycho-oncology services in the Developing world are discussed.

54 The Assessment and Management of Symptoms in Advanced Cancer Bruera E Department of Palliative Care and Rehabilitation Medicine, M.D. Anderson Cancer Center, Huston, USA Patients with advanced cancer develop a number of physical and psychosocial symptoms. These symptoms occur in clusters and include pain, fatigue, anorexia, nausea, dyspnea, anxiety, depression, and delirium. In the past the pathophysiology and assessment of these symptoms were considered separately. Recent evidence strongly suggests that there are common factors influencing the production, perception, and expression of these symptoms, including afferent stimulation of the somatic and visceral nerves, tumor induced byproducts, and cytokines. The assessment of symptom intensity has become established clinical practice. In recent years there has also been increased emphasis on major confounders including the presence of somatization, chemical coping, delirium, and mood disorders. This presentation will discuss the aspects of multidimensional assessments and pharmacological as well as nonpharmacological management of the main symptom complexes in patients with advanced cancer.

55 How Can Psycho-Oncology Facilitate Palliative Care Development in an Eastern European Country? Hungarian Experiences Muszbek K Hungarian Hospice Foundation, Budapest, Hungary In 1988, for the first time in Eastern Europe, an organized psycho-oncological service for cancer patients was launched in Hungary. The emphasis was still at large put on somatic care and curative processes in the 1980s and 1990s in this region. The main ambition was to draw the attention to psycho-social and spiritual aspects of the illness. This psycho-oncology service organized the first conferences and meetings on the dilemmas of breaking bad news, telling the diagnosis. At this time, even the word cancer was taboo. This

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initiative has paved the way to a new, more outright kind of communication with cancer patients. By the educational program of the psychooncology team within the National Oncology Institute, psychological support became available in a growing number of clinical oncology departments. In 1991, the psycho-oncology service was one of the founders of the first hospice foundation. The participants of the trainings helped establish several palliative units throughout the country. Due to a close cooperation, both fields started an impressive development. The National Cancer Control Programme, launched in 2006, includes the establishment of a nationwide palliative care system as well as the availability of psychological support in each cancer centre. Budapest has become an international training centre in the field of both psycho-oncology and palliative care. Presenter would like to give an outline on the interactions of psycho-oncology and palliative care based on the experiences of the last 15 years. Intersociety Symposium Multinational Association of Supportive Care in Cancer (MASCC)}Medical Oncology, Supportive Care, Psycho-oncology: Areas of Cooperation

56 The Role of Medical Oncologists Monfardini S Division of Medical Oncology, General and University Hospital Padua, Padua, Italy In the sixties of the 19th century, at the very beginning of the development of the medical treatment of neoplasia, those entering this field were identified by the other clinical oncologists, at least in Europe, as cancer chemotherapists. This improper definition was however always rejected, since it was quite clear to anyone of us that Medical Oncologists were supposed to take care not only of the prescription and administration of various forms of medical treatment of tumors (endocrine therapy, chemo and immunotherapy), but of the therapy of the complications produced by the neoplasia (e.g. pain, anemia, infection, etc.) and by the treatment itself (e.g. granulocytopenic fever, bleeding from thrombocytopenia, mucosytis, etc.). For example one of the cornerstones was the initial assessment of the physical well-being of the patient developed through the definition of the performance status of Karnofsky. The definition of the degree of toxicity followed afterwards. The

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need of a special psychological support was perceived also in the seventies with different answers to these last needs. In the attempt to improve the quality of global management and cancer care, supportive care and psycho-oncology have been the subject of an extensive clinical research effort. If one would try to minimize the importance of these issues, the magnification of the special lens of cancer in the elderly, would be very useful. Supportive therapy in fact is strictly related to the possibility of administering chemotherapy in older patients, meaning that not only the prevention and treatment of toxicity, but also possible correction of or support or adaptation of therapy for all deficits revealed by a multidimensional evaluation (mood, CNS deterioration, physical function, type and degree of comorbidity).

57 Supportive and Palliative Care in an Integrated Cancer Care Model Tiernan E Department of Palliative Medicine, St. Vincent’s University Hospital, Dublin 4, Ireland Optimizing cancer care outcomes requires an integrated and holistic approach to patients. For many patients with cancer, it is the physical and psychological symptoms complicating the disease and the side-effects of treatment that are the greatest source of distress. The physical and psychological comfort of patients are inextricably linked, for example, there has been a significant association demonstrated between the presence of pain and psychiatric diagnoses in cancer patients. Poor control of symptoms will not only affect overall quality of life, but may also impact on the ability to make appropriate treatment decisions and comply with treatment, and may alter the course of the cancer itself. The palliative care approach to patients focuses on improving their quality of life by addressing physical, psychological, social and spiritual problems. As such, it complements the conventional oncological approach and therapies. The WHO definition of palliative care encourages the early introduction of palliative care in conjunction with anticancer treatment. As palliative care is associated by most with incurable illness, the term ‘supportive care’ is used by many to reflect a similar philosophy and approach to patient care

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throughout the entire continuum of the cancer experience including rehabilitation and survivorship. For many the two terms, palliative and supportive are used interchangeably. In this presentation practical examples of integrated care models of conventional and supportive/palliative oncology will be described, with particular emphasis on the perspective of the supportive/palliative care physician, and some of the challenges and potential rewards in adopting such approaches will be explored.

58 Cancer-related Fatigue: Different Roles of Care Professionals and Their Work in an Integrative Way Foubert J Faculty of Healthcare, Erasmushogeschool, Department Gezondheidszorg, Brussels, Belgium Of the numerous symptoms associated with cancer and cancer treatment, fatigue has been ranked by patients as the longest lasting and disruptive. Although family and healthcare providers may observe indicators of fatigue, the patient provides the best documentation of symptoms. The use of reliable and well-validated assessment scales allows the impact of the condition, and more importantly, the efficacy of a treatment to be assessed. The assessment of fatigue is multidimensional in nature (Portenoy, 1998). Ambiguous literature and a previous lack of specific tools to measure fatigue created difficulties in establishing assessment and management guidelines. Because of the high prevalence of CRF patients should be screened for fatigue at diagnosis, treatment initiation, and appropriate intervals as needed (Mock et al., 2004). Psychological distress, lack of confidence, expected negative outcomes, pessimism and socio cultural dimensions have been associated with fatigue (Carver et al., 2003). The mechanisms that produce fatigue are currently unknown. Interventions for CRF include education and pharmacologic and non-pharmacologic measures. Nurses play a vital role in using cognitive behavioural approaches to help patients and their families explore and reframe the meaning of cultural beliefs, values and life goals. In addition the nurse should implement preventive techniques before high levels of fatigue occur. Education should begin at diagnosis and the initial assessment. The nurse should discuss the impact

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of treatment-related fatigue with the patient and his family, review preventive interventions such as nutrition and exercise, and assist the patient in evaluating fatigue as treatment progresses.

59 The Role of the Psycho-oncologist Within Oncological Rehabilitation Koch U Institute of Medical Psychology, Hamburg University Medical Center, Hamburg, Germany Prevention, cure, rehabilitation, and palliation pursue different goals within the medical care of cancer patients, despite a number of areas of overlap. This presentation first analyzes the goals and tasks of psycho-oncology within these subsystems of healthcare. The analysis shows that, at least in Germany, relatively advantageous factors and conditions are present for psycho-oncological procedures within oncological rehabilitation. The internationally accepted definition of rehabilitation is based on a comprehensive, bio-psychosocial model. Major goals in the rehabilitation of cancer patients consist of assistance in coping with the effects of the cancer illness and its treatment, the extensive restoration of functions and activities, and the greatest possible degree of participation within social settings. The necessity to base the achievement of these goals on knowledge from and the strategies of psychosocial medicine is no longer a topic of much controversy. The approximately 100 oncological rehabilitation clinics currently present in Germany generally provide psycho-oncological services. An extended stay in these rehabilitation clinics (usually three weeks) provides the required conditions for appropriate psycho-oncological assessment and intervention programs. The presentation discusses options in this context as well as constructive and problematic interaction styles of the psycho-oncologists within the rehabilitation team. Intersociety Symposium World Psychiatric Association}Section on Psycho-Oncology (WPA)} ‘Stigma’: Mental Health and The rights of Cancer Patients and Their Families

60 Psychosocial Health in Cancer: Paradigms of Interventions Fawzy IF

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Department & Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, USA

Med 64: 206–221; President’s New Freedom Commission on Mental Health. 2003. Interim Report to the President, October 2002.

This presentation will provide a rationale for including psychosocial care as an integral part of treatment for cancer patients and their families. Various intervention philosophies will be discussed. A historical overview of work in the field including early research interventions designed to alleviate distress, improve quality of life, and enhance coping will be provided. Second generation intervention research aimed toward improving compliance, decreasing distress, enhancing coping and improving physiological parameters as well as long term effects including recurrence and survival will also be reviewed. Finally, a model for future intervention research will be offered.

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61 Ways to Increase Attention to Psychooncology Issues in Cancer Centers: Decreasing Stigma for Patients, Families and Staff Riba MB Department of Psychiatry, University of Michigan, Ann Arbor, USA There is a great need to understand the barriers and obstacles for patients, families and staff regarding integrating psychooncology care and issues into usual and routine oncology treatment. There are underlying individual issues regarding having psychiatric symptoms, currently and in the past. There are family dynamics and historical issues that make addressing more acute psychiatric problems more difficult. There are also doctor– patient issues and institutional barriers that are factors. At the University of Michigan, we tried to organize our program into a multi-disciplinary of care that is accessible to patients and families in terms of location, costs and easy of referral. In addition, we try to provide education and training to our patients and staff regarding the need for routinely providing a way to assess, detect and treat psychiatric issues, both on an outpatient as well as in inpatient settings. We are also trying to develop research methods and models to encourage many disciplines to engage in helping us better understand how to best help our patients and families. This presentation will provide an overview about some of our clinical, education work and research endeavors. References: Holland JC. 2002. History of psycho-oncology: overcoming attitudinal and conceptual barriers. Psychosom

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Training Young Oncologists in Doctor–Patient Relationship Aitini E Medical Oncology and Hematology Department Mantova, Parma University, Italy When I started teaching medical oncology at Parma University ten years ago, I decided to understand how important the doctor–patient relationship was for my young colleagues. It was a difficult task. I had no idea how to hit the mark and with what instruments. So I asked if they had read or knew of some texts I consider essential to understanding what may be the feelings and emotions of cancer patients and their families. Using slides I showed some titles: ‘The death of Ivan Illich’ by Lev Tolsto`j, ‘The man with the flower in his mouth’ by Luigi Pirandello, ‘Cancer ward’ by Alexander Solgenitsin, ‘Illness as metaphor’ by Susan Sontag, ‘The Dying Animal’ by Philip Roth and others. These are only some examples but probably the most important in world literature, exploring emotions and feelings of cancer patients from the particular point of view of the great writers. Unfortunately most of them have not read and don’t know these works which I believe to be very important in the cultural background of an oncologist. I am convinced that before teaching relationship techniques such as communication skills or assessment of quality of life and quality of care it is important to instil in the young oncologist a culture focused on the doctor–patient relationship. The empathy, staying near without invading and the ability to listen are qualities which must come primarily from one’s own philosophy of life and everyday behaviour and which can be developed subsequently through the acquisition of relationship techniques. Symposium Recent Findings In Communication Skills: Implications for Oncology Practice, Teaching and Research (supported by Novartis)

63 Communication Skills, Burnout and the Oncology Team Fallowfield L, Jenkins V, Catt S, Langridge C, Cox A

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CRUK Psychosocial Oncology Group, Brighton & Sussex Medical School, University of Sussex, UK PURPOSE: To examine: perceived informational roles of multidisciplinary team (MDT) members, communication between and within oncology teams and their patients, and the impact that working within a team has on psychological wellbeing and job satisfaction. METHODS AND INTRODUCTION: MDTs evolved in response to the increasing complexities of patient care with the expectation that each discipline would contribute their own particular skills and knowledge to enhance decision-making about therapeutic options available for patients. The putative benefits of such an approach were that successful teamwork would lead to better patient management and greater satisfaction for individual team members. There has been little systematic evaluation of team functioning and its impact. We assessed: the perceived informational roles of individuals within 10 teams dealing with breast, colorectal and gynaecological cancer, their psychological health (GHQ12) and burnout (MBI). We also completed an audit of satisfaction from patients being treated by the teams. Post assessment MDTs attended a 1.5 day workshop to discuss results and troubleshoot problems identified. RESULTS: The information giving roles of many team members were misunderstood and under-recognised by their colleagues especially the roles of radiographers, and nurses. In several teams issues such as family history, sexual and psychological well being and clinical trials were omitted altogether and this was borne out from the patient audit. Psychological morbidity was high in 50% of MDTs especially among team leaders. Maslach Burnout Inventory showed team leaders and nurse to have high levels of emotional exhaustion, radiographers depersonalisation and low personal accomplishment was greatest amongst histopathologists. Teams found the workshops useful and many changed their practice of information giving and recording as a result. CONCLUSIONS: Calling a group of healthcare professionals a team does not necessarily make them one. Substantial investment in team training may be needed to ensure that effective teamwork conveys benefits to both patients and healthcare professionals. ACKNOWLEDGEMENTS: Cancer Research UK funded the research programme.

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64 Communication Skills Training in Cancer Care: Lessons Derived from Four Controlled Studies Razavi Da,b a Internal Medicine Institut Jules Bordet, Brussel, Belgium; bPsychosomatics and Psycho-Oncology Research Unit, Universite´ Libre de Bruxelles, Brussel, Belgium Changing communication skills is a difficult task as communication involves habitual and automatic patterns of relating and is deeply rooted in habits. Like other complex learning, communication skills’ learning takes time. The majority of communication skills (CS) training programs designed for health care professionals are based on adult theory for complex learning. Therefore, most training programs are at least in part learnercentred and matched to the participant needs. Lessons derived from our four controlled studies confirm the usefulness of CS training programs for health care professionals working in cancer care. To be effective training should include learnercentred, skills-focused and practice-oriented techniques, be organised in small group and be at least 3-day long. There is still CS training research needed. First, future studies should assess the adjunct of new techniques in the present CS training models in order to increase effectiveness (i.e. increasing the intensity of training, using complementary techniques such as stress management, anchoring training in the clinical practice by organising training at the workplace, including communication aids). Second, little is known about the process of learning new CS. Future studies should investigate personal, institutional and educational factors facilitating or inhibiting CS learning. Third, assessment of CS training programs should include more participantand patient-based distal and objective measures (such as participants’ stress and burnout, and/or patients’ emotional wellbeing and retention of information provided). These suggestions will be presented and discussed using the experience derived from the studies conducted by our group.

65 Teaching Communication Skills: Lessons Learned from Structured Observations of Teaching Practices Back A

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Seattle Cancer Care Alliance, University of Washington, Fred Hutchinson Cancer Research Center, USA Communication skills training can be effective if taught using small group techniques, but what should happen in the small groups? Parle and Maguire developed a teaching model invoking roles for skill and knowledge deficits, self-efficacy, outcome expectancies, and perceived support as factors influencing communication behaviors. Yet a Cochrane systematic review commented that it was unclear whether results of communication skills courses could be generalized to other faculty. In a series of 4 day residential workshops, we used qualitative techniques to develop a model of small group teaching that identifies teaching practices that contribute to learner engagement and selfefficacy. Teaching observations were collected over 100 hours of direct contact time between four expert facilitators and 120 medical oncology fellows participating in Oncotalk, a US National Cancer Institute-funded, four-day retreat focused on end-of-life communication skills. Methods utilized included small group teaching observations, semi-structured interviews with faculty participants, video or audio recording with transcript review, and evaluation of results by faculty participants. Teaching skills observed during the communication skills retreats included a linked set of teaching practices: identifying a learning edge, proposing and testing hypotheses, and calibrating learner self-assessments. Based on observations and debriefings with faculty, a conceptual model of teaching was developed that illustrates an iterative loop of teaching practices aimed at enhancing learner engagement and selfefficacy. This study extends current theory and teaching practice prescriptions by describing specific teaching practices required for effective small group teaching, will be used to inform faculty development project in a new project. Symposium Biopsychosocial Aspects of Depression (supported by Wyeth)

66 Abnormal Illness Behaviour and Depression in Cancer Patients Chaturvedi SK National Institute of Mental Health & Neurosciences, Bangalore, India

Copyright # 2006 John Wiley & Sons, Ltd.

Unexplained somatic symptoms have been reported in cancer patients. These symptoms could be due to depression, anxiety, somatization or a manifestation of abnormal illness behaviour (AIB). Somatic symptoms can also arise out of treatments for the cancer like radiation treatment or chemotherapy. Cancer related somatic symptoms have cognitive, psychological, and physiological cause each of which is amenable to treatment. The occurrence of somatoform disorders in cancer patients is likely to complicate the treatment and outcome of cancer. Common somatic symptoms in cancer have been found to be pain, fatigue, anorexia, tiredness or exhaustion, weakness, reduced energy, lethargy, and tremors. Somatic concern and preoccupation are also common. The occurrence of unexplained somatic symptoms, persistent fatigue and tiredness in disease free cancer patients has raised doubts of the occurrence of AIB in cancer patients. Studies have documented an association between psychological disorders and AIB in cancer and indicate a role for personality variables and low social support causing maladaptive responses to cancer. Different forms of AIBs like denial, irritability, and dysphoria have been described in cancer patients in association with depression. The somatic symptoms create a difficulty in diagnosing depression in cancer patients. Somatic symptoms in cancer respond to counseling and antidepressants. Recent studies favour the use of newer antidepressants in the management of depression and somatization in cancer patients. Symposium Antidepressant’s Spectrum of Action in Cancer Patients (supported by Pfizer)

67 Indications and Limits for the Use of Psychopharmacological Drugs in Oncology Brunello Na, Torta Rb a Department of Biomedical Sciences, University of Modena and Reggio Emilia, Italy; bPsychoncology Unit, University of Turin, Turin, Italy In the past, psychopharmacological drugs in oncological patients have been mainly used as sedative compounds; recently, though, antidepressants, because of their curative effect both on depression and on anxiety and sleep disorders, represent the most prescribed drugs. Moreover, it is now well known that antidepressants, through their effects on central and peripheral ways of pain

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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control, also act on relieving pain, synergistically with analgesics. Besides, antidepressants are able to promote an increase in BDNF and other neurotrophic factors, which are essential for neurons’ growth and repair after injuries. New evidence about immunitary effects of antidepressants shows that these drugs also act as immunomodulators, regulating cytokines, which are important in several autoimmunitary disorders and in immunological response to pathologies, possibly in cancer as well. The risk of using psychopharmacological drugs in oncological patients is represented by their side effects and their potential pharmacodynamic and pharmacokinetic interactions with other therapies. In fact, old tricyclic antidepressants, although highly effective on depression and anxiety, are burdened with heavy side effects, that limit their usage; fortunately, new molecules such as SSRI, SNRI, NaSSA, and benzamides combine a comparable efficacy with low side effects and interactions profile. However, these new drugs may exert some disturbing effects in oncological patients as well, and this could interfere with patients’ compliance. Therefore, for a correct and helpful use of these drugs, it is important to know how they act and interact in course of cancer and its therapies. Symposium There’s No Need for Family Support or We Unmet Needs?

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tion of the Mammary Gland Dispensary of Hiroshima University Hospital. Documented informed consent was obtained from the patients and their husbands. 74 patients participated in the study at more than three months after mastectomy and 63 survivors were followed up three years later. RESULTS: Cross-sectional studies showed that (1) patient-perceived poor communication in the family correlated with patients’ coping style of Helplessness/Hopelessness, (2) family-perceived poor general functioning of the family correlated with anxiety among family members, (3) as the result of cluster analysis according to family functioning, patients and their family members were classified into 3 types: Supportive type, Conflictive type, and Intermediate type, and persons of Conflictive type reported higher level of depression or anxiety than other two types. A 3-year prospective study showed that inappropriate affective responsiveness in the family at baseline significantly correlated with both depression and anxiety among survivors three years later. CONCLUSIONS: The close linkages between family functioning and psychosocial wellbeing in Japanese breast cancer survivors seems to be basically consistent with those results derived from Western psycho-oncological researches. Collaborative development of evidence-based and practical psychosocial interventions for cancer patients and their families among Western and Asian countries would be urgently needed.

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Family Functioning and Psychological Well-Being among Japanese Breast Cancer Survivors Saeki Ta, Inoue Sb, Yamawaki Sc, Okamura Hd, Kataoka Td a Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan; bGraduate School of Health Sciences, Hiroshima University, Hiroshima, Japan; cGraduate School of Education, Hiroshima University, Hiroshima, Japan; dDepartment of Pediatrics and Child Health, Kurume University, School of Medicine, Kurume, Japan

Japanese Experience of Marital and Sexual Changes after Cancer Treatment}Unique or Universal? Takahashi M Department of Social Gerontology, The University of Tokyo, Tokyo, Japan

PURPOSE: The results of our several studies focusing on the relationship between family functioning and psychosocial well-being among Japanese breast cancer survivors will be presented. METHODS: 100 ambulatory patients after mastectomy for stage I or II localized breast cancer drawn consecutively from the outpatient popula-

Copyright # 2006 John Wiley & Sons, Ltd.

A cancer diagnosis has a deep psychosocial impact on both a patient and his/her spouse. Using data collected from a number of researches conducted in Japan, this presentation will discuss the impact of a cancer on the sexual life of Japanese couples. This presentation will focus on three factors related to how Japanese couples’ communication about sexual matters are affected after cancer. First, the concept of ‘sasshi’, or guessing a partner’s thoughts and desires, is examined. In a ‘high context society’ such as Japan, where many people share homogenous cultural backgrounds,

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upbringing and expectations, people’s communication depend on a type of guess work where direct and concrete statements regarding wishes and desires are avoided. Second, the emotion of ‘ushirometasa’ which means a feeling of indebtedness or guilt is examined in relation to how couples negotiate dealing with sexual changes after treatment. Lastly, the effect of the patient’s gender on the couples’ sexuality related communication is discussed, because the level of ‘sasshi’ and ‘ushirometasa’ may differ between genders as well as individually. We argue that there is a careful balance between the influences of unique cultural environments that people live in and the universal experience of having cancer. While some phenomena will be culturally unique or expressed in culturally specific ways, there are some universalities in how people in different cultures experience problems and develop solutions. Thus, there is great value in examining the different cultural and social aspects that relate to experience of cancer.

70 The Needs of Family Support in Rehabilitation Intervention of the Cancer Patients Abe PK Department of Orthopedic Surgery and Rehabilitation Oncology, Chiba Cancer Centre, Chiba, Japan PURPOSE: The results of our study of rehabilitation intervention of cancer patients in our institute will be presented. There are some needs not only of the patients but also family and their stakeholders. METHODS: We took retrospective study of introduced patients and their family members. The subjects were over twelve hundred of introduced patients for our department from April 1995 to March 2005, from six years to ninety-three years old, male/female 1:1, we analyzed in this study. RESULTS: Ninety-nine percent of the patients had family members. We took two major ways of approach to support their family members. One is biological, body-oriented way such as how to handle their patients from the physical rehabilitation viewpoints. Another is psychological, educational way such as giving right information about how to care for the cancer patients. CONCLUSION: There are some needs of family support in the context of rehabilitation interventions in our institute. But also we have shortage of staffing, time, money and formal

Copyright # 2006 John Wiley & Sons, Ltd.

support by local and central government from social policy side. Symposium Psycho-Oncology in Austria

71 The Development of Psycho-Oncology in Austria with its Present Status and Future Perspectives Andritsch E Division of Oncology, Department of Internal Medicine, Medical University Graz, Graz, Austria In October 2003 the Austrian Association of Psycho-oncology (O¨PPO) was founded in the first instance to have a platform to communicate experience and knowledge for different health professionals dealing with psycho-oncological aspects. One of the main goals is to establish a national network for all professionals working in psycho-social care of cancer patients. Another aim of the O¨PPO is to implement an uniform national psycho-oncological training to be integrated in different educational programs of clinical oncologists, psychologists psychiatrists, nurses and other related professions. Another important and necessary step is to establish guidelines for therapeutic strategies in psycho-oncology in comparison and collaboration with international societies. This association now has members from various disciplines spread increasingly all over Austria. It will be presented in this lecture what was going on in the field of Psycho-oncology in Austria during the last years, which activities took place until now and what are the plans for the future and steps for further development.

72 Cooperative Research of Multidisciplinary Professionals and Different Institutions in Austria Holzner B Department of Psychiatry, Medical University of Innsbruck, Innsbruck, Austria Research in oncology may profit from a multidisciplinary approach and for scientific studies for achieving large sample sizes the cooperation of various institutions is needed. In 2003 the Austrian Platform of Psycho-Oncology founded a study group to support and to organize (psycho)oncological research in Austria. Since then the group initiated multi-center studies with the focus on the development of a computer-based tool for

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psycho-oncological indication and the evaluation of quality of life in the daily oncological routine. Both projects should on the one hand, optimize individual medical care of cancer patients and on the other hand, building the basis for answering various scientific research questions. First results of these studies as well as the design for further investigations are presented.

73 The Model of Cooperation between the Austrian Society of Haematology and Oncology and the Austrian Association of Psycho-Oncology Samonigg H Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria Psycho-Oncology should be a self evident part in the state of the art treatment in Oncology. Therefore, the collaboration between oncologists, haematologists, and all professions working in the psychosocial care for cancer patients is an essential issue. In April this year an interdisciplinary task force consisting of members of the Austrian Society of Haematology and Oncology (oncologists, haematologists) and of the Austrian Association of Psycho-oncology (psychiatrists, psychologists) was founded with the aim to work on joint targets to optimize and establish standards of psycho-social care as well as to build up a national and international network for research in this field. First results and the experience of the conjoint work of this working group will be presented.

74 The Present Curriculum of Psycho-Oncology in Austria and its Further Development Sperner Unterweger B Department of Psychiatry, Medical University of Innsbruck, Innsbruck, Austria The Division of Psycho-Oncology of the Medical University Innsbruck has been offering a curriculum in Psycho-Oncology in cooperation with the Tyrolean Medical Association to medical doctors and clinical psychologists for 10 years. The 1 year curriculum is organized on 10 weekends giving a theoretical and practical overview of psycho-oncology and psycho-immunology. Successful participants are awarded with a diplo-

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ma. The number of participants is limited with 20 and some personal experience in the fields of oncology or psycho-oncology is recommended. Main topics of the curriculum focus on communications skills, psycho-oncological interventions, stress management and all aspects of palliative care. The characteristics of different oncological therapies are explained by oncologists together with psycho-oncological experts working in the same unit. Research aspects and methods of psychosocial assessment represent other important issues. Each weekend course also consists of at least 4 hours of psychotherapeutic supervision and self reflection. Experiences and evaluation results of 10 curricula will be presented and future developments will be outlined. Symposium Relevance of Psychodynamic Psychotherapy in Cancer patients

75 Differential Diagnosis between Grief and Depression in Terminally Ill Patients Bacque´ MF Unite´ de Recherche en psychologie, Psychologie Universite´ Louis-Pasteur, Strasbourg, France Depression prevalence in terminal stage of life is well-known (around 75%). But how to distinguish depressive symptoms from normal leaving-life grief expression? If depression linked to pain is frequent, multiple losses sorrow is often masked behind somatic complaints. Is there an indication to help dying people to quit life or is it preferable to help them to live life until the end? This is often a debate between psychologists and medical staff. Being aware of changes that precede death is sad but it becomes pathological when despair, hopelessness, futility of life, dysphoric feelings, guilt and devalorisation are obvious. When fatigue, delusion, control loss, pain and anterior psychiatric troubles are evident there is a need for drugs treatment (antidepressant, sedative, analgesic). Suicidal ideas may be hidden behind euthanasia demand. Medical team is endangered because of that logical existential distress that may convince it. While just asking, as Chochinov (1997) proposed, the only question ‘Are you depressed’ is relevant, to propose to the patient a kind of ‘life balance’ is useful too (Bolmsjo¨, 2000). Individual interviews with terminally ill patients show that they need identity recognizing, linking events of their life to search a sense, family reconciliation,

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believing in transcendence and continuity of human specie. CONCLUSION: There is a high complementarity between psychological and medical approach at the end of life. A specific balance between normal grief of existence and pathological depressive syndrome is necessary to allow terminally ill patients to live fully in front of death limit.

76 Beyond Cancer Patients Coaching Derzelle M Department of Psycho-Oncology, Institute Jean Godinot, Reims, France The fruit of twenty years of clinical experience with cancer patients, working in a specialty where there is a climate made of an ‘en bloc’, homogeneous strategy, leads inexorably towards the question of time as being essential and central, when trying to analyze what constitutes the therapeutic relationship with a patient who suffers from cancer. This relationship is marked initially by the falling apart of an illusive identity, produced by the shock of the diagnosis that has been thrown upon the patient. Later, during remissions, there is another falling apart, this time, of another, superficial, and illusive, identity that had been provided by the containing, almost skeleton like, effect of long term treatments. All along this path, there are landmarks that point out to a need for a clinical renewal in cancerology. On one hand, there is a need for a theoretical work-up of the question of transference, particularly difficult with these patients. On the other hand, we must learn to conceptualize what is going in terms of the loss of the self, or better said, falseself, rather than just the simple working through of a painful bereavement process.

77 Support Group for Women with Breast or Gynecologic Cancer: Psychosocial and Psychodynamic Analysis Machavoine JLa, Prevel MCb, Andre Mb, Labbe Eb, Jamard Ab a Department of Psychiatry, Hopital Jacques Monod, Flers, France; bDepartment of Gynecological Surgery, Hopital Jacques Monod, Flers, France INTRODUCTION: Every three weeks, since 2000, a psycho-oncologist and a nurse have led a

Copyright # 2006 John Wiley & Sons, Ltd.

support group for women with breast cancer or gynecologic cancer. PATIENTS AND METHODS: Patients came from General Hospital, where they received chirurgical or chemotherapy treatment in relation with the Regional Cancer Center. 50% of patients had a consultation with a psychooncologist; 20% (more than 60 patients) have shared a support group (90 meetings). There is no pre-established program but free verbal associations focused on cancer. Thematics are: illness, treatments, relationship with doctors and families (husband, children, parents). 45% patients mastectomies were followed by a breast reconstruction. PURPOSE: Support group to help women to cope with consequences of cancer. RESULTS: Decrease of loneliness (mirror effect) and improvement of coping identifications are principal consequences of exchange of experience and expression of feelings in the support group. Support group has a protective shield function in front of potential psychotraumatic reality. If attention is paid to separate women with first cancer from those with metastatic cancer, there is no anxiety contamination. With articulation between intersubjectivity and intrapsychic area, group has a function of supporting the Ego, without alienation risk. CONCLUSION: In front of our individualistic western society, support group may be considered as ‘suppletive’ to build bonds and help group and individual elaboration of existential crisis of cancer (anxiety, vulnerability, body-image and relationship perturbations).

78 Cancer, Sexuality and Intimacy: Indications and Limits of Interdisciplinary Interventions Marx E Department of Psycho-Oncologie, Centre Paul Strauss, Strasbourg, France Cancer impact on sexuality is different from one individual to another. It depends on treatments, personality structure of the patient, the way their masculinity or feminity was built up and partner relationship. Cancer may reveal pre-existent relationship problems. Frequently denied in oncology, questions of sexual harmony and quality of life cannot be separated. Stress, anxiety, depression linked to cancer and treatments spoil sexuality and libido, usually invested in by patients. Paradoxically, a complete information for treatment of cancer is delivered to patients but

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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sometimes insufficient concerning sexuality. Information is often given on sexual dysfunction or infertility and answers can be found in informed consent. The aim is to decrease somatic and psychological impact of cancer. But on the one hand, patients and their partners need to be informed of numerous side effects and on the other hand, it is difficult for them to talk about sexuality associated with intimacy. Oncologists and nurses are not yet trained enough in communication about intimacy. Interventions are adjusted on potential sexual and reproductive problems associated with cancer treatments but not enough on self-image or psychological incidences. Sex therapist’s experience shows that it is necessary to introduce as soon as possible a global approach of sexual function, whatever the location of cancer. Health institutions need to provide skills to their teams. Making the patients feel free to talk about sexuality and intimacy in individual or partners discussions is useful. One of the psycho-oncological specialities is precisely to give heed to these questions.

79 Confrontation to Mortality and its Aftermath on Psychological Recovery Pucheu S Department of Psycho-oncologie, HEGP, Paris, France Psychosocial impact of cancer can be understood in different ways. Our psychodynamic question is: how can the intrapsychic process of recovery when a person is confronted to cancer be analysed? We hypothesize that death anxiety is the first step for patients to go past, i.e. to live from now with uncertainty, because of no guaranty for physical recovery. Some patients reach this step without difficulties thanks to the restoration of the adaptive splitting and denial (defense mechanisms against our mortal condition, which allow every human being to live with). Some other patients has been restored, adopting a kind of ‘heroic’ way to adapt to uncertainty, i.e. cancer, have to be assessed without rest as a positive experience. For them, it seems to be difficult to reach again ‘normality’, i.e. to live in an ordinary manner. At least, some patients are unable to reach a psychic recovery without an extreme psychic suffering. In this context, psychodynamic psychotherapy is needed. A psychic work is necessary to understand which anterior traumas are reactivated and cancer

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becomes the occasion to replace non-elaborated memories and then find again a psychic well-being. Some short clinical illustrations will be presented. Symposium Multidisciplinary Teamwork in French and Belgian Cancer Supportive Care Services

80 Assessment of Satisfaction with Care in Patients Attending the Interdisciplinary Supportive Care Department (DISSPO) of Institut Curie in Paris, France Bre´dart Aa, Dolbeault Sa, Savignoni Ab, Storch Ya, Box Fa a Department of Psycho-Oncology, Institut Curie, Paris, France; bDepartment of Biostatistics, Institut Curie, Paris, France PURPOSE: This pilot study is aimed at evaluating satisfaction with care, quality of life and care needs in patients (pts) attending the Interdisciplinary Supportive Care Department (DISSPO) of Institut Curie in Paris (France). It also assesses the referral process to the DISSPO. METHODS: Pts referred to the DISSPO are prospectively compared to control patients matched on age, gender and ward setting. Information on quality of life, support care needs and perceptions of care quality is collected, in baseline (T0) and at two months (T1), using the EORTC QLQ-C30, a study-specific support care needs questionnaire and the EORTC satisfaction with care module (IN-PATSAT32). RESULTS: Preliminary analyses performed on 34 pairs of pts at T0 and 10 pairs at T1 evidenced at T0 significant differences on time since diagnosis, length of hospital stay, level of pain, perception of nurses’ availability, helpfulness of other hospital personnel, and need for help in physical functioning, and at T1, perception of hospital access. General satisfaction scores tended to decrease from T0 to T1 for DISSPO pts and to remain constant for control pts. Global quality of life scores tended to increase for DISSPO pts and to decrease for control pts. 21% of the patients were not referred to the DISSPO despite their support care needs as identified from a specific item checklist. PERSPECTIVE: Final results will be presented on the 100 pairs of pts recruited as expected for this study. ACKNOWLEDGMENT: This study was support by the Haute Autorite´ de Sante´ (France). To be presented in the symposium entitled ‘Multidisciplinary teamwork in French and Belgian Cancer Supportive Care Services’.

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81 Developing and Implementing Screening Tools and Supportive Care Guidelines: Experience of the Institut Gustave Roussy Cancer Center, France Dauchy Sa, Poulain Pa, Teller AMb a Department of Supportive Care, Gustave Roussy Institute, Villejuif, France; bDepartment of Nursing, Gustave Roussy Institute, Villejuif, France The Supportive Care Department at the Gustave Roussy Institute has been created in 2002 to coordinate and empower pre-existent supportive care teams (SCT) previously working separately. A preliminary study highlighted inpatients’ unmet needs and also differences among carers providing curative therapies in terms of competence and involvement in supportive care. To achieve a real integration of supportive care as part of oncological care, systematic screening of distress and needs appeared necessary. The first step was to implement a systematic screening of patients’ status made by oncological nurses only. It created a heavy workload for nurses, and as the medical staff was not prepared to deal with the needs highlighted, the SCT couldn’t cope with all referred patients. Thus it appeared urgent to strengthen the competences of carers, by providing them with guidelines available on the intranet. Those clinical guidelines, aimed to allow a basic intervention level before a specific supportive care intervention, have been first established for psycho-oncology. At the same time SCT proposed multidisciplinary meetings for the most difficult cases. After a few months both nurses and doctors ask for a screening supportive care tool and we were able to start implementing a distress screening with a French adaptation of the Distress Thermometer and the Problem List. Allowing oncological teams to improve competences in supportive care has been useful to implement a systematic distress screening in a large cancer treatment center. Whether this results in a real improvement for cancer patients’ care must now be proven.

82 Supportive Care in Belgian Services: Do they Respond to Patients and Caregivers Needs? Libert Y, Merckaert I, Lie´nard A, Razavi D Department of Supportive Care, Jules Bordet Institute, Cancer Center, Free Brussels University, Brussels, Belgium

Copyright # 2006 John Wiley & Sons, Ltd.

From January to November 2004, a multicenter, Belgian, descriptive, cross-sectional study assessed qualitatively and quantitatively Belgian cancer patients’ needs and desire for help from health care professionals. All consecutive cancer inpatients and one consecutive outpatient out of two from ten hospitals were invited to participate. All primary caregivers of these patients were also invited to participate. Patients and caregivers completed validated questionnaires assessing their emotional state and difficulties experienced in the last month. Moreover patients and caregivers were asked to report if they had wished and obtained help from health care professionals. Results of this study will be briefly exposed and discussed with regard to available supportive care services in Belgium in general and at the Jules Bordet Institute, Cancer Center of the Free Brussels University in particular.

83 Improving Medical Care for Cancer Patients with the Development of Supportive Care: A Translational Experience at the Northern France Comprehensive Cancer Center Reich Ma, Sedda ALa, Ait-Kaci Fa, Neu Jean Cb, Adens Ac a Psycho-oncology Unit, Centre Oscar Lambret, Lille, France; bSupportive Care Unit, Centre Oscar Lambret, Lille, France; cMedical Oncology Unit, Centre Oscar Lambret, Lille, France Supportive care has been recently developed in France as a specific translational medical activity through a financial input of the national health system called ‘Cancer Plan’. Since March 2006, we have launched a feasibility study regarding the usefulness of implementing a translational supportive care unit gathering all the nursing and medical skills in terms of supportive care. The aim of that prospective study is (1) to improve the medical care for cancer patients, (2) to spare the workload of the medical oncologists, (3) to organize a better regulation of our unexpected inpatients admittance. This study represents one of the main plans of our institution. It is conducted by one general practitioner who has to manage all the nurses, physicians, and medical social workers who have any specific skills in terms of supportive care, i.e. pain control, nutrition, psycho-oncology and welfare. During this meeting, we will be able to report the preliminary results of our study.

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84 Multidisciplinary Case Discussion Meeting in the Supportive Care Setting: A 5 years-old Successful Experience at Centre Le´on Be´rard, Lyon Godet A, Chvetzoff G Supportive Care Department Centre, Le´on Be´rard, Lyon, France This is a presentation of the Complementary Care Committee of Le´on Be´rard Cancer Center. Members of this horizontal committee constitute a think tank capable of analyzing and monitoring the management of supportive care. The unit was created in 2000, with reference to the model of cooperative multidisciplinary organ committees that already existed in cancer centers. This is where medical specialists share information and discuss difficult cases of patients necessitating supportive care: symptom control, palliative care, interpersonal or psychological problems, social difficulties, etc. at the time when the patient returns home, for instance. Health professionals with recognized expertise in different domains participate in the meetings: medical oncologists, general practitioners, psychiatrists, dieticians, nurses, social workers, psychologists, physiotherapists., which makes it possible to have multidisciplinary discussions of optimal care modalities and to elaborate consistent, and possibly consensual care plans. After the discussion, the committee makes practical suggestions which are communicated to the physicians in charge. Many patient cases have been discussed over the past 5 years. Based on the analysis of some of these cases, we will demonstrate the benefit of this approach for decision-making and treatment relationship. We will discuss the changes that have occurred over the years in the functioning of the committee (participants, reasons for referral), as well as the point of view of caregivers about this tool which stands both as a decision-making too and a guarantee of treatment appropriateness. Symposium Cancer Support Groups; Patient and Leader Outcomes

85 Support Groups for People with Cancer: The Experiences of Non-attendees Butow Pa, Ussher Jb, Kirsten La, Wain Gc, Smith Kc

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a

Medical Psychology Research Unit, School of Psychology and Department of Cancer Medicine, University of Sydney, Sydney, Australia; bGender Culture and Health Research Unit, PsyHealth School of Psychology, University of Western Sydney, Sydney, Australia; cDepartment of Gynaecological Oncology, Westmead Hospital, Sydney, Australia

PURPOSE: While support groups assist coping, little is known about why cancer patients drop out of such groups or choose not to attend. METHODS: 47 cancer support groups participated in a prospective cohort study. Questionnaire were completed at baseline by 417 participants and at 6 and 12 month follow-up by 347, 87 of whom had left their support group. 26 people who had never attended a support group also completed questionnaires; Interviews were carried out with all participants. RESULTS: There were no significant differences between leavers and attendees on demographic variables. Leavers had attended for a shorter time (23 vs 39 months) (X2 ¼ 11:18; p ¼ 0:001; were more likely from urban groups (55% vs 39%) (X2 ¼ 7:14; p50.01) and from hospital-based groups (84% vs 58%) (X2 ¼ 19:55; p50.001). More non-attendees were men (50% vs 44% of attendees); not born in Australia (46% vs 17% of attendees; and non-tertiary educated (77% vs 44% of attendees). Anxiety and depression levels were similar in all participants. Leavers reported positive (practical issues and time to move on) and negative reasons for leaving (dissatisfaction). Non-attendees report individual factors (resisting the position of ‘cancer patient’; currently having enough support; being fearful of exposure, and personality factors) and group factors (lack of knowledge about groups; avoidance of negative aspects of groups; not finding the right group; and practical issues) as behind their decision. CONCLUSIONS: A number of factors need to be considered to encourage group attendance.

86 Challenges, Support/Training Needs, and Psychological Well-being of Cancer Support Group Leaders: An Australia-wide Study Juraskova Ia, Butow Pb, Zordan Rc, Kirsten Ld, Sedgwick Ca a Medical Psychology Research Unit, School of Psychology, University of Sydney, Sydney NSW, Australia; bThe Cancer Council NSW, Sydney,

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Australia; cSchool of Psychology, University of Western Sydney, Sydney NSW, Australia; d Department of Gynaecological Oncology, Westmead Hospital, Sydney NSW, Australia PURPOSE: Cancer support groups play an important role in reducing psychological morbidity in people with cancer and their carers. However, little research has been conducted into the experience of cancer support group leaders, despite increasing evidence of their crucial role in group outcomes and longevity. The current project aimed to comprehensively assess the challenges, rewards, support/training needs and psychological wellbeing of Australian cancer support group leaders. METHODS: 230 group leaders completed study questionnaires (response rate 76%). Using open-ended and closed questions, challenges and rewards of facilitating a support group, and support/training needs were assessed using two purpose-designed measures. The psychological status of leaders was assessed using the Maslach Stress & Burnout Scale and the Depression, Anxiety and Stress Scales. RESULTS: The two most frequently identified PRACTICAL–professional CHALLENGES related to ‘being contacted outside meeting times’ (67%) and ‘benefiting from leadership/counseling training’ (56%). ‘Handling domineering group members’ (36%) and ‘feeling guilty when unable to help members’ (31%) were the two most common PERSONAL–professional CHALLENGES. The most commonly reported TRAINING/SUPPORTNEEDS were: feedback from group members (90%), the development of leaders’ website (82%), and of interactive manual (80%). Leaders reported high levels of psychological health. Qualitative findings will be presented. CONCLUSIONS: These findings provide evidence for the development and evaluation of strategies to address supportive/training needs of support group leaders. A randomised controlled trial evaluating the effectiveness of minimal vs intensive interventions in supporting, and improving the skills of, Australian cancer support group leaders is underway.

a

Medical Psychology Research Unit, School of Psychology and Department of Cancer Medicine, University of Sydney, Sydney, Australia; bGender Culture and Health Research Unit: PsyHealth, School of Psychology, University of Western Sydney, Sydney, Australia; cDepartment of Gynaecological Oncology, Westmead Hospital, Sydney, Australia PURPOSE: While the popularity of cancer support groups has grown, little is known about the effectiveness of different types of non-therapeutic groups. This study explored the relationship between support group characteristics and outcomes for people with caner and their carers. METHOD: Characteristics differentiating support groups (location, setting, specificity, leader training and leader personal cancer experience) and outcomes of importance (quality of life, anxiety, depression, self-efficacy and satisfaction with group) were determined through a consensus process with consumers and representatives of cancer services. Participants were from 47 groups purposively selected from existing state-wide nontherapeutic cancer support groups (n ¼ 173) on the basis of differentiating group characteristics. 417 cancer patients (40% with breast cancer and 36% with prostate cancer) and carers completed questionnaires at baseline and 6 and 12 months later. RESULTS: In general participants showed improvement over time on all outcomes. No clear pattern of relationship between group characteristics and psychological and satisfaction outcomes was found. However it was noted that anxiety levels improved markedly over time particularly in metropolitan general groups led by a non-health professional. The prospective study also revealed poorer psychological and satisfaction outcomes for rural participants and carers. CONCLUSIONS: Regardless of type of group attended, participation resulted in improvement over the 12 month assessment period. Typing the groups according to pre-defined differentiating characteristics was of limited value in predicting outcomes. Nevertheless people at particular risk of poor outcomes were participants in rural areas and carers.

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Efficacy of Support Groups with Differing Characteristics Kirsten La, Butow Pa, Ussher Jb, Wain Gc, Hobbs Kc

Leaders’ Skills Development and Support Program Sundquist K, Pearce K Supportive Care Development Cancer Council NSW, Woolloomooloo, Australia

Copyright # 2006 John Wiley & Sons, Ltd.

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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PURPOSE: To develop and deliver skills-based training workshops for cancer support group leaders and to provide ongoing support for them in their role. METHODS: Effective leadership skills are an important factor in the maintenance and continuation of cancer support groups. To date, more than 200 group leaders in NSW have participated in one-day training workshops, facilitated by two psychologists. Both skilled and novice leaders attended the workshops. Twothirds of the participants were cancer survivors, and one-third were health professionals. The majority of participants were from regional or rural cancer support groups. Workshop sessions included small group facilitation techniques, group dynamics and strategies for dealing with challenging situations, taking care of own needs, new resources, and where to find useful information. RESULTS: Formative evaluation was undertaken to adapt the content and processes to better meet the needs of the participants. Pre and post evaluations showed improvement in levels of perceived confidence in group facilitation. Impact evaluations have identified a stronger understanding of the facilitator’s role and an increased awareness of support and information services available. CONCLUSIONS: Evaluation and feedback from participants has clearly demonstrated the need for, and benefit of leadership training. Further research is being conducted into the needs of leaders of cancer support groups in NSW, and the development and evaluation of other supportive interventions.

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tion. METHOD: Focus group interviews and ethnographic observation were conducted with 9 representative Australian cancer support groups. Discourse analysis and positioning theory was used to interpret the results. RESULTS: Support groups were positioned by participants as providing a unique sense of community, unconditional acceptance, and information about cancer and its treatment, in contrast to isolation, rejection, and lack of knowledge about cancer frequently experienced outside the group. Increased empowerment and agency were positioned as the most significant consequences of group support, consisting of increased confidence and a sense of control in relation to self, living with cancer, and interactions with others, in particular the medical profession. The support group was also positioned as facilitating positive relationships with family and friends because of relieving burden, and providing a safe space for the expression of emotion. However, groups were also positioned as occasionally challenging, in contrast to the normalising experience of support from family and friends. CONCLUSION: As no difference was found between professionally led and peer led support groups, it is concluded that it is not the type of the group, nor the professional background of the leader, which is of importance, but whether the group provides a supportive environment, mutuality, and a sense of belonging, and whether it meets the perceived needs of those attending.

90 89 The Experience of Peer Support Groups for People with Cancer: What do Cancer Support Groups Provide which Other Supportive Relationships do Not? Ussher Ja, Butow Pb, Kirsten Lb, Sandoval Ma a Gender Culture and Health Research Unit: PsyHealth School of Psychology, University of Western Sydney, Sydney, Australia; bMedical Psychology Research Unit, School of Psychology and Department of Cancer Medicine, University of Sydney, Sydney, Australia PURPOSE: This qualitative study examined the question of what do such groups provide which other supportive relationships do not, and what are the self perceived consequences of support group attendance in relation to identity re-evalua-

Copyright # 2006 John Wiley & Sons, Ltd.

Communication Skills Training: The COMSKIL Model Brown R, Bylund C COMSKIL Lab Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, USA Researchers have been studying communication in physician–patient consultations for many years. Currently, research in this area is multi-disciplinary and multi-methodological. As this research has progressed, a considerable body of evidence on the best practices in physician–patient communication has been amassed. This evidence provides a foundation for communication skills training (CST) at all levels of medical education. Although the communication skills training literature has demonstrated that communication skills can be taught, one critique of this literature is that it is

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not always clear which skills are being taught and if those skills match up with those being assessed. In this presentation we present the Memorial Sloan-Kettering Cancer Center Comskil Laboratory conceptual model for CST which seeks to answer those critiques by explicitly defining the important components of a consultation. Other methods use sequenced guidelines as a mechanism for teaching about particular communication challenges, we propose that consultation communication can be guided by an overarching goal, which is achieved through the use of a set of pre determined strategies. Strategies are common in CST; however, strategies often contain embedded communication skills. These skills can exist across strategies and we see to make them explicit in these contexts. We also separate from the skills, process tasks which need to be addressed in teaching. We also describe how our assessment practices address the lack of concordance between skills taught and those assessed. Symposium Communication Skills Training: Evidence of its Efficacy and New Developments

4 months following the consultation when their treatment options were discussed. Four consultations (2 from pre- and 2 from post-training cohorts) per doctor were audio-taped. Doctors completed questionnaires immediately pre, and 5 months post training. RESULTS: Tape analysis showed that doctors differed in the following consultation behaviours: establishing doctor– patient team (p ¼ 0:000), following a consultation pathway (p ¼ 0:027), and avoiding coercion (p ¼ 0:043). Patient group differences were found in satisfaction with doctor communication (p ¼ 0:003), but not in levels of decisional conflict (p ¼ 0:427), anxiety (p ¼ 0:354), or satisfaction with their decision (p ¼ 0:103) or the consultation (p ¼ 0:103). No group differences were detected in doctor stress and burnout levels or information provision satisfaction. Doctors appreciated the training program and would recommend it to others. CONCLUSIONS: This is one of the first studies to rigorously evaluate the impact of communication skills training on doctor behaviour, and patient and doctor outcomes.

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A Randomised Controlled Trial of Consultation Skills Training (IBCSG 33-03) to Improve Communication About Cancer Treatment Options and Clinical Trials: Interim Analyses Using Australian & New Zealand Data Butow Pa, Juaskova IJa, Brown Rb, Zoller Pc a Medical Psychology Research Unit, School of Psychology and Department of Cancer Medicine, University of Sydney, Sydney, Australia; bDepartment of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, USA; cQuality of Life Office, International Breast Cancer Study Group, Bern, Switzerland

Improving Facilitators’ Communication Skills Training Through Training, Assessment and Feedback Bylund C, Brown R, Kissane D COMSKIL Laboratory, Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, USA

PURPOSE: This multi-centre Australian and European randomised controlled trial aims to evaluate a consultation skills training (CST) program for oncologists, targeting information delivery and shared decision-making. This interim analysis reports Australian and NZ data only. METHOD: 21 oncologists were randomised to receive the CST or not. Patients of doctors in the intervention group were recruited prior to (n ¼ 157) and following the training (n ¼ 181). Patients of doctors in the control group were recruited at comparable times. All patients completed questionnaires prior to, 2 weeks and

Copyright # 2006 John Wiley & Sons, Ltd.

PURPOSE: Effective communication skills training programs use role play as an integral part of the experiential learning experience. In order for these role plays to proceed effectively, facilitators are essential to guide the learning process, reinforcing newly acquired skills. Thus, training facilitators is critical to the success of communication skills programs. However, this training and its assessment has not been well documented in the research literature. Other disciplines, such as psychotherapy and behavioral sciences, place an increasing emphasis on demonstrating ‘treatment fidelity’}that is, that all subjects in an intervention are getting the same type of treatment. For communication skills training, this would involve continued assessment of small group facilitators’ skills. METHOD: We will present an innovative method of facilitator training, assessment and feedback that is in use at Memorial Sloan-

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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Kettering Cancer Center’s COMSKIL laboratory. RESULTS: This method conceptualizes the training program as including both a train-the-trainer program of six communication skills modules as well as the facilitators’ first six teaching experiences. The training includes assessment of performance using coded video recordings of facilitators’ small group work, regular feedback, and debriefing. CONCLUSIONS: The significance of this project is twofold. (1) Assessing the skills of facilitators over time is important to maintaining the high level of quality desired in a communication skills training program. (2) In order to further research in this area through randomized controlled trials, the demonstration of a proven method of assessing the treatment fidelity of a skills training program will be essential.

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litators have been trained via the English, Welsh and Scottish Cancer Trials Networks to deliver workshops throughout the UK. Further modules dealing with trials in Screening and Chemoprevention, Paediatrics and Adolescent Cancer and Complex, Multi-Arm Studies have recently been added to the programme. CONCLUSIONS: It is possible to develop a comprehensive, accredited educational programme delivered by trained facilitators that improves the communication of HCPs when talking about RCTs. ACKNOWLEDGEMENTS: Cancer Research UK funded the research programme, NCRN and WCTN workshops and AstraZeneca UK an unrestricted educational grant for production of materials.

94 93 An Intervention to Improve Communication About Randomised Clinical Trials (RCTs) of Cancer Therapy Fallowfield L, Jenkins V, Langridge C CRUK Psychosocial Oncology Group, Brighton and Sussex Medical School, University of Sussex, Falmer, UK PURPOSE: To develop, evaluate and train facilitators to deliver an educational intervention for healthcare professionals (HCPs) when communicating about RCTs. METHODS: Four educational modules using videotapes, didactic presentations and interactive exercises were developed with help from patients, clinicians, research nurses and data managers. Topics covered generic issues, trials of adjuvant therapy, palliation and trials offering treatment not available outside a trial setting. Communication with different types of patient such as the deeply anxious, suspicious about experimentation in medicine, over-informed and deferential was also covered. 101 HCPs attended evaluation workshops using before and after subjective and objective outcomes. After establishing efficacy the programme was then rolled out nationwide by trained facilitators. RESULTS: Post workshop analysis of participants’ videotaped consultations showed greater competence in key interviewing behaviours crucial to ensure properly educated consent from patients and greater self-confidence in approaching different types of patient about different types of trials (Jenkins et al. BMJ, 2005). More than 80 faci-

Copyright # 2006 John Wiley & Sons, Ltd.

Training in Communication Skills from a Distance: An Oxymoron or Reality? Girgis Aa, Cockburn Jb, Butow Pc, Schofield Pd, Tattersall MHNe a Centre for Health Research and Psycho-oncology, The Cancer Council NSW, University of Newcastle and Hunter Medical Research Institute, Newcastle, Australia; bDepartment of Behavioural Sciences in Medicine, University of Newcastle, Newcastle, Australia; cMedical Psychology Research Unit, School of Psychology and Department of Cancer Medicine, University of Sydney, Sydney, Australia; d Supportive Care Research Group, Peter MacCallum Cancer Centre, Melbourne, Australia; eDepartment of Cancer Medicine, University of Sydney, Sydney, Australia PURPOSE: We assessed the effectiveness of a consultation skill training (CST) program in enhancing cancer patients’ quality of life and reducing their anxiety, depression and unmet needs; and improving oncologist burnout; in the first international study to utilise videoconferencing to deliver CST. METHODS: Randomised controlled trial, with 29 Australian medical and radiation oncologists to the CST program ðn ¼ 15Þ or usual care ðn ¼ 14Þ: The CST included 14 hours of contact over 6 months; focusing on detection and management of psychosocial issues. Patient, oncologist and satisfaction measures were collected. At the conclusion of the CST, eligible patients (attending the clinic for the first time) of participating doctors were recruited (n ¼ 186 in CST group, n ¼ 185 in usual care group),

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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completing telephone surveys at baseline, one week and three months after entry into the study to assess quality of life, anxiety, depression and unmet psychosocial needs; and disease and demographic characteristics. RESULTS: Despite high overall patient functioning at baseline, the intervention was associated with improvements in patients’ short-term (significant) and longer-term (trend) anxiety, short-term depression (trend), longer-term psychological needs (trend) and longer-term patient care and support needs (trend). The intervention was also highly acceptable to participants. CONCLUSION: The challenges of evaluating this type of intervention were substantial and may have hindered our ability to detect significant improvements in patient outcomes. Implications of these for future research and for utilising videoconferencing as a strategy for improving the reach of consultation skills training will be discussed. Symposium Cancer and working life

95 Factors Affecting Return to Work, Work Ability and Work Satisfaction among Icelandic Cancer Patients}Gender Perspective Sigurdardottir Na, Gunnarsdottir HKb, Jonsdottir Ta, Rafnsdottir GLb, Sigurdsson Ha a The Icelandic Oncology Center of Data and Coordination, Reykjavik, Iceland; bResearch Center for Occupational Health and Working Life, Reykjavik, Iceland PURPOSE: The aim of this study was to explore the factors affecting return to work, work ability and work satisfaction among cancer patients in Iceland with a special focus on gender. METHODS: Patients were selected from breast, lymphoma, testicular, and prostate cancer patients listed at registers of hospitals or cancer registers, aged 25–57 at the time of diagnosis. The reference group was an age matched randomized sample from the National Population Register. The data were collected in connection with a Nordic questionnaire study on cancer and work life. The questions concerned demographic background, physical and psychosocial wellbeing and social support at work, changes in work activity and work ability. In Iceland the questionnaire was sent to 423 cases, 335 women, 88 men, and 1743 referents, 1379 women, 364 men. RESULTS: Answering rates were 60% and 44% respectively.

Copyright # 2006 John Wiley & Sons, Ltd.

Data analyses are in process. Preliminary results indicate that there are gender differences as to how cancer diagnosis affects one’s working life. CONCLUSIONS: Patients can live and work many years after the first diagnosis of cancer. Therefore the results should be of highest concern for the individual cancer survivor, professionals working with cancer patients, and for cancer societies.

96 Employment and Work Ability of Cancer Survivors in Three Nordic Countries Lindbohm MLa, Martikainen Rb, Taskila Ta, Hietanen Pc a Centre of Expertise for Health and Work Ability, Finnish Institute of Occupational Health, Helsinki, Finland; bCentre of Expertise for Good Practices and Occupational Skills, Finnish Institute of Occupational Health, Helsinki, Finland; cFinnish Medical Journal, Helsinki, Finland PURPOSE: We examined the employment of cancer survivors and changes in their work activity after the disease, using data of a Nordic study on cancer and work life. We also investigated whether some disease related or socio-demographic factors, or social factors at work are related to selfassessed impairment of work ability. METHODS: Cancer patients (breast, lymphoma, testicular, prostate) were selected from the registers of hospitals in Finland, Iceland and Norway. The data on demographic factors and social factors at work were collected with a questionnaire from working aged survivors ðN ¼ 1591Þ: RESULTS: Among those employed at the time of cancer diagnosis, 87% were still employed at the time of the questionnaire (1–6 years after the diagnosis). About 6% of them had changed workplace, 4% occupation and 9% work tasks because of cancer; 3% had remained unemployed. Thirty percent of the survivors reported that their physical and 20% reported that their mental work ability had impaired due to cancer. The survivors who had other diseases or had had chemotherapy most often reported impaired work ability. Those who had a strong commitment to the work organization or had a good social climate at work less frequently reported impairment. CONCLUSIONS: Most of the survivors stayed in working life after their disease. However, cancer caused changes in work activity among some survivors. One third of them experienced decrease in work ability due to their illness. Other diseases, type of

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treatment and social factors at work were related to impaired work ability.

97 Cancer and the Risk of Early Retirement Pension Carlsen Ka, Dalton SOa, Diderichsen Fb, Johansen Ca a Department of Psychosocial Cancer Research, The Danish Cancer Society, Copenhagen Denmark; b Department of Social Medicine, Faculty of Health, The University of Copenhagen, Copenhagen, Denmark BACKGROUND: Annually approximately 1 000 000 people in EU are diagnosed with cancer at the age of 30–69 years. This group of cancer patients contributes significantly to the overall increasing number of cancer survivors which points to the need for addressing a number of survivor specific problems for middle aged cancer patients. One of the problems that cancer survivors have to face is their affiliation to the labour marked. PURPOSE: We conducted a nationwide and population-based follow-up study based on Danish registries to evaluate to what extent cancer patients leave the work force for early retirement pension adjusted for cancer type, age, socioeconomic status and comorbidity. RESULTS: The known risk factors for early retirement pension as high age, low education, single without children and low income are also seen among cancer survivors. In addition we found that cancer patients have an increased risk for early retirement pension. The size of the risk is dependent of type and stage of disease ranging from no increased risk among persons with melanoma (RR: 1.3; 95% CI: 0.9–2.0) to a high risk among persons diagnosed with leukaemia (RR: 7.1; 95% CI: 4.4–11.6). The risk for early retirement is dependent on cancer stage at diagnosis (Regional RR: 1,5; 95% CI: 1.1–2.0; Local RR: 1.7; 95% CI: 1.5– 2.0; Metastatic RR: 3,9; 95% CI: 3.2–4.6). CONCLUSION: Compared to a cancer free control group cancer survivors have an increased risk for early retirement pension. This increased risk is seen up to five years after diagnosis.

98 Cancer Or Culture}Work Experiences Of Norwegian and Finnish Breast Cancer Survivors Gudbergsson SBa, Fossa˚ SDb, Dahl AAc

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a

The Cancer Clinic, Department of Psychosocial Oncology, Rikshospitalet-Radiumhospitalet Medical Center, University of Oslo, Oslo, Norway; bThe Cancer Clinic, Section of Long Term Studies, Rikshospitalet-Radiumhospitalet Medical Center, University of Oslo, Oslo, Norway; cThe Cancer Clinic, Department of Clinical Cancer Research, Rikshospitalet-Radiumhospitalet Medical Center, University of Oslo, Oslo, Norway BACKGROUND: Although treatment often of various stages of breast cancer is common across countries, the consequences of cancer and treatment may vary due to national or cultural differences. AIM: To compare subjective health, mental distress, and working conditions in diseasefree breast cancer survivors (BCSs) (stage I and II) treated with surgery and radiation in Norway and Finland. PATIENTS AND METHODS: Agematched samples of 240 BCSs from each country. They filled in the same questionnaire covering demographic and work data, the Hospital Anxiety and Depression Scale, the Short Form 12, the Nordic Questionnaire for Psychological Factors at Work, and the Utrecht Work Engagement Scale. RESULTS: The Norwegian BCSs had significantly lower level education, lower social class, lower proportion of fulltime work, but higher annual household income. Compared to the Finnish BCSs, the Norwegian BCSs showed the following significant differences: higher mental work capacity, evaluated their work place atmosphere as more encouraging/supportive, distrustful and suspicious, and were overall more satisfied with their work place atmosphere. Somatic health and work engagement variables showed no significant differences. The levels of depression and mental quality of life were significant lower in the Norwegian BCSs, while the level of physical quality of life was significantly higher. CONCLUSIONS: In spite of poorer demographic findings, the Norwegian BCSs generally showed better working conditions, depression, and physical quality of life results. Since mean age and treatment modalities are equal, we have reasons to believe that cultural and work life differences rather than cancer variables explain these differences. ACKNOWLEDGEMENT: This study was sponsored by a research grant from The Norwegian Foundation for Health and Rehabilitation (grant no H0-54010/002), and a grant from the Nordic Cancer Union.

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99 Social Job Resources, Optimism and Work Engagement Among Employed Female Cancer Survivors and Their Referents Taskila-Abrandt T, Hakanen J, Lindbohm ML Finnish Institute of Occupational Health, Centre of Expertise for Health and Work Ability, Helsinki, Finland PURPOSE: Due to the improved prognosis of many forms of cancer an increasing number of cancer patients return to work. However, cancer survivors may experience mental and physical impairments in health as a result of their illness. The purpose of the study was therefore to explore, whether work engagement differ between employed cancer survivors and people without cancer. We also examined whether personal and job resources may enhance work engagement among cancer survivors. METHODS: The data, collected in a Nordic study on cancer and work life, consists of 441 employed women with breast cancer and lymphoma and a reference group of 560 women. Utrecht Work Engagement Scale (UWES) and other validated tools were used to examine the effect of personal (optimism) and social (support, climate, etc.) or lack of social (discrimination) job resources on work engagement. RESULTS: In general, women with cancer experienced less work engagement than their referents. The more time had passed since the diagnosis, the less engagement cancer survivors experienced. Job resources (social support from supervisors and coworkers and a good social climate at work) had similar effect on the work engagement of cancer survivors and the referents. However, personal resources (optimism and pessimism) had a stronger effect on cancer survivors’ wellbeing at work. CONCLUSIONS: Job resources seem to play equally important role in the work engagement of the cancer survivors and people without cancer whereas personal characteristics seem to be more important for cancer survivors’ wellbeing at work. Symposium Complementary and Alternative Medicine (CAM) Interventions for Cancer Populations with Psychoneuroimmunology (PNI) Outcomes

100 Mindfulness-based Stress Reduction (MBSR) and Acute Stress Responses in Women with Cancer Van Wielingen Lb, Carlson La, Campbell Tb

Copyright # 2006 John Wiley & Sons, Ltd.

a

Department of Oncology, University of Calgary, Calgary, Canada; bDepartment of Psychology, University of Calgary, Calgary, Canada

PURPOSE: This study is a waitlist-controlled trial investigating the impact of an MBSR program on the acute cardiovascular and neuroendocrine stress responses of cancer patients. METHODS: Thirty-four women with a diagnosis of cancer (mostly breast) were recruited from the Tom Baker Cancer Centre. Participants were either registered for immediate MBSR participation ðN ¼ 20Þ; or were waiting for the next program ðn ¼ 14Þ: Physiological responses (cardiovascular and neuroendocrine) to a series of standard laboratory stressors were assessed both before and after participation in the immediate MBSR program, or before and after the 8-week waiting period. RESULTS: Analyses of preliminary data revealed that when compared to the control group ðn ¼ 7Þ; MBSR participants ðn ¼ 10Þ demonstrated greater systolic blood pressure recovery following a public speaking stressor at postintervention, Fð1; 15Þ ¼ 4:39; p ¼ 0:05: Multivariate analyses of covariance will be conducted with the larger sample to assess for significant group differences in terms of pre- to post-intervention change in both cardiovascular and salivary cortisol responses and recovery. CONCLUSIONS: This study is the first to evaluate the efficacy of MBSR to reduce acute stress responses associated with both the physiological and psychological symptoms of cancer and its treatment. It is hypothesized that there will be significant changes in the stress response after MBSR group participation, which might reflect increased regulation of HPA axis and autonomic system function. ACKNOWLEDGEMENTS: Funded by the Canadian Institutes of Health Research New Investigator Allowance and a University of Calgary Graduate Research Award.

101 The Psychoneuroimmunological Effects of Reflexology in Women with Early Breast Carcinoma Sharpe D, Walker AA, Walker V, Green V, Alexandropoulos A Institute of Rehabilitation Oncology Health Centres, University of Hull, Hull, UK PURPOSE: A pragmatic randomised controlled trial was carried out to evaluate the psychoneuro-

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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immunological effects of reflexology in early breast cancer. METHODS: 183 women with early breast cancer were randomised six weeks postsurgery to self-initiated support (SIS) (comparator intervention), SIS plus reflexology, or SIS plus scalp massage (control for physical and social contact). Patients randomised to reflexology and massage had eight sessions at weekly intervals. The primary and secondary endpoints were 18 and 24 weeks post-surgery, respectively. Pre-randomisation, and at the two endpoints, blood was taken to enumerate lymphocyte subsets (CD profiles), cytokine production (Th1, Th2), and hormones (prolactin, cortisol, growth hormone). Mood, coping and quality of life were assessed at the same time points using standardised tests. RESULTS: At week 18, massage, but not reflexology, was significantly better than SIS in terms of the primary outcome measure, namely the Trial Outcome Index (TOI) of FACT-B. At the secondary endpoint (week 24), reflexology, but not massage, was better than SIS in terms of TOI. Analysis of neuroendocrinological factors for the first 120 women found that women randomised to reflexology, but not to massage, had fewer B lymphocytes than those receiving SIS alone. However, neither reflexology nor massage affected any of the T lymphocyte subsets, cytokine production, or hormones. CONCLUSIONS: Reflexology and massage have modestly beneficial effects on quality of life. However, neither reflexology nor massage had statistically significant effects on any endocrinological and immunological parameters thought to be relevant to an anti-tumour response.

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surgery, hormone therapy, and radiotherapy. Patients were randomised to a high level of support in the Behavioural Oncology Unit (comparator intervention) or to the same support plus relaxation training (RT) and guided imagery (GI). Patients kept daily diaries of the frequency of relaxation practice and imagery vividness. On 10 occasions during the 37 weeks following the diagnosis, blood was taken for immunological evaluation (CD profiles, NK and LAK cell activity, and cytokines). Mood, coping and quality of life were assessed at the same time points using a battery of standardised measures. RESULTS: Between-group analyses found that patients randomised to RT þ GI reported significantly better quality of life, mood and coping, and they had significantly higher numbers of activated T cells (CD25+) and NK cells (CD56+) during the study. In addition, the number of mature T cells (CD3+) was significantly higher following chemotherapy and radiotherapy. A within-group analysis of those randomised to RT þ GI found that relaxation frequency correlated significantly with the number of CD4+ cells, the CD4:8ratio, and IL1 levels. CONCLUSIONS: RT þ GI improved key parameters of quality of life and altered putative anti-cancer host defences during, and after, multimodality therapy. ACKNOWLEDGEMENT: Funding from the Cancer Research Campaign. Symposium Psychotherapy with Cancer Patients

103 102 The Psychoimmunological Effects of Relaxation and Guided Imagery in Women with Locally Advanced Breast Carcinoma Walker LG, Walker MB, Simpson E, Heys SD, Ogston K Institute of Rehabilitation Oncology Health Centres, University of Hull, Hull, UK PURPOSE: A pragmatic randomised controlled trial was carried out to evaluate the psychoimmunological effects of relaxation training and guided imagery in women undergoing multimodality treatment for locally advanced breast cancer. METHODS: Eighty women with large, or locally advanced, breast carcinoma participated. Patients underwent primary chemotherapy followed by

Copyright # 2006 John Wiley & Sons, Ltd.

Psychotherapy Proposals in Oncology: Paradigms of Reference Catanzaro P Department of Oncology, Haematology and Biological Sciences, Perugia Regional Hospital, Perugia, Italy PURPOSE: Cartesian mind/body dualism has given way to the Kantian paradigm of appearance (mind/body as phenomena) and non-apparent (noumenon) reality, which Chiozza adopted in his theory of the psychosomatic basis of disease. According to Chiozza, cancer then, becomes the somatic expression of an unresolved specific conflict, that, had it not been repressed by the patient, would have been experienced as a dramatic life event, and not as a cancer. The author will comment on the implications of this

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statement on psychoanalytically-oriented psychotherapy with cancer patients. METHOD: An analytically-oriented psychotherapy, be it individual or group, short or long-term, verbal/nonverbal or mixed, is conducted with the intent of making unconscious contents available to consciousness. In group psychotherapy, oncologists, after appropriate training, form part of the therapeutic team. RESULTS: A psychotherapy, perceived by patients and medical staff as actively aimed at combating cancer, positively affects patient motivation for, and compliance with, the psychotherapeutic and traditional antiblastic treatments. Oncologists show increased interest in clinical psycho-oncology when the psychotherapy is clearly a part of an integrated program. CONCLUSIONS: Despite the fluctuating attitudes of positive/negative transfer, establishing an alliance-based transfer where both patient and therapist work to render conscious the unconscious, can make psychoanalytically-oriented psychotherapies valid adjunctive approaches to cancer treatment. Modified forms are particularly effective in palliative care. ACKNOWLEDGEMENTS: The Umbrian regional psycho-oncology services are financed by the Umbrian Association Against Cancer, the Umbrian Association of Oncologic Radiotherapy and the Italian Association Against Leukaemia and Lymphomas.

gists and/or psychologists in training, are also present. RESULTS: The presence of an oncologist allows for the immediate resolution of medical queries that may arise during the psychotherapy. Through the therapy sessions, and the aftersession supervision, the oncologist has become more skilful in discerning the latent emotional content of the patients’ verbalizations. The medical/psychiatric collaboration benefits not only the patients’ well-being by increasing their sense of receiving comprehensive care, but also has positive consequences on the psychological state of the oncologist that find practical applications in her clinical practice. CONCLUSIONS: The soma and psyche are treated as a unit in a group psychotherapy that includes an oncologist as co-therapist . The oncologist, with a minimal outlay of time, acquires practical knowledge of the psycho-social implications of cancer and is able to utilize this knowledge in treating her patients. Furthermore, her psychological attitudes regarding patients, cancer and self-knowledge have been positively affected. ACKNOWLEDGEMENTS: The Umbrian regional psycho-oncology services are financed by the Umbrian Association Against Cancer, the Umbrian Association of Oncologic Radiotherapy and the Italian Association Against Leukaemia and Lymphomas.

105 104 A Group-Analytic Approach to Psychotherapy: The Oncologist as Co-therapist Corgna Ea, Catanzaro Pb, Valencia-Reyes Ab, Nataloni Gb, Armanni Gb a Department of Oncology, Haematology and Biological Sciences, Perugia Regional Hospital, Perugia, Italy; bPsycho-Oncology Service, Department of Oncology, Haematology and Biological Sciences, Perugia Regional Hospital, Perugia, Italy PURPOSE: The author will evaluate the effectiveness of including a non-psychiatric specialist as co-therapist in an analytically inspired group psychotherapy, emphasizing the impact of the therapy on patient/doctor communication, and on her personal and professional life. METHOD: A group-analytic psychotherapy with cancer patients, led by a psycho-oncologist and a medical oncologist, meet weekly in a hospital setting for a one-hour session. Two silent observers, oncolo-

Copyright # 2006 John Wiley & Sons, Ltd.

Psychotherapy with Cancer Patients through the Medium of the Arts Nataloni G Department of Oncology, Haematology and Biological Sciences, Perugia Regional Hospital, Perugia, Italy PURPOSE: When emotions elicited by the diagnosis, treatment and course of cancer are difficult, and at times, impossible for patients to verbalize coherently, non-verbal methods of communication are advantageous. The author will comment on the contribution of non-verbal forms of communication, particularly art and music, to psychotherapy with cancer patients. METHOD: A psychodynamic approach to individual or group psychotherapy employs non-verbal techniques when verbal disclosure proves inadequate. Patients communicate through the medium of their choice, either with personal material, or with material of others that has significance for them.

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The therapist uses both verbal and non-verbal methods in interpretation. RESULTS: The content that emerges through the diverse forms of therapy, offers substantial material for interpretation that has positive impacts on the acceptance of physical changes due to disease and treatment and on stress, which is reduced in all phases of the disease, especially during the palliative and final stages. The use of non-verbal therapy is particularly effective to elaborate the grief that the group experiences at the death of one of its members. CONCLUSIONS: Communication through an opportune art form is a valid method of catharsis when patients cannot express themselves verbally. The therapist is made aware of the patients’ underlying emotional states, and can stimulate them towards actively participating in their treatment, and can better enhance their quality of life. ACKNOWLEDGEMENTS: The Umbrian regional psycho-oncology services are financed by the Umbrian Association Against Cancer, the Umbrian Association of Oncologic Radiotherapy and the Italian Association Against Leukaemia and Lymphoma.

the psychiatrist and all patients have undergone radiotherapy. Standard psychoanalytic techniques are used as well as verbal/non-verbal expression through the mediums of art and music. RESULTS: Having a radiotherapist as co-coordinator in group psychotherapy is of benefit to patients and radiotherapist alike. The patients, both verbally and through their constant attendance records, have expressed satisfaction with the therapy perceiving it as ‘more complete.’ The author has noted improved doctor/patient relations and the risk of burn-out has been substantially reduced. CONCLUSION: The active participation of a radiation oncologist in group psychotherapy has shown to improve the quality of life of the patients and has benefited the emotional and motivational status of the radiotherapist. ACKNOWLEDGEMENTS: The Umbrian regional psycho-oncology services are financed by the Umbrian Association Against Cancer, the Umbrian Association of Oncologic Radiotherapy and the Italian Association Against Leukaemia and Lymphomas.

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Symposium Innovative Models of International Psychosocial Oncology Training

The Experience of a Radiotherapist as Co-conductor of an Analytically Oriented Group Psychotherapy with Cancer Patients Perrucci Ea, Nataloni Gb, Catanzaro Pb a Department of Oncology, Haematology and Biological Sciences, Perugia Regional Hospital, Perugia, Italy; bPsycho-Oncology Service, Department of Oncology, Haematology and Biological Sciences, Perugia Regional Hospital, Perugia, Italy PURPOSE: Developments in complex oncological care have highlighted the need for the training of medical staff in the psycho-social implications of cancer. The author comments on her training in psycho-oncology and subsequent role as cotherapist in group psychotherapy, evidencing the improvements in the therapeutic alliance. She also illustrates the working-out of psychological difficulties encountered as a radiotherapist and as a co-therapist. METHOD: After attending a training course in psycho-oncology organized by the Umbrian chapter of the Italian Society of PsychoOncology, the author, together with a psychooncologist, currently conducts an analytically oriented group psychotherapy. The patients are screened prior to their insertion in the group by

Copyright # 2006 John Wiley & Sons, Ltd.

107 Innovative Models of International Psychosocial Oncology Training Schachter SRa, Golant Mb, Roth Ac, Pronobis Jc a Director of Bereavement Services Calvary Hospital/Hospice Bronx, New York, USA; bVP Research & Development, The Wellness Community, Los Angeles, CA, USA; cDepartment of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center New York, NY, USA In October 2005, a team of psychosocial oncologists from the United States was invited to the newly organized Polish National Psychosocial Oncology Society to train 40 of their psychiatrists, psychologists, and other health care professionals. The US team came from three diverse settings: tertiary care (Memorial SloanKettering Cancer Center, New York City), palliative care (Calvary Hospital Bronx, New York), and community-based support (The Wellness Community Washington, DC). The structure and topics discussed in the training were jointly developed by the US and Polish psychosocial

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oncology team. We present in this symposium a model of training that may be applicable to other countries interested in further developing or initiating a psychosocial oncology program. The training was broad, and included describing and outlining a seamless delivery model for psychosocial oncology treatment for patients and their families. This encompasses tertiary care, palliative care, and community-based support. We discuss evidence-based Critical Pathways of care including psychosocial oncology basics, meaningbased interventions, psychosocial support, psycho-educational treatment, sexuality, and issues related to end-of-life care. Moreover, we identify essential trainer skills which include flexibility, range of knowledge vs specialization, empathy and nurturing support among professional caregivers (as differentiated from patients or clients). In addition, cultural sensitivity, adaptation and teachable moments, creating and maintaining a safe environment, protecting confidentiality, and incorporating a ‘needs assessment’ as an essential training component will be discussed. We also address the practical challenges including simultaneous translation, technology/computer gaps, program needs that emerge as a by-product of the training, effective use of handouts and advance preparation. Finally, we explore the joys and benefits for the trainer including role modeling for clinicians, mentoring, personal and professional meaning, and facilitating an international network of trained psychosocial oncologists.

to psychosocial care. The communication technologies used to deliver psychosocial care in oncology, such as videoconferencing, have value as well as limitations. There is a paucity of outcome studies and technology assessments that would ensure only evidence-based practices are implemented. Many critical healthcare technology decisions are made on an ad hoc basis that does not incorporate a transparent process of seeking and appraising the evidence on effectiveness, or on optimal implementation strategies for the specific local context. Health Technology Assessment (HTA) is a critical element in the process of identifying which technologies will deliver the greatest benefit from a population group perspective. HTA is best thought of as an essential component of various evidence-based practice initiatives, rather than as a narrow initiative to inform funding policy. This paper will discuss a comprehensive approach to examine broad implications of technological innovation in psychosocial care: (1) Assessment of technologies: Which technologies are clinically effective? Which are not? (2) Potential use of technology: What is the willingness of people from diverse population groups to use technology? Who is most in need of improved access to psychosocial care? (3) Issues and concern around implementation: What capabilities are needed to carry out technology-based programs of support? Which technologies are acceptable or appropriate for patients, families and the general public?

Symposium Online Support Groups for People Affected By Cancer (supported by the Wellness Community)

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108 Health Technology Assessment in Psychosocial Supportive Care Kazanjian Aa,b a Health Care & Epidemiology University of British Columbia, Vancouver, BC, Canada; bSociobehavioural Research Centre, British Columbia Cancer Agency, Vancouver, BC, Canada Progress in combating cancer includes consideration of psychological functioning and quality of life. The cancer care system faces geographic barriers, financial resource constraints and a fragmentation in governance structures. This challenges our ability to provide equitable access

Copyright # 2006 John Wiley & Sons, Ltd.

A Model of Supervision for Facilitators of Online Support Groups Berman H Clinical Programs, The Wellness Community} Greater Boston, Newton, MA, USA The provision of facilitated online support groups for people with cancer and their loved ones is a significant development in the field of psychosocial oncology. As clinicians pioneer this territory, there are few guidelines for the actual practice of online support groups. Clinicians are trained to work face to face with people, responding to both verbal and non-verbal cues. The internet is an arena in which new paradigms of working are required. Practice guidelines is an important step in quality control and the ethical protection of group participants. Online support groups challenge

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many notions of traditional cynical work. Trainees need to understand the rationale behind the interventions used, the difference between working face to face and online as well as how to manage the logistics of groups. Once trained, there is a need for ongoing training and support. Supervision is the mechanism by which we ensure the excellence of training and ongoing clinical services. The Virtual Wellness Community has developed and implemented a weekly online supervision training model for the professional facilitators. This presentation will describe the development of the training and supervision paradigm and the ingredients necessary for it to be effective. Selections of supervision transcripts will be used to identify and demonstrate key challenges of interacting online such as staying focused, conveying or dealing with emotions, and addressing loss. Data will be presented on the similarities and differences between online vs face-to-face support group facilitation.

110 The Canadian Experience in Advancing On-line Support Groups in Psychosocial Oncology Golant Ma, Doll Rb, Kazanjian Ac a Research, The Wellness Community, Santa Monica, USA; bCancer Rehabilitation, BC Cancer Agency, Vancouver, Canada; cHealth Care & Epidemiology, University of BC, Vancouver, BC, Canada The British Columbia Cancer Agency (BCCA) provides comprehensive cancer control programs including prevention, diagnosis, treatment and psychosocial care in the province of BC. This paper will describe recent collaborative work between the BCCA, national and international partners in utilizing technology to improve access to psychosocial care. Research has demonstrated that psychosocial care significantly contributes to reducing the burden of cancer by improving adjustment to the disease and other dimensions of quality of life. But in spite of these advances there are significant barriers in access to high quality psychosocial interventions and support to cancer patients and their caregivers outside of comprehensive cancer centers. Communication technologies are currently embraced by the public and private sectors as a means to transmit information, promote education and maintain relationships over small and large distances. The interactive environments created by the use of

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telehealth show promise for developing knowledge, self-efficacy, and problem-solving skills in the oncology context. This paper will describe work conducted in Canada in partnership with the Wellness Community in the USA in advancing synchronous and asynchronous on-line support provided by health care professionals. Participants will learn how this approach has been developed and utilized by psychosocial specialists who have received training in this modality. Descriptions of the benefits and challenges to this work will be described. The development of a national network with the potential to promote international collaboration will be explored through the application of research approaches in this emerging field.

111 Exploring Models to Overcome eHealth Cancer Information and Support Disparities Among Spanish-Speaking Populations: Community Solutions Rios P The Wellness Community, Greater Miami, Miami, USA Latinos are enthusiastic Internet users, however, cultural and economic barriers and limited availability of Spanish Internet websites (PEW) impede their use of eHealth resources. Health care providers must harness the Internet’s capacity to reach Spanish-speaking people with cancer. The Wellness Community (TWC) is developing methodologies to improve access to Internet-based education and support services for Latinos with cancer. First, TWC launched The Virtual Wellness Community in Spanish. Second, TWC convened a Thought Leader Summit}bringing together experts from the Latino community from targeted fields including health care, government, eHealth technology, and Latino advocacy (including survivors). The Summit identified key barriers and solutions to accessing eHealth information and support. Third, based on recommendations from the Summit Leaders, TWC organized separate focus groups of professional community stakeholders in Miami and of Hispanics with cancer to investigate the specific eHealth needs of Hispanic cancer patients and to prepare an intervention. Finally, a community-based Latino Internet training program in Miami was designed based on the feedback from the various groups. The training sought to increase Latinos motivation and

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behavior in accessing cancer information and support online. TWC will report findings including barriers for Hispanics accessing cancer related eHealth information and support, methods by which Hispanics seek support online, and the impact of the training session on Hispanics’ use of the internet to access Ehealth information and support. These strategies provide a model to reduce Latino disparities and improve access to cancer-related information and support on the Internet. Symposium Music Therapy Video for Adolescents/ young Adults (AYA) Undergoing Stem Cell Transplant (SCT)

and weekly brainstorming and working sessions allowed for extensive design mapping and feasibility assessments between the various study roles. Adolescents and young adults with cancer responded very positively to our web-based data collection, as they are entrenched in this technology-driven world and are comfortable providing information via a web-based system. Study personnel, from interveners to evaluators and project managers, have also responded very positively to the easily accessible and efficient system. And, the core administrative team has a means of efficiently tracking and communicating across sites.

113 112 Development and Use of Remote Web-based Data Entry for AYA Self-Report Measures, Study Quality Assurance and Reports Ming Ya, Musick BSa, Burns Db, Stegenga Kc, Haase JEd, McCorkle Kd, Monahan Pa a Department of Biostatistics, Indiana University, Indianapolis, IN, USA; bSchool of Music, Indiana University, Indianapolis, IN, USA; cChildren’s Mercy Hospital, Kansas City, MO, USA; dSchool of Nursing, Indiana University, Indianapolis, IN, USA Data management is integral to every clinical trial and the required technical support for a behavioral clinical intervention trial is complex. This paper describes the development of a seamless webbased data management system to support a multi-site behavioral oncology intervention trial targeting adolescents and young adults undergoing stem cell transplant. The SMART Data Management System supports multiple study roles, facilitates extensive quality assurance mechanisms, houses all data elements, schedules and tracks all study activities, reports real-time performance, assists personnel through all data collection steps for each participant, provides electronic randomization notification, and provides a portal for adolescents and young adults to complete self-report measures while in the hospital. Through the collaborative, combined expertise of an interdisciplinary team (data managers, biostatisticians, music therapists, nurses, clinical research associates, project managers, and physicians), the end-to-end data management system was designed, developed, tested, and implemented in just under 10 months. Frequent communication

Copyright # 2006 John Wiley & Sons, Ltd.

Is There A Better Way? Comparison of Human Subjects Requirements and Timelines across Six Sites McCorkle Ka, Ferguson Vb, Kintner Ec, Roll Ld, Robb Se, Haase JEa a School of Nursing, Indiana University, Indianapolis, USA; bBarnes-Jewish College, St. Louis, USA; c Michigan State University, East Lansing, USA; d South Texas Methodist Children’s Hospital, Texas Transplant Institute, San Antonio, USA; eUniversity of Missouri at Kansas City, Kansas City, USA The increasing number of multi-site studies and the differences in the policies and procedures across sites requires a more complex coordination of entities in order to obtain IRB approval and begin accruing patients. The differences in perceived roles and requirements of approval agencies, layers, and types of approval, as well as, differences in timelines and documentation requirements often contribute to delay in proposed timelines and increased start-up expenses. The purpose of this paper is to describe the variability in local Institutional Review Board (IRB) and other regulatory processes required and their impact on the start-up of a multi-site behavioral oncology intervention trial. Sample includes six institutions which provided access to adolescents undergoing stem cell transplant. Researchers conducted a systematic examination of requirements which included an IRB documentation review and the various approval layers within each institution. A matrix comparison of site procedures was developed. The documentation review for the IRB’s revealed that most approving bodies require similar kinds of information for an initial review. There is large variability in the

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format in which information is requested among the various approving bodies. A large discrepancy in informed consent requirements and the availability of communication between compliance staff, reviewers and investigators was also noted. The elements described above, coupled with multiple review processes and differing timelines at each layer within and among each participating institution creates a complex interplay for start-up and promotes inconsistency. Providing a standardized form for all approval layers would positively impact the time and cost burden of start-up.

114 Messages in the Music: AYA and Parent Perspectives of the TMV Intervention Burns Da, Haase JEb, Robb Sc, Phillips Cb, Bell Cb a School of Music, Indiana University, Indianapolis, IN, USA; bSchool of Nursing, Indiana University, Indianapolis, IN, USA; cSchool of Music, University of Missouri at Kansas City, Kansas City, MO, USA This pilot study investigated parent and adolescent/young adult perceptions of a music video intervention and the final product. Eight parents and 6 adolescents completed the music video intervention and qualitative interviews. Openended, audio taped interviews were conducted 100 days post-transplant in a quiet setting of the parents’ and AYA’s choice, or by phone. Interview data were transcribed and analyzed using mixed qualitative, descriptive and phenomenological methods. Six central themes emerged from the over 350 statements made by the parents. The six central themes included the adverse effects of the cancer experience and SCT, gratitude for the benefits of the music video intervention, relationships of connectedness, enhanced communication, what the AYA exhibited to the parent while involved in the project, process of parent gaining insight, parent response to music video project. The adolescent/young adult comments suggested multiple benefits from participating in the intervention. Some comments suggest that AYA were able to use the intervention as a distraction from the time spent in the hospital and from the seriousness of their illness. AYA were also able to use the intervention and final product to share their experience with others, which provided a sense of connection. Overall, parents and adolescents/young adults were very positive about the

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music video production intervention. Most were able to identify benefits. Comments suggest that the intervention can help address common concerns that occur during the stem cell transplant process.

115 Lessons Learned from Interdisciplinary Collaboration to Implement a Behavioral Intervention within a Cooperative Group Haut PRa, Haase JEb, Robb Sc, Roll Ld, Stegenga Ke, McCorkle Kb, Monahan Pa, Musick Ba a School of Medicine, Indiana University, Indianapolis, IN, USA; bSchool of Nursing, Indiana University, Indianapolis, IN, USA; cSchool of Music, University of Missouri, Kansas City, MO, USA; dSouth Texas Methodist Children’s Hospital, Texas Transplant Institute, San Antonio, TX, USA; eChildren’s Mercy Hospital, Kansas City, MO, USA To address the complexity and scale of problems in biological/behavioral sciences, the NIH Roadmap encourages increased efforts to change the way science is conducted and supported. One focus of change is use of new organizational models to conduct interdisciplinary, ‘team’ science. This paper describes our experience of conducting a multi-site behavioral clinical trial as a team representing a cross-section of healthcare research disciplines (data managers, nurses, music therapists, physicians, social workers, statisticians). Our RO1 study, originally funded through the National Institute of Nursing Research, was also activated as the first behavioral intervention study to be conducted through the Children’s Oncology Group, a large cooperative cancer trials group funded by the National Cancer Institute. When studies are developed and implemented through such disparate funding mechanisms and with so many disciplines represented, there are inevitably different cultural expectations. For example, within a cooperative group, funding is tied to each study participant enrolled and member sites often wait to initiate IRB submissions until after study activation. A study ends when accrual goals are reached. Within the NIH RO1 mechanism, funding is not tied to enrollment, so IRB applications are submitted often before being funded, to begin accruing patients to meet the specified timeframe for study completion. In this presentation we will discuss

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three lessons learned: our efforts to develop an interdisciplinary perspective (distinguished from multi-disciplinary) and effective ways to establish communication, critical administrative support mechanisms from the funding agency perspective, and ways to negotiate the ‘cultural’ differences encountered among disciplines and funding agencies.

116 Theoretical Synergy to Enhance Positive Adjustment to Cancer: The Haase Resilience in Illness Model and Robb’s Contextual Support Model of Music Therapy Robb Sa, Haase JEb a School of Music, University of Missouri at Kansas City, Kansas City, MO, USA; bSchool of Nursing, Indiana University, Indianapolis, IN, USA Research on ‘positive health’}the protective variables such as resilience, positive coping, meaning and purpose, and social and emotional support}is increasingly recognized as a way to explain the processes by which individuals adjust positively to cancer. This presentation describes the linking of two theoretical models to address the psychosocial adjustment of adolescents/young adults undergoing stem cell transplant. Components of the Haase Resilience in Illness Model, also called the Adolescent Resilience Model (ARM), include protective factors of derived meaning (hope, spiritual perspective), perceived social support from friends and health care providers, family environment (communication, adaptability, cohesiveness), and positive coping (confronting, optimistic, supporting). Risk factors in the ARM are illness-related distress and defensive coping. The ARM components are targeted through a music therapy intervention based on Robb’s Contextual Support Model of Music Therapy. Robb’s theory hypothesizes that effective music therapy interventions contain elements of (1) structure; (2) autonomy support; and (3) relationship involvement. The contextual support elements of a therapeutic music video intervention developed by Robb, can potentially influence ARM outcomes of resilience via multiple paths. For example, focus on developing the music video supports AYA movement from defensive to positive coping, offers a means to communicate the traumatic events and unspoken thoughts and

Copyright # 2006 John Wiley & Sons, Ltd.

emotions being experienced as part of their diagnosis and treatment, and encourages family and provider support. The intervention may also provide short-term reductions in illness-related distress. These, in turn, can foster the resilience outcomes of self-transcendence, mastery/confidence, and self-esteem. Symposium African American Women Breast Cancer Survivors Perspectives of Quality of Life (QOL)

117 Not Encompassing My Experiences Haase JEa, Russell Ka, Ziner KMa, Kooken Wa,b, Lu YFYa a School of Nursing, Indiana University, Indianapolis, IN, USA; bDepartment of Nursing, Bradley University, Peoria, IL, USA Outcome disparities between African-American and Caucasian breast cancer survivors are well documented. In this presentation we describe African-American breast cancer survivors’ responses to being involved in research and their evaluation of 13 proposed, well established measures of quality of life (QOL), including measures of disease and treatment, generic, and global QOL. Focus groups were conducted to obtain participants’ responses to the instruments which were to measure QOL variables in the larger quantitative study. Two initial focus groups provided participants with a rare opportunity to openly discuss their experiences and the resulting data were unexpectedly rich. As a result, to make full use of the rich data, we added a third group and Group-as-a-whole Theory in conjunction with Colaizzi’s empirical phenomenology methods for analysis. The combined sample consisted of African-American women breast cancer survivors ðn ¼ 21Þ whose ages ranged from 38–78 (M ¼ 59:85; SD ¼ 9:37) with time-since-diagnosis from 1 to 7 years. Two major themes were found. Questionnaires Not All Encompassing of My Experience provided information on problems participants had with the clarity, comprehensiveness, time-sensitivity, missing elements of experiences, and measures’ cultural appropriateness. In addition to offering concrete suggestions for adjusting the measures, the second major theme, Ways to Fix Questionnaires, had the following sub-themes: There Wasn’t Anything that Really Got to the Meat of Anything; Testing If Really

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Interested; and Second-guessing to Provide Researcher’s Desired Responses. We will discuss the implication of these findings for future research with African-American survivors and QOL measurement. ACKNOWLEDGEMENTS: Funded by National Institutes of Health/National Cancer Institute NCI RO3 CA 097737, African-American Breast Cancer Survivors QOL.

118 I’ve Been Through Something: A Poetic Exploration in Cultural Competence and Care Kooken WCa,b, Russell KMa, Haase JEa a School of Nursing, Indiana University, Indianapolis, IN, USA; bSchool of Nursing, Bradley University, Peoria, IL, USA The use of alternative formats to present research findings is rare. In African-American culture use of emotion is equated with sincerity and wellbeing. One way to express emotion within a cultural context is through story-telling or literature. African-American culture has a long history of the use of literature and in particular poetry, as a safe way to express their deepest emotions. The purpose of this research was to describe the common experiences of African-American women breast cancer survivors through poetry. Using Group-as-a-Whole theory and both empirical and interpretive phenomenological approaches to analysis, transcripts from 3 focus groups including 21 African-American breast cancer survivors from differing socioeconomic groups were analyzed. Data were first analyzed using Colaizzi’s approach. Familiarity with the dialogue and emerging themes led to an awareness of the poetic way in which African-American women described their experiences. As analysis progressed, black feminist literature contextualized the survivors’ experiences. The transcript dialogues were used to create a poetic interpretation of the experience of African-American women surviving breast cancer. In constructing the poetry the participants’ words were used verbatim, as often as possible. Seven groups of poems were written and describe the journey from diagnosis to survivorship as experienced by African-American women. Poetry is a culturally appropriate way to analyze data from this research and its use may raise the level of awareness of the African-American woman’s experiences of breast cancer survivorship to allow for more culturally sensitive healthcare.

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119 A Litany of Symptoms and Their Effects on Quality of Life of African-American Breast Cancer Survivors Russell KMa, Lu YFYa, Kooken Wa,b, Ziner KWa, Haase JEa a School of Nursing, Indiana University, Indianapolis, IN, USA; bSchool of Nursing, Bradley University, Peoria, IL, USA Women with breast cancer often experience a wide range of symptoms that influence their quality of life (QOL). Little research has been done to specifically describe symptom experiences and their influence on QOL of African-American women with breast cancer. This presentation is part of a symposium on findings from Phase I of our study of African-American breast cancer survivors’ QOL. The sample consisted of African-American women breast cancer survivors ðn ¼ 21Þ whose ages ranged from 38 to 78 (M ¼ 59:85; SD ¼ 9:37) with time-since-diagnosis from 1 to 7 years. Three focus groups provided these participants a rare opportunity to openly discuss their experiences and data were unexpectedly rich. We used Group-as-a-whole Theory in conjunction with Colaizzi’s empirical phenomenology methods for analysis. In this presentation we describe the symptoms that participants experienced and examine how these symptoms affected their QOL. Many uniquely interpreted or managed symptoms described by this sample reflect both AfricanAmerican and feminist perspectives. The symptoms were commonly linked holistically with physical, psychosocial, and spiritual dimensions. Within these dimensions, the women described: making sense of and managing symptoms; critical moments they experienced to ‘get through’ the symptoms; ways they negotiated symptoms and emotional responses, including the presence of strong spiritual connectedness to God; and emergence from the journey as a new person. Findings suggest there is an essential need for developing culturally sensitive symptom assessment and symptom management interventions that are acceptable within the cultural context of AfricanAmerican women breast cancer survivors.

120 The Process of Becoming a Breast Cancer Survivor Russell KMa, Lu YFYa, Kooken Wa,b, Ziner KWa, Haase JEa

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a

School of Nursing, Indiana University, Indianapolis, IN, USA; bSchool of Nursing, Bradley University, Peoria, IL, USA Definitions and perspectives of survivorship range from survivorship defined as ‘beginning at diagnosis’, to survivorship as ‘5 years out’ from treatments. Little is known about survivorship perspectives of African-American women with breast cancer. The process they experience in becoming a survivor is not well described and the phases of discovery, diagnosis, treatment, and transition into survivorship have not been explored in great depth. The purpose of this paper is to describe this process or the journey that was described by 21 diverse African-American women breast cancer survivors. This presentation is part of a symposium presenting findings from empirical phenomenological analysis from African-American women breast cancer survivor participants in three focus groups. The women’s age ranged from 38 to 78 (M ¼ 59:85; SD ¼ 9:37) with time-sincediagnosis 1–7 years. Data were analyzed using empirical phenomenology and group-as-a-whole theoretical perspective. Findings showed similarities among the women and the following key processes of becoming survivors emerged: (1) Marking Time, (2) Managing Knowledge for Being a Survivor, (3) Taking control of Something– anything, (4) Moving on: Redefining Self from Inside Out, and (5) The New Me. We will describe each of these processes and relate them to the phases of diagnosis, treatment, and transition into survivorship. Our findings point to the importance of closely examining approaches to care when addressing needs of African-American women breast cancer survivors and to tailor our quality of life interventions to the processes that occur in becoming a survivor.

communication to be informative and emotionally supportive. Little is known about African-American women breast cancer survivors’ experiences of communication with their healthcare providers. The purpose of this paper is to describe the communication experiences of African-American women breast cancer survivors with their healthcare providers. The sample consisted of 21 African-American breast cancer survivors from lower, middle and upper socioeconomic strata within the Midwestern region of USA who were 1–7 years post-diagnosis. The women’s ages ranged from 38 to 78 (M ¼ 59:85; SD ¼ 9:37). A cross-sectional design of three separate focus groups was used and analysis was done using Colaizzi’s phenomenological methods from a Group-as-a-whole Theory perspective. Results emerged in two major categories: Surviving Poor Communication and What Helps. Themes within Surviving Poor Communication included: They Don’t Tell Us; You Don’t Need to Know; It Doesn’t Matter What You Know; What Does Matter; Taking Dangerous Short Cuts; You Don’t Know Me; Invisible Patient; and, Hit and Run Care. Themes within What Helps included: Being Given Control, Being There and Being Vigilant, and Strategies to Enhance Communication between African-American Breast Cancer Survivors and Healthcare Providers. Findings suggest AfricanAmerican breast cancer survivors did not get the information and support from healthcare providers. Healthcare providers must be aware that poor communication can be an additional burden as African-American women struggle to survive breast cancer. Symposium A Knowledge Management Approach to Intervention Research in Psychosocial Oncology

122 121 The Process of Becoming a Breast Cancer Survivor Ziner KWa, Kooken Wa,b, Haase JEa, Russell KMa, Lu YFYa a School of Nursing, Indiana University, Indianapolis, IN, USA; bSchool of Nursing, Bradley University, Peoria, IL, USA Communication content and delivery methods between patients and healthcare providers are linked to long term quality of life (QOL) in cancer survivors. Survivors expect healthcare providers’

Copyright # 2006 John Wiley & Sons, Ltd.

Neighbourhood: Building a Research Program for Men with Reproductive Cancers Butler L Faculty of Health Professions, School of Nursing Dalhousie University, Halifax, Nova Scotia, Canada Evaluating the dynamic relationships among the evidence, context and facilitation is key to understanding how evidence-based interventions in psychosocial oncology are translated to practice. This is particularly significant given that most

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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clinicians combine explicit knowledge with tacit or experiential knowledge through known communities of practice resources. The author is developing an intervention that is rooted in the theoretical underpinnings of knowledge translation. Theories selected highlight the need to understand change at both the individual and systems level. The presentation will describe how advanced information and multimedia technologies will be used to create an innovative online cancer care environment to assist individuals in understanding and managing their care on a continuous basis. The services will be guided by the principles and practices of healthcare knowledge management, sharing, and translation and will result in the development of a patient-specific care map and knowledge-driven healthcare services. Using a care map, available via a web-based portal called the Neighbourhood, the author will share the approach to developing a proactive, customized healthcare planner and guide to support men with prostate cancer at the individual and community level, through ongoing and prospective healthcare events and issues. The Neighbourhood will empower patients to make informed decisions throughout their cancer experience, and the patient information contained in it will be useful to family physicians and care service providers who deliver specialized care to patients. This will lead to improved care of patients within the home and will potentially reduce the burden on resources in the Canadian healthcare system.

123 Positioning Psychosocial Screening in the Forefront of Clinical Oncology Practice: Why Hasn’t It Happened Yet? Carlson LE, Bultz B, Clifford S, Hilliard F, Groff S Division of Psychosocial Oncology, Department of Oncology, Faculty of Medicine, University of Calgary/Tom Baker Cancer Centre, Alberta Cancer Board, Canada There is ample evidence documenting high levels of psychosocial symptomatology including pain, distress and fatigue in cancer patients at all stages of treatment and recovery. The US National Comprehensive Cancer Network published and actively disseminates guidelines and algorithms for Distress Screening, including recommendations that distress be assessed at every clinical encoun-

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ter. The Canadian Strategy for Cancer Control endorsed Pain and Fatigue as the 5th and 6th Vital signs in cancer care. The Journal of Clinical Oncology published commentary endorsing routine distress screening, as did Lancet and PsychoOncology. Despite these obvious successes and endorsements, very few programs have implemented broad routine clinical distress screening, and none, to our knowledge, have published evaluation of such screening on subsequent patient outcomes. In such a climate, what are the possible factors limiting the implementation of routine, broad-based screening programs? Some of the systemic, personal, social and economic barriers will be reviewed, calling upon our recent experience implementing online computerized distress screening in Calgary, Canada. These include systemic factors such as caregiver time pressure, rigid role expectations, operating in silos, and short-term budgeting and planning. Societal factors such as valuing and funding acute care rather than prevention (disease care vs health care), ongoing stigma related to mental health issues, fear of new technology in an atmosphere of privacy protection, and failure to show cost savings of distress screening will also be touched upon. Strategies used to overcome some of these issues will be shared and issues to consider when planning comprehensive psychosocial screening programs discussed.

124 Knowledge Translation in Psychosocial Oncology: Can Theory Help? Degner LF Cancer Nursing, Faculty of Nursing, University of Manitoba, Winnipeg, Canada For many years there was a prevalent assumption that simply bringing evidence to health care professionals, such as in the form of practice guidelines, was sufficient to lead to change in their practice behaviors consistent with the best available empirical knowledge. We now know that this assumption is incorrect given the results of a recent systematic review by Grimshaw et al. (2004) who reported an improvement of only 6–14% in practice performance towards consistency with newly introduced guidelines in 36 cluster randomized trials of different types of interventions. Grimshaw concluded that the lack of a coherent theoretical basis for understanding professional

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and organizational behavioral change limits our ability to formulate hypotheses about which interventions to promote knowledge uptake are likely to be effective under different circumstances. This paper reports on a variety of theoretical perspectives, including (1) social network theory, (2) the Royal College of Nursing Institute Framework ‘Getting Evidence into Practice’, (3) contextualized feedback intervention theory, and (4) Gabbay and leMay’s (2004) formulation of ‘mindlines’. These perspectives provide a way of thinking about knowledge translation and uptake in psychosocial oncology that may prove useful in formulating interventions to assist health care professionals with knowledge use in a variety of settings.

125 Use of Consultation Recordings in Oncology Practice: Merits and Challenges Hack T Faculties of Nursing and Medicine, University of Manitoba, Winnipeg, Canada There is empirical support for the provision of consultation recordings in oncology, particularly for recordings of the initial treatment consultation. Consultation recordings are rated favourably by patients and oncologists, decrease patient distress and anxiety, enhance patient learning, understanding, and recall of information, and improve patient satisfaction. Despite these advantages, consultation recording use is not standard clinical practice in oncology. Barriers to adoption of this promising intervention are systemic, social, and personal, and must be systematically addressed prior to any widespread uptake of this intervention. The author is using a knowledge management framework to evaluate and promote the use of consultation recordings in oncology. There are many knowledge management theories, each of which provides insight into how to alter oncologist and patient behaviour to increase consultation recording use. Successful knowledge management approaches to behavioural change require an understanding of the attitudes and motivation of key stakeholders}patients and oncologists in the case of consultation recording use. Knowledge translation efforts depend on the support and involvement of these stakeholders. Using mixed methods approaches, the authors have embarked on a series of research steps towards launching a large dissemination trial of

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consultation recording use. Using surveys, interviews, and focus groups, the authors are detailing the benefits of consultation recordings and the barriers to large-scale adoption. The description and rationale for these various approaches will be shared during this session, along with a discussion of the hurdles faced in conducting intervention research when the goal is broad dissemination of the intervention. Symposium Psychooncology in Switzerland: Past, Present, Future (Supported by Swiss Cancer League)

126 The Wounded Family. Adolescents Confronted with Emotions Related to the Oncologic Illness of a Parent. Pilot Project in a Middle School of the Italian Part of Switzerland Bianchi Micheli Ga, Canova Rb, Monteggia Martignoni Cb, Gianini Jb, Tomamichel Ma a Servizio di Psichiatria e Psicologia Medica OSC, Lugano, Switzerland; bLega ticinese contro il cancro, Bellinzona, Switzerland Each year many children face the illness or death of a parent, relative, friend or acquaintance. These are events that trouble the apparently safe world of the child or adolescent. In order to avoid the unresolved pain becoming angst in adult life, the child needs a sincere attitude of listening, help and support, and to be able to ask all the questions he wishes. One of the hardest tasks for adults is to face the feelings originating in children’s experience of loss. Often the fear of inadequately responding to the children’s pain and the desire to protect them pushes parents, teachers and caregivers to underestimate their feelings, thoughts and concerns. Left alone with strong and incomprehensible new emotions, children experience anxiety and fear. The support of the adult becomes indispensable in order to help them understand and integrate the new life experience in their personal story. This pilot project, offered by the ‘Lega Ticinese contro il cancro’ in a middle school in Biasca since 2001, is part of a chapter on deviance prevention, through education towards the ability to handle ones’ own emotions in different life experiences. Helping children to receive and accept their emotional changes, as well as communicating them without denying or trivializing them, is a clear commitment toward prevention and education aimed at promoting self-

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respect as well as respect towards others. The work done with the children opened a dialogue about these subjects with teachers and parents as well.

127 Psychooncology in Switzerland: Past, Present, Future Hu¨rny C Bu¨rgerspital St. Gallen, St. Gallen, Switzerland In 1976 Fritz Meewein, psychoanalyst and pioneer of psychooncology, founded the working group psychooncology AGPO within the Swiss Group for Clinical Cancer Research SAKK. On request of the oncologists in the first decade the AGPO investigated the way physicians were breaking bad news. Already at this point in time communication was a main focus. In the following years AGPO initiated the development of quality of life assessments in the SAKK and the IBCSG. PRESENT: With the initiative and the support of the Swiss Cancer League a task force communication skills in oncology was founded in 1998 with the goal to improve the communication with cancer patients of professionals. It resulted in a three day practical training of communication skills, mandatory for board certification in oncology since 2002. The Swiss Society for Psychooncology, founded in 2003, includes about 100 professionals working with cancer patients. The main focus of the society is at this point to define postgraduate educational needs and requests for the different professionals for psychooncological counselling or psychooncological psychotherapy. The landmark survey (2002–2004) by the Swiss Cancer League of the psychosocial services for cancer patients and their relatives showed a very heterogeneous pattern throughout the country and many unmet needs. FUTURE: To better meet the psychosocial needs of cancer patients and their relatives in Switzerland major efforts are needed in coordinating the existing services to a dense network on the level of patient empowerment, in psychosocial education of primary care givers and psychooncological specialists.

128 Improving Communication Skills of Oncology Physicians and Nurses: Evaluation of the Swiss Programme Wo¨ssmer Ba, Bernhard Jb, Dietrich Lc, Hu¨rny Cd, Kiss Aa

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a

Psychosomatic Medicine, Universityhospital, Basel, Switzerland; bPsychoonkology, Universityhospital, Bern, Switzerland; cPsychoonkology, Kantonsspital, St. Gallen, Switzerland; dBu¨rgerspital, St. Gallen, Switzerland INTRODUCTION: In 2001 the Swiss Cancer League established together with a group of 6 seminar leaders a communication skills Training for oncologists and nurses. The course consists of a 2.5 days initial workshop, a half day follow-up workshop, and up to five feedback units by telephone. Interviews with simulated patients were videotaped prior to the intervention and at the follow-up workshop. Participation was voluntary for oncology nurses and mandatory for oncologists who needed the course for their board certificate. In order to assess the success of this communication skills training a total of 258 videos from nurses and oncologists was analysed. METHODS: Interviews were analysed with the Roter Interaction Analysis System (RIAS). Furthermore, segments in the interview were identified when professional and patient communicate in a reciprocal way. RESULTS: A total of 54.692 utterances were analysed. After the intervention in nurses there is a significant increase in the proportion of empathic statements (1.6 versus 3.2%), of reassuring statements (2.3 versus 3.4%), a decrease in medical information given (17.8– 13.3%), and increase in closed and open questions concerning psychosocial information (2.8 versus 4.0%), In oncologists there is an increase in checking/summarising utterances (1.8 versus 2.3%), and an increase in patients’ explicit agreement statements (3.6 versus 4.7%). There is a significant training effect on the length of speech patients may use without being interrupted by the professional: 3.7 versus 4.3 utterances. SUMMARY: Compared to much longer intervention programs in the literature the Swiss communication training in Oncology seems to be successful in oncologists and especially in nurses.

129 Learning to Live with Cancer#}The Swiss Experience Dietrich L Psychooncology, Kantonsspital, St. Gallen, Switzerland Learning to live with cancer is a structured education and support program for cancer patients and their relatives. The main aims of the

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program are to inform about cancer and to enhance coping strategies. The program was developed by Prof. G. Grahn (Lund, Sweden). In a research project learning-needs of cancer patients and their relatives were identified. Based on this results a structured education program containing 16 hours education was developed in collaboration with patients and relatives and evaluated after first courses. Afterwards ‘Training to Trainers’ were offered to experienced nurses in Oncology in Europe. There nurses from Switzerland participated and in 1998 the first courses were offered in Bern and Geneva. Since then more than 100 patients and relatives participated in a course and six ‘Training the Trainers’ were held for nurses. The program provides basic information and enables the participants to improve their coping strategies and help to regain a feeling of control. Its a cognitive and an emotional support. The discussion between the participants helps to share experiences. During the eight sessions information are given to the human body, the cancer disease, diagnose, treatment, including research and complementary care, nutrition, side effects, crisis, coping, relaxation of body and mind and expression of feelings with expressive art. In 2002 the ‘Swiss Association Learning to live with cancer#’ was created to promote the offer of the program, to protect the quality and control the evaluation.

130 National Survey of Psychosocial Oncology: Patient Needs and Patient care Navarra S, Eichenberger C, Fluri M, Hopf C, Navarra K, Twisselmann W Swiss Cancer League, Berne, Switzerland METHODS: From 2002 to 2004 we comprehensively took stock of psychosocial services for cancer patients and their relatives. Surveys were conducted among three groups: 416 cancer patients with different diagnoses and 281 of their relatives; 641 professionals from various disciplines; 108 public and private hospitals, 20 cantonal cancer leagues RESULTS: Every other patient and every other relative has important psychosocial needs that are not being met. The following psychosocial needs were mentioned most often by patients and their relatives: Information about the disease, treatment, and care; Support from friends and families; Support in

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dealing with negative feelings; Financial and jobrelated advice and practical help in everyday life; Being able to contribute to their own wellbeing. According to the survey participants, the central problem areas are: A lack of information about existing services; Insufficient understanding of the needs of patients and relatives; A lack of coordination and collaboration among different groups of professionals. CONCLUSION: On the basis of these results we suggest the following measures: An information campaign among health professionals and the general public about the range of available psychosocial services and their effectiveness; Systematic needs assessment in cancer care, followed by systematic referral to psychosocial services if necessary; Regional networking among the providers of psychosocial services. ACKNOWLEDGEMENTS: We thank Oncosuisse for funding this project. Symposium Mind, Body and Time: Circadian Rhythms in Psycho-Oncology}1

131 Circadian Timing System Alterations In Cancer Patients Innominato PF INSERM U776 and FSMSIT Paul Brousse Hospital, Villejuif, France The circadian timing system (CTS) exerts a timedependent control of homeostasis for different physiological, behavioral, cellular and biochemical functions within the human body, with a period of about 24 h. The CTS consists of a central pacemaker, the suprachiasmatic nuclei (SCN) and of molecular clocks in each cell, which are coordinated by the SCN through neuroanatomic pathways and rhythmic neuroendocrine outputs. Environmental cues entrain and synchronize the endogenous rhythms generated by the CTS. CTS status can be assessed by measuring marker rhythms of circadian physiology, including rest/ activity, body core temperature, sleep–wake, cortisol and melatonin. Most assessments, however, require rather invasive measuring techniques, and are cumbersome for use in clinical practice. Conversely, circadian rest/activity rhythm can be continuously and non-invasively assessed with a wrist accelerometer (actigraph). The robustness of CTS rhythms can be altered in several conditions, including cancer. Circadian physiology can be

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nearly normal or markedly altered in cancer patients. The extent of alteration of rest/activity or cortisol predicted for patient survival and quality of life. Moreover, anticancer treatments can affect the CTS at all levels (central coordination, signalling outputs, molecular clocks). The CTS itself can be considered as a target of pharmacological or behavioral treatments, aimed at restoring its physiological functioning. Irrespective of cause, CTS alterations are often clustered with psycho-physical symptoms, such as fatigue, anorexia and depression. Current research objectives in this field involve the development of comprehensive CTS assessment and treatments tailored to the individual circadian function of cancer patients.

132 Role of Neuroimmune Communication in Subjective Health Complaints of Cancer Patients Dantzer R Department of Pathology, College of Medicine, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA Cancer patients experience a high prevalence of fatigue and mood disorders that are exacerbated by adjuvant cancer treatments. Similar symptoms develop in patients whose immune system is activated to clear the hepatitis C virus or to kill tumoral cells that are resistant to chemotherapy and radiotherapy. Administration of interferonalpha and/or interleukin-2 to these patients induces symptoms of sickness including fatigue, decreased appetite and sleep disorders. Mood disorders develop on top of these symptoms in about 30% of the patients receiving immunotherapy, and the symptoms mimic those observed in major depressive disorders or in bipolar disorders. Activation of the peripheral innate immune system in laboratory animals also induces signs of sickness that wane off to leave a depressive-like state. Peripheral inflammation is relayed to the brain by both the sensory nerves that innervate the site of inflammation and the overflow of inflammatory mediators that enters the general circulation. Activation of indoleamine 2,3 dioxygenase, a key enzyme in the metabolism of tryptophan, represents an important mechanism for the depressive-like effects of immune activation. Enhanced activity of this enzyme results in decreased levels of tryptophan, so that less tryptophan is

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available for the synthesis of serotonin, and increased levels of potentially neurotoxic kynurenine metabolites. Based on these convergent lines of evidence from the bench and bedside, we propose that subjective health complaints of cancer patients are caused by the local and systemic inflammation that is associated to the developing tumor and is exacerbated in response to adjuvant cancer treatments.

133 Symptom Clusters in Cancer Patients Dodd MJ, Miaskowski C Physiological Nursing University of California San Francisco, San Francisco, USA PURPOSES: 1. Can subgroups of oncology outpatients be identified based on a specific symptom cluster (i.e. pain, fatigue, sleep disturbances, and depression) and do these subgroups differ on outcomes (i.e. functional status, and quality of life (QOL)? 2. Does symptom cluster group membership change over time during and after cancer treatment? METHODS: Secondary analysis of two studies: study 1 included 191 cancer patients with various cancer diagnoses, using a crosssectional design; study 2 included 101 breast cancer women, using a randomized clinical trial that tested an exercise intervention for fatigue. The symptoms and outcomes were measured once in study 1, and three times in study 2. Hierarchical cluster analysis yielded the patient subgroups. RESULTS: In both studies, a 4-cluster solution was obtained. In study 1 and 2, these subgroups were categorized as low on all symptoms; high on all symptoms; and the two remaining subgroups were combinations of various symptom severities. In both studies the low symptom subgroup reported significantly better outcomes than the other 3 groups. In study #2, the 4 patient subgroups were the same at T1 (beginning of CTX), T2 (completion of CTX), and T3 (at the end of the trial). Some of the patients’ subgroup group memberships changed at T2, patients reported more severe symptoms, and changed at T3, patients reported less severe symptoms. CONCLUSIONS: Oncology outpatients can be grouped based on the severity of selected symptoms. Group membership changed across CX treatment and had an effect on outcomes. ACKNOWLEDGEMENTS: Supported by the Oncology Nursing Foundation.

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134 The Epidermal Growth Factor Receptor and Symptom Clustering in Cancer Patients Rich TA Department of Radiation Oncology, University of Virginia Health System, Charlottesville, VA, USA A hypothesis presented here is that symptom clustering of fatigue, appetite loss, and sleep disruption can be produced by targeted signaling by members of the epidermal growth factor receptor (EGFR) that disrupts anterior hypothalamic modulation of the circadian axis. A simplified model of the circadian axis shows it is composed of a dominant input (ambient light), a central oscillator (the clock), and outputs to the anterior hypothalamus that are mediated by hard wired connections and ‘diffusible’ messengers that convey clock signals to specific nuclei in the anterior hypothalamus. The hypothalamic nuclei modulate, amplify, or inhibit signals from the core oscillator to downstream brain centers depending on the specific nucleus and the presence of specific signals. In a laboratory rodent brain infusion model, exogenous administration of transforming growth factor-alpha (TGF-a) and neuregulin-1 into the third ventricle produces circadian locomotor inhibition, loss of appetite, temperature disruption and sleep alterations. Additional support for this hypothesis are the clinical data from patients with metastatic colorectal cancer that indicate a significant correlation exists between circulating levels of TGF-a with disrupted circadian motor activity, and fatigue and loss of appetite. These preclinical and clinical data support the hypothesis that ligands of the EGFR target specific hypothalamic nuclei that play a modulatory role in the circadian axis. This knowledge may prove useful in the design and study of targeted interventions in the future management of cancer patient’s symptoms. Symposium Mind, Body and Time: Circadian Rhythms in Psycho-Oncology-2

135 Quality of Life Domains in Cancer Patients Efficace F Quality of Life Unit European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium

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There is general consensus that quality of life (QOL) is a subjective multidimensional construct. QOL areas include physical functioning, psychological and social well-being, as well as disease and treatment related symptoms. However, more recently other aspects, for instance, spiritual or existential concerns are receiving more attention. Measurement of only one or two domains does not provide a comprehensive assessment of QOL. As an example, whilst performance status is an important clinician reported index, it does not capture the overall patient’s burden in terms of QOL. Understanding how disease and its associated health care interventions affect the lives of cancer patients is especially important as current treatments (surgery, chemotherapy, and radiation) often have side effects which might be short-term or time-limited or chronic and persistent. Over the last fifteen years, the need to monitor QOL has been increasingly recognized as an important aspect of comprehensive cancer care and this has also become evident by the tremendous boost in the number of publications dealing with QOL in oncology. At present a number of QOL questionnaires are available to be used in oncology; these include the EORTC QLQ-C30, the FACTG, the FLIC and the CARES. Instruments used to measure QOL vary in the number and characterization of the dimensions they evaluate. These differences basically stem from the fact that the instruments are developed to target different populations and purposes. Thus, selecting the most appropriate questionnaire to be used in given setting is also of paramount importance.

136 Circadian Rhythms and Mood Disorders: Chronotherapeutic Implications Benedetti F Department of Neuropsychiatric Sciences, Istituto Scientifico Universitario Ospedale San Raffaele, Milano, Italy In the last few years (1) protocols have been defined to optimize chronotherapeutics (wake therapy, formerly known as sleep deprivation, and light therapy), and (2) light has been shed on the molecular mechanisms that regulate the functioning of the master clock of human body. Chronotherapeutics is the only treatment in psychiatry that evolved directly out of neurobiological models of behavior, and these recent

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advances allow to define the relevance of the biological rhythms control in bipolar illness. Both pharmacological antidepressants (SSRI, TCA, MAOI) and chronotherapeutics promote the CREB-mediated gene transcription in the suprachiasmatic nucleus of the hypothalamus. Lithium lengthens circadian rhythms, and can inhibit GSK-3b, thus leading to rapid proteasomal degradation of Rev-erbalpha and activation of clock gene Bmal1. The mood stabilizer valproic acid seems to share some of these effects. These are the same transductional–trascriptional pathways by which light stimuli synchronize every morning the molecular clock through the retino-hypothalamic tract, and which are targeted by chronotherapeutics. In very recent studies we showed that polymorphisms in the promoter genes for clock genes (CLOCK, GSK-3b, hPER-3) and for genes influencing serotonergic activity (SERTPR) can influence core features of the bipolar illness such as age at onset, rate of recurrence, lifetime prevalence of sleep disorders}and response to treatments. Such parallel findings point to an intimate relationship between the neurotransmitter system targeted by drugs and the circadian system targeted by chronotherapeutics. The definition of the specific mechanisms involved will probably help the understanding of the pathophysiology of bipolar illness.

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cortisol, DHEA, urinary catecholamines, glycosylated hemoglobin, cholesterol, blood pressure and waist circumference. Bivariate correlations identified relevant medical and demographic control variables, and hierarchal regressions examined trauma and support as predictors of circadian disruption and allostatic load. RESULTS: Neither childhood nor recent trauma was associated with circadian disruption. However, childhood sexual abuse predicted greater allostatic load (partial r ¼ 0:34; p50:05). Social support was associated with more rhythmic diurnal cortisol profiles (confidant support, partial r ¼ 0:30; p50:05; affective support, partial r ¼ 0:31; p50:05), but not with allostatic load. Secondary analyses showed that abuse during childhood was related to elevations of epinephrine (sexual abuse, partial r ¼ 0:46; p5 0:05; physical abuse, r ¼ 0:37; p50:05) and overall free salivary cortisol (partial r ¼ 0:32; p50:05). CONCLUSIONS: Childhood trauma predicted higher allostatic load and greater activation of endocrine stress responses, while supportive social relationships favored strong circadian rhythms. Results contrast with findings from non-cancer samples, and support the notion that social relationships in childhood and adulthood might impact gynecologic cancer outcomes by way of biological pathways.

138 137 Trauma and Support: Links with Circadian Disruption and Allostatic Load in Gynecologic Cancer Sephton Sa,b, Weissbecker Ia a Department of Psychological and Brain Sciences, USA; bJames Graham Brown Cancer Center, University of Louisville, Louisville, Kentucky, USA

Circadian Rhythms and Physical Functioning in Cancer Patients Spiegel D, Giese-Davis, J, Barr Taylor C, Kraemer H Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA

PURPOSE: Research shows that social relationships may impact cancer progression. Among women with gynecologic cancer we investigated biological correlates of childhood trauma and social support with a focus on physiological measures of chronic stress: circadian disruption and allostatic load. METHODS: Women within five years of diagnosis of ovarian ðn ¼ 21Þ or endometrial ðn ¼ 24Þ cancer provided retrospective reports of childhood and recent trauma (TES) and current supportive social relationships (DUKE). We assessed diurnal salivary cortisol rhythms and calculated an allostatic load summary score using 10 indices including serum

The normal diurnal cortisol cycle has a peak in the morning, decreasing rapidly over the day, with low levels during the night, then rising rapidly again to the morning peak. Disruption of this pattern has been associated with more rapid cancer progression in both animals and humans. It is characterized by a flatter daytime slope and higher than normal cortisol values late in the day. In a sample of 99 women with metastatic breast cancer, we found that a flatter daytime slope was associated with dexamethasone non-suppression, but not with pharmacologic or behavioral stimulation of cortisol secretion. Specifically, escape from suppression caused by 1 mg of dexametha-

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sone administered the night before was associated with flatter daytime cortisol slopes (r ¼ 0:30; p ¼ 0:005; N ¼ 88 at waking, r ¼ 0:29; p ¼ 0:005; N ¼ 90 at wake plus 30 minutes; r ¼ 0:26; p ¼ 0:01; N ¼ 90 at 1200 h; r ¼ 0:29; p ¼ 0:005; N ¼ 93 at 1700 h; and r ¼ 0:28; p ¼ 0:007; N ¼ 92 at 2100 h). Flatter (abnormal) daytime cortisol slopes were modestly associated with the rise in cortisol from waking to 30 minutes after awakening (Spearman r ¼ 0:29; p ¼ 0:004; N ¼ 96), but not with waking Cortisol level (r ¼ 0:13; p ¼ 0:19; N ¼ 96). However, we could not detect any association between daytime cortisol slope and activation of cortisol secretion by either CRF infusion or the Trier Social Stress Task. Flatter daytime cortisol slopes were significantly correlated with the slope of DHEA (r ¼ 0:21; p ¼ 0:04; N ¼ 95), but not with NK cell number or cytotoxicity. Our findings suggest that flatter daytime cortisol slopes among metastatic breast cancer patients may be related to disrupted feedback inhibition rather than hypersensitivity in response to stimulation. This study was supported by NIA/NCI Program Project AG18784.

139 Quality of Life During Chronotherapy in Cancer Patients Garufi C, Perrone M, Vanni B, Falcicchio C, Campanella C, Terzoli E, Pugliese P Istituto Regina Elena, Rome, Italy Chronotherapy takes into account the possible benefits of administering drugs according to biological timing. In this setting Quality of Life (QoL) evaluation, especially in patients with advanced colorectal cancer, is an important endpoint. We utilized three different approaches to asses QoL during chronotherapy. The first has been centred on the QoL modifications in patients treated with different chronotherapy schedules comprising 5-fluorouracil/folinic acid  oxalipaltin, CPT-11, Mytomicin-C. QoL was assessed using the EORTC QLQ C30 questionnaire completed before and after every 9 weeks of treatment. In the 248 assessed patients mean QoL scores were stable during the entire course of treatment with an improvement of functioning scales and symptom mean scores after 18 weeks. The second approach has been centred on the relationship between performance status (PS), toxicity, response to chemotherapy, anxiety and depression evaluated by HADs and QoL. Patients with better

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prognostic factors as PS 0, low toxicity, good response to therapy and low anxiety and depression had better mean Global Health and Global QoL scores. The third approach has been focused on the feasibility of an integrated psychological approach in clinical practice whereby the psychooncologist had an active role in the health care team and routinely utilized psychological approach to improve QoL. After 18 weeks a significant improvement of adaptation and awareness, decrease in anxiety, increase of patients who positively experienced the impact of chronotherapy on QOL, anxiety, depression, interpersonal relationships, free-time were observed, a majority of patients positively experiencing this modality during the whole treatment. Symposium Cancer Survivorship and Theory: Multidisciplinary Approaches to Research

140 Cancer Survivorship: Theoretical Perspectives from Nursing Bauer-Wu S Dana-Farber Cancer Institute, Boston, MA, USA The nursing lens of cancer survivorship incorporates a holistic perspective, which views it as a multi-faceted experience with effects on well-being in its many dimensions: physical, psychological, social, spiritual, and functional. Equally important and relevant concepts that have been welldeveloped by nurse scholars are uncertainty in chronic illness, adaptation to illness, and coping and health within the context of culture and environment. Four different nurse-generated theories and frameworks will be highlighted in this presentation. (1) Quality of life in cancer survivors, conceptualized by Ferrell, Dow et al., describes the multi-dimensionality of quality of life and takes into account late effects of cancer and the importance of the existential and spiritual aspects of survivorship. (2) Mishel’s theory of ‘uncertainty in illness’ addresses significant psychological sequelae of cancer survivors, such as fear of recurrence. (3) The Roy Adaptation Model describes adaptation to illness with a biopsychosocial perspective, through four response modes: physiologic, self-concept, interdependence, and role function. (4) The Culture Care theory by Leininger, a nurse anthropologist, which emerged nearly 30 years ago, highlights cultural and social structures influencing health. This theory

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emphasizes that healthcare/nursing care needs to be culturally congruent, safe, and meaningful to individuals. While each of these theoretical perspectives is helpful in guiding cancer survivorship research and clinical practice, a merging of these perspectives that transcends discipline is needed.

141 The Application of Developmental/Aging Theories to Cancer Survivorship Research Bellizzi K Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA More than 60% of cancer survivors are age 65 or older and 16% of those over 65 have a history of cancer. With the aging population and increase in survival rates, we can expect a significant increase in older cancer survivors over the next few decades. These older adult survivors face the dual challenges of aging and cancer. Two approaches that can be used to help us understand how older cancer survivors adjust to their illness within the context of normative aging are (1) life course developmental theory and (2) selection, optimization and compensation (SOC) framework. The life course theory can be used to address issues such as adaptation to cancer by examining constructs, such as life trajectories, turning points, transitions, linked lives, timing in lives, etc. Understanding these life course constructs can provide insight into between group and within group differences in adaptation to cancer in older adults. SOC is a relatively new framework that has been used to examine successful aging. Its application to cancer control can be useful to the extent that it can explain adaptation to the new cultural world of life with cancer by examining the regulation of three important interdependent components of the model: selection, optimization and compensation. The application of these two theories to cancer control efforts in the aging population will be discussed.

142 The Role of Health Communication Theory in Cancer Treatment and Survival Finney Rutten LJ Division of Cancer Control and Population Sciences, National Cancer Institute/SAIC-Frederick, Bethesda, MD, USA

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PURPOSE: We discuss physician–patient communication relevant to treatment and post-treatment care. The manner in which physicians communicate with their patients is fundamental to the effective delivery of clinical services across the continuum of cancer care. The physician– patient interaction is especially significant within the context of providing care to cancer patients. Cancer patients rely upon their physician for support at the time of diagnosis, and for assistance with treatment decisions, and follow-up care, and during cancer survivorship. Physician communication is also important to patients and their families as they struggle with the challenges of end of life care. METHODS: We review literature describing proposed models of physician–patient interaction and important content goals for this interaction within the context of cancer treatment and survival. We then highlight the significance of the physician communication in the survival context. RESULTS/CONCLUSIONS: Our critique of the current literature emphasizes the need for conceptual refinement and theory-driven hypotheses to examine the underlying mediating and moderating mechanisms by which physicians’ communication influences patient outcomes. Mishel’s theory of ‘uncertainty in illness’, frameworks of personal control, the expectancy-value model, reinforcement expectancy theory, and the ‘Transformation Model of Communication and Health Outcomes’ are discussed as possible frameworks to guide this important area of research.

143 The Application of Psychosocial Theories to Cancer Survivorship Research Jeffery D Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA Cancer survivorship research has burgeoned in the past 30 years as a consequence of the increased prevalence of survivors, and awareness about the long-term psychosocial and physical consequences of cancer and its treatment. The majority of research in cancer survivorship has been framed by psychological theories, such as theories of stress and coping, health beliefs, and cognitive processing. A review of currently funded research in the Office of Cancer Survivorship, National Cancer Institute (US), reveals that there is no

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prevailing theoretical approach, and that a theoretical framework, concept, or theory is occasionally absent in these studies. Common behavioral theories, such as the Health Belief Model and Social Cognitive Theory, will be presented along with more recent conceptual models such as those developed by sociologists Deimling, Bowman and their colleagues to understand family appraisal of the cancer experience, and to examine cancerrelated health worries in an elderly population. The ‘culture broker’ model, used in rehabilitation research and originally conceived to help foreignborn individuals negotiate the health care system, will be presented as an example of a model that has not heretofore been used in survivorship research but holds promise. To promote international collaborative research in cancer survivorship, theoretical models are needed that reflect culture, health care and community environments, social relationships, socioeconomic status, and previous experiences in addition to the more familiar psychological constructs of emotions, cognitions, and behavior. Symposium Cross-cultural Comparison on the Impact of Cancer on the Family

144 Cancer: Intervention Techniques for a Culturally Diverse Population of Caregivers Baider L Department of Clinical Oncology and Radiotherapy, Sharett Institute of Oncology, Jerusalem, Israel Despite the growing evidence of the profound impact of serious, chronic medical illness on the family}and the especially compelling evidence of the role of family and caregiver behavior in shaping the clinical course of medical illness} families and caregivers are often ignored in many medical settings. The most fundamental notion that has changed is the recognition that cancer is an emotional crisis for the entire family unit. This has led to the concept and practice of emotional support and psychological intervention being offered for all the family members and caregivers. There are significant correlations between the psychological distress of patients and spouses in both genders, supporting the finding of many studies that there is indeed a relationship between the psychological distress of the partners. Do spouses constitute a support system or are they in

Copyright # 2006 John Wiley & Sons, Ltd.

fact a ‘distress’ system? Does spouse support influence the patient’s level of coping with cancer disease? Would improvement in the psychological condition of one partner be transmitted to the other partner? Whatever the reasons for the psychological distress experienced by the partner, the implication seems clear. Spouses/partners cannot be considered automatically as the natural support for cancer patients. They may, in fact, be unable to provide support, because they themselves need to receive support and psychological guidance. The presentation will provide a glimpse into various therapeutic interventions, along with behavioral and educational skills, directed at partners, families and caregivers in Israel from culturally diverse backgrounds including the Arab, Russian and Orthodox Jewish populations.

145 Who Cares for the Caregiver in the Advanced Cancer Setting? The Role of Emotional Support Burns C Cancer Psychosocial Services, Australian Capitol Territory Department of Health, Canberra City, Australia Estimates of Australian family caregiving prevalence range from 120 to 170 households per thousand with around 50 per thousand intensely so at any one time. A Canberra study of advanced cancer patients found 71% of caregivers were spouses, 17% were adult daughters, 8% either relatives or friends and 4% were parents. Nonspouse caregivers were significantly more likely to be young (36% under 40) and female (89%) when compared with spouses of patients. Far fewer of the non-spousal group was married (56%). Caregiving could be intensive, with one-third of spouses reporting they contributed more than 100 hours per week. Adult children of both sexes provided high levels of secondary support; nonspouses relied upon their brothers. Only 16% indicated no family support. Health consequences as measured by scores from the SF36 were markedly different compared with a weighted population sample from Canberra and deteriorated over time. Gender, age and place of birth were significant predictors. Unmarried caregivers reported strikingly low scores on the role emotional scale of the SF36. Overall, 91% of caregivers reported they could share their feelings with someone but over time gender differences

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emerged with male caregivers (84%) less likely to share their feelings with someone while all female caregivers (100%) identified they had emotional support. Analysis identifies a mosaic pattern of support}family and friends were the most important source but only half of the partners agreed they could share their feelings with each other. The health team was far less emotionally supportive when compared with patient reports.

146 Quality of Life of Caregivers: American Cancer Society’s Studies Kim Y Behavioral Research Center, Atlanta, USA Currently, over 10 million Americans are cancer survivors, and this number is estimated to double by 2030 as the population ages and as more of those diagnosed with cancer survive as a result of advances in medicine and better cancer prevention practices. Each cancer survivor represents a family who must also adjust to the individual’s cancer, yet what we know about the impact of cancer on family caregivers remains limited. The American Cancer Society’s Quality of Life Survey for Caregivers has been developed to examine the quality of life (QOL) of family caregivers of cancer survivors and to identify the demographic, psychosocial, and physical predictors of caregivers’ QOL and unmet needs. A total of 1635 caregivers completed the baseline survey. The results identify gender as playing a significant role in how family members perceive their caregiver role, which in turn affects their QOL. Husband caregivers appear to benefit from their caregiver role, whereas adult daughters suffer from the role. Younger caregivers have more difficulty in meeting their needs in various aspects. In addition, caregivers endorse different caregiving motives depending on their relationship quality with the survivor, which also relate to the extent to which caregivers find benefit from their caregiving experience, are satisfied with life, and report depressive symptoms. These findings suggest family caregivers will benefit from programs to improve their QOL that are targeted for particular groups of caregivers demographically and by differences in relationship quality. Symposium Cancer in Women: Personality Correlates and Coping

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147 Personality Correlates of Breast Cancer Patients Kreitler Sa, Kreitler MMa, Barak Nb, Inbar Mb a Psychooncology Unit, Tel-Aviv Sourasky Medical Center, Ichilov Hospital, Tel-Aviv, Israel; b Oncology Institute, Tel-Aviv Sourasky Medical Center, Ichilov Hospital, Tel-Aviv, Israel PURPOSE: Previous studies failed to provide reliable information about personality correlates of cancer patients mainly because of the inadequacy of the studied characteristics. The goal was to examine whether a coherent set of personality tendencies grounded in a comprehensive theory of behavior}the cognitive orientation (CO) theory of health behavior and wellness}can be identified in breast cancer patients. METHODS: The participants were 200 breast cancer patients in different disease stages, in the age range of 31–75 years and disease duration from 3 months to 15 years and 200 healthy controls matched in demographic characteristics. They were administered individually a questionnaire of background information and the CO questionnaire of breast cancer (with pretested reliability and validity) including beliefs referring to goals, oneself, norms and reality, assessing personality dispositions identified in pretests as relevant for breast cancer. RESULTS: The patients and controls differed significantly in most personality dispositions, and in beliefs of all four types. Discriminant analyses showed that the main psychological tendencies of the patients included concern with controlling oneself and others, dependence on the evaluations of others, emotional blocking, and conflicts, for example, in regard to self identity and giving to others. The relation of these tendencies to demographic and medical characteristics (e.g. disease stages, tumor grades, receptors) was examined. CONCLUSIONS: There exists a clear-cut, comprehensive and relevant set of psychological correlates of breast cancer patients that has not been identified previously and could serve as basis for future psychological interventions accompanying medical treatments.

148 The Cognitive Orientation of Cervical Cancer Kreitler MMa, Kreitler Sa, Inbar Mb a Psychooncology Unit, Tel-Aviv Sourasky Medical Center, Ichilov Hospital, Tel-Aviv, Israel; bOncology

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Institute, Tel-Aviv Sourasky Medical Center, Ichilov Hospital, Tel-Aviv, Israel PURPOSE: The goal was to examine whether a coherent pattern of personality variables grounded in the cognitive orientation (CO) theory of health behavior and wellness can be identified in women diagnosed with cervical cancer. The CO theory was selected because it provides an empirically sound and theoretically comprehensive framework for examining psychological correlates of cancer diseases. METHODS: The participants were 26 women (31–72 years old), diagnosed with cervical cancer in different disease stages, and disease duration 3 months to 6 years, and 30 healthy controls matched in demographic characteristics. They were administered individually a questionnaire of background information and the CO questionnaire of cervical cancer (with pretested reliability and validity) including beliefs referring to goals, oneself, norms and reality, assessing personality dispositions identified in pretests, conducted according to the standard CO methodology, as relevant for cervical cancer. RESULTS: Patients and controls did not differ in demographic variables but differed significantly in most variables grounded in the CO theory: beliefs of the four types, and the themes representing the contents. Discriminant analyses showed that the main tendencies differentiating between the groups included realism, striving for independence coupled with needs for help and support, avoidance of sharing and insistence on justice. The relation of these tendencies to demographic and medical characteristics was examined. CONCLUSIONS: There exists a clear-cut set of psychological correlates of cervical cancer that differs from those identified so far in other cancer types in women. The detected pattern could serve as basis for future adjuvant psychological interventions.

149 The Cognitive Orientation of Cancer of the Ovaries Kreitler Sa, Kreitler MMa, Weissler Kb, Safra Tc a Psychooncology Unit, Tel-Aviv Sourasky Medical Center, Ichilov Hospital, Tel-Aviv, Israel; bK. Weissler, Habrosh – Halfway Houses Association, Netanya, Israel; cOncology Institute, Tel-Aviv Sourasky Medical Center, Ichilov Hospital, Tel-Aviv, Israel PURPOSE: The goal was to explore personality correlates of ovarian cancer by means of the

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cognitive orientation (CO) theory. This approach was selected because prior research demonstrated its usefulness in identifying personality tendencies characteristic for specific disorders and relevant for eventually helping patients suffering from these disorders. The study reports the first steps in constructing a CO questionnaire of ovarian cancer. METHOD: There was a pre-test sample of 14 women with ovarian cancer, and additional samples of 25 women with ovarian cancer and 20 healthy women matched in age and education as controls. The age range was 39–54, and the mean number of education years 14.3. The pretest participants were interviewed individually according to the standard instructions of the CO theory for identifying characteristic themes for the disease. The 10 identified themes were used for constructing a CO questionnaire, which included statements to which the participants had to respond in terms of four belief types (about oneself, goals, norms and reality). RESULTS: The women with ovarian cancer did not differ from the controls in age or education, but differed significantly from them in three of the four belief types and in 7 of the 10 themes, and scored higher on tendencies for controlling others, pleasing others and serving others. CONCLUSIONS: The findings indicate that there is a set of psychological characteristics of ovarian cancer, identified in terms of the CO theory that justifies a further large-scale study designed to construct a CO questionnaire of ovarian cancer.

150 Personality Correlates of Colon Cancer Patients: Does Gender Matter? Kreitler Sa, Kreitler MMa, Mivtach Rb, Figer Ac a Psychooncology Unit, Tel-Aviv Sourasky Medical Center, Ichilov Hospital, Tel-Aviv, Israel; bRon Institute, Psychotherapy Center, D. N. Emek Hayarden, Kvutzat Kineret, Israel; cOncology Institute, Tel-Aviv Sourasky Medical Center, Ichilov Hospital, Tel-Aviv, Israel PURPOSE: A previous study done in the framework of the cognitive orientation theory showed that there is a coherent set of psychological tendencies characterizing colon cancer patients as distinguished from healthy controls (1). The goal of the present study was to examine whether the identified psychological tendencies differ for men and women. METHOD: The participants were

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126 women and 101 men diagnosed with colon cancer 4 months to 11 years earlier. They were administered individually a questionnaire providing demographic and medical information, and the cognitive orientation (CO) questionnaire of colon cancer assessing personality correlates characteristic for colon cancer patients. RESULTS: Comparisons of the groups of men and women showed no significant differences in the demographic and medical characteristics. They were then compared in terms of eight factors that resulted from a factor analysis of the items of the CO questionnaire and matched those that resulted in a previous study (1). The findings showed that women scored significantly higher in three factors (keeping harmony in the environment; fulfilling duties; pleasing others) and lower on three factors (suppressing anger; being tough to oneself; fighting injustice). CONCLUSIONS: The findings indicate that the psychological profile of women with colon cancer differs in several respects from that of men. Regardless of their social or biological origin, the differences indicate the necessity of considering the particular aspects of gender in coping with cancer.

pleted a baseline assessment before a routine, annual TVS screening test (ROUTINE group). Both groups completed a follow-up assessment 1 month after baseline. RESULTS: Repeated measures GROUP  TIME ANOVA’S indicated significant GROUP main effects for IES-Intrusion (p50.001) and IES-Avoidance (p50.001) scores, OC-related monitoring (p50.001) and blunting behavior (p50.05), and perceptions of personal risk for OC (p50.05). Relative to the ROUTINE group, women in the ABNORMAL group reported greater OC-specific distress, engaged in more monitoring and blunting behaviors related to OC and OC screening, and perceived themselves as at greater lifetime risk for OC. At 1 month follow-up, t-test analyses indicated the ABNORMAL group reported less feelings of reassurance (p50.001) and well-being (p50.05) following their recent OC screening experience. CONCLUSIONS: Receipt of an abnormal, yet ultimately benign, test result during routine cancer screening can be a significant stressor and can impact affective, cognitive, and behavioral endpoints, with potential implications for future screening behavior.

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151 Affective, Cognitive, and Behavioral Response to an Abnormal Ovarian Cancer Screening Test Result: A Longitudinal Case Control Study Andrykowski Ma, Pavlik EJb a Department of Behavioral Science, University of Kentucky, College of Medicine, Lexington, KY, USA; bObstetrics and Gynecology, University of Kentucky, College of Medicine, Lexington, KY, USA PURPOSE: To identify the affective, cognitive, and behavioral impact of receipt of an abnormal, yet ultimately benign, test result in the course of routine screening for ovarian cancer (OC). METHODS: 164 asymptomatic women completed a baseline assessment immediately prior to a repeat transvaginal sonography (TVS) screening test intended to clarify an abnormal TVS result received 2–16 weeks earlier during routine OC screening (ABNORMAL group). 164 women, matched on age and screening history (# prior TVS tests, prior Hx of abnormal result), com-

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Patterns of Fatigue in Ovarian Cancer Patients Receiving Chemotherapy Basen-Engquist Ka, De Moor Cb a The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA; bChildren’s Hospital Boston, Boston, MA, USA PURPOSE: The goal of this study was to use real time assessment to identify patterns of fatigue during the chemotherapy cycle, to determine if ovarian cancer patients could be grouped based on fatigue pattern, and to explore whether the fatigue subgroups differed in their symptom profiles. METHOD: 33 women receiving chemotherapy for advanced ovarian cancer used handheld computers to record fatigue and other symptoms several times a day throughout a chemotherapy cycle. Changes in fatigue were modeled separately for each patient using linear regression with days from chemotherapy administration as the independent variable; hierarchical cluster analysis of the slopes and intercepts was conducted to identify groups. Differences between the groups were analyzed using a mixed model analysis. RESULTS: Three fatigue patterns were identified:

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(1) temporary, small rise in fatigue the week after chemotherapy administration, followed low levels for the remainder of the cycle; (2) a large increase in fatigue peaking 3 days after chemotherapy administration, then decreasing throughout the rest of the cycle; (3) high levels of fatigue throughout the chemotherapy cycle. There were significant differences among the clusters in pain, trouble concentrating, sleep quality, and positive mood, but not nausea or number of night awakenings. Cluster 3 generally reported the worst symptoms. CONCLUSIONS: These results indicate that there is a subgroup of patients for whom fatigue is a continuous problem. Research is needed to focus on the identification of patients who are risk for high fatigue so that early intervention, including aggressive symptom management, can be implemented.

153 Decision Types Regarding Prophylactic Oophorectomy Among Women Seeking Brca1/2 Testing Hurley K, Rubin L, Jhanwar S, Wedderburn W, Balistreri L Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA PURPOSE: To investigate the impact of decision types about prophylactic oophorectomy (PO) on risk perceptions, risk-related distress, and PO intentions among women seeking genetic counseling and testing for BRCA1/2 mutations. METHOD: 67 women (age X=50.2, SD ¼ 12:5; 88% Caucasian) were interviewed prior to genetic counseling and BRCA1/2 testing to assess: perceived risk of ovarian cancer, intrusive ideation (IES), avoidance (IES), and PO intentions. RESULTS: Cluster analysis on pros/cons of PO yielded four decision types: Disengaged (low on all pros/cons) ðN ¼ 10Þ; Ambivalent (high on most pros/cons) ðN ¼ 16Þ; Risk-Focused (high on risk reduction pros; low on all other pros/cons) ðN ¼ 23Þ; and Physician-Guided (like Risk-Focused group, but expressing significantly higher ratings of importance of physician recommendation in choosing PO ðN ¼ 18Þ: Physician-Guided types reported the highest levels of avoidance when compared with other decision types and were significantly more avoidant than Disengaged types ðp ¼ 0:02Þ: Ambivalent types demonstrated a nonsignificant trend towards higher intrusive ideation. Ambivalent types reported the greatest perceived

Copyright # 2006 John Wiley & Sons, Ltd.

risk for ovarian cancer; both Ambivalent and Risk-Focused types reported significantly greater perceived risk than Disengaged types ðp ¼ 0:01Þ: Disengaged types were significantly different in their intentions to undergo PO than other decisions types (p50.01). CONCLUSION: Results suggest that at-risk individuals can be meaningfully categorized into decision types with similar levels of intention to undergo PO but for different reasons. Findings replicate previous cluster structure found in similar at-risk sample.

154 Coping and Communication Skills versus Supportive therapy for Women Diagnosed with Gynecologic Cancer Manne Sa, Rubin Sb, Rosenblum Nc, Edelson Ma, Winkel Gd a Population Science Fox Chase Cancer Center, Philadelphia, USA; bGynecology, University of Pennsylvania, Philadelphia, USA; cGynecology Thomas Jefferson University, Philadelphia, USA; d Psychology City University of New York, New York, USA PURPOSE: Women diagnosed with gynecological cancer undergo an aggressive surgical and chemotherapy regimen with an uncertain outcome. The purpose of this study was to compare the efficacy of two psychological interventions, supportive counseling (SC) and coping and communication skills therapy (CCST), in reducing psychological distress among women diagnosed with gynecological cancer. Emotional expressiveness was evaluated as a treatment moderator. 353 participants were randomly assigned to six sessions of SC, CCST or Usual Care (UC). METHODS: Women received six individual sessions and one booster session one month after the sixth session. Participants receive post-test surveys 3, 6 and 9 months post-baseline. RESULTS: Results of intent-to-treat growth curve modeling indicated a significant Group X Time treatment effect (Fð2; 561Þ ¼ 3:4; p ¼ 0:03) for BDI. There were no group differences at baseline and 3 months post-test, but there was a marginally significant effect at 6 months for both CCST when compared with UC at six months and a significant effect for CCST compared with UC at nine months. There was a marginally significant effect for SC vs UC at nine months. Tests for a moderating effect for positive emotional expressiveness indicated that SC was significantly more

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effective among patients high in positive emotional expression. Expressiveness did not moderate the effects of CCST. CONCLUSIONS: CCST had a significant impact on depressive symptoms nine months after intervention completion and SC had marginally significant impact on depressive symptoms. SC was significantly more effective among women who were more easily able to express positive emotions. Symposium Developing and sustaining a PsychoSocial Oncology Program: Lessons Learned

155 Psychosocial Oncology at a Comprehensive Cancer Center Graci G Department of Psycho-Social Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Chicago, IL, USA The field of Psychosocial Oncology (PSO) is burgeoning, due largely in part from an increase in awareness regarding controlling symptom management issues and concerns related to psychosocial functioning in cancer patients. While there is a documented need for these services, there are numerous challenges that psychosocial oncology professionals must encounter while attempting to develop and maintain a self-supporting PSO program/department. This presentation will address how to build an outpatient PSO department and effectively manage and support it. Our program at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL focuses on evaluating and treating the social, emotional, physical, functional, and practical aspects of cancer from prevention to cancer survivorship to the end of life. This program involves a multidisciplinary team consisting of physicians, clinical psychologists, social workers, nutritionists, and clinical nurse specialists who are committed to enhancing and preserving patients’ quality of life, access to care, and treatment of symptoms related to cancer. This presentation will discuss the major obstacles to overcome to succeed in maintaining a successful program. A major challenge to overcome has been billing, generating, and collecting revenue for services. Applying for community, state, federal and private funding has become a priority and necessity in maintaining this type of program. Education to our oncologists and other healthcare professionals regarding the

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positive impact PSO care has on patients’ wellbeing is fundamental. Physicians will spend less time treating the emotional needs of cancer patients and addressing non-compliance issues when PSO services are available.

156 Developing an Integrative Psychosocial Oncology Program in a Phase I Clinical Center Marcus J Department of Psychosocial-Oncology, Cancer Therapy & Research Center, S. Antonio, TX, USA Patients with cancer that is refractory to standard therapy, or for whom there is no standard treatment, often find themselves at a crossroad dealing with a wide variety of psycho-social, financial, and physical issues. If their performance status permits, the possibility of entering into experimental treatment in a Phase I clinical trial presents unique challenges as well as opportunities for integrating a holistic approach to realistic psycho-social oncology care. An integrative, multidisciplinary psycho-social oncology team in a Phase I Clinic is an excellent vehicle for helping cancer patients and their loved ones navigate the difficult course of informed consent, treatment concerns, symptom management and changes in family dynamics. The psycho-social oncology team addresses potential risks and realistic expectations of Phase I trials, symptoms associated with disease progression and/or treatment, and psychosocial concerns that arise during research enrollment. Using a triage model within the structural confines of the Phase I Trial center, an initial need’s assessment can be cost-effectively completed by an Advanced Oncology Nurse Practitioner, who then identifies and refers issues to appropriate disciplines within the team. The Psycho-Oncologist monitors the psychosocial adaptations to disease and treatment burden on the patient and family. An integrative multidisciplinary psycho-social oncology team can improve the quality of holistic psychological and physical care for patients in Phase I clinical trials, thereby reducing the physiological and emotional burden that cancer patients inevitably face.

157 Doing Small Things with Great Love: Psychosocial Oncology in Private Practice Wade-Walsh M

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Department of Psycho-Oncology, Northwest Medical Specialties, Tacoma, WA, USA Discussion will cover challenges and successes of a psychosocial oncology service in both a private psychotherapy practice and in a private outpatient oncology clinic. We will discuss educating healthcare providers about psychosocial oncology, research challenges, reimbursement, multidisciplinary relationships, and how the joy of helping people find peace and hope makes it all worth it. Health professionals’ understanding of the work of a psychosocial oncologist directly relates to their ability to refer, and to their confidence in the benefits to the patients. Dr Walsh will offer several suggestions for educating oncology doctors and nurses about the nature and value of our work. Most research at our clinic is developed and sponsored by pharmaceutical companies. So, our research department is primarily set up for data collection, and we do not have staff for research design, grant writing, or data analysis. Despite these limitations, there are still possibilities for psychosocial research. Concerning reimbursement for psychosocial services, we will discuss diagnosis and billing codes, getting insurance contracts, and some of the trade-offs between insurance reimbursement, private pay, and sliding scale fees. Psychosocial oncology is inherently multidisciplinary by nature. However, cultivating multidisciplinary relationships of cooperation and respect among health care providers can be quite challenging. On this issue, we offer hope and practical solutions. Lastly, Dr Walsh will share a few simple, yet powerful examples of how doing this work even on a small scale can bring great rewards for both patient and therapist. Symposium Integrative Supportive Care: Symptom Management

158 Management of Sleep Disorders Graci G Department of Psycho-Social Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Chicago, IL, USA Insomnia is the most common sleep disorder reported by cancer patients. Oncologists have noticed that alterations in sleep patterns are endemic among their patients, yet sleep problems are rarely assessed in a typical patient evaluation.

Copyright # 2006 John Wiley & Sons, Ltd.

Other concerns, such as morbidity and mortality, appear to take precedence. The cause of chronic sleep difficulties is multifaceted and up until recently, little attention has been given to the potential factors associated with the pathogenesis of cancer-related insomnia. The unique contributions of psychological, medical, treatment side effects, environmental, behavioral, and pharmaceutical pathways on cancer-related insomnia cannot be ignored. This primary objective of this symposium is to educate health care professionals about the etiology and risk factors for disturbed sleep and how to evaluate and manage cancerrelated sleep disorders, specifically cancer-related insomnia. Psychological, behavioral and pharmacological approaches to the management of sleep disturbance will also be reviewed. Nurses, physicians, and other healthcare providers are in a unique position to greatly improve the quality of sleep in cancer patients. The overarching objective of treating sleep difficulties is to improve daily functioning and increase quality of life ratings. Cancer patients face many challenges; sleep problems do not have to be one of the necessary consequences associated with the cancer experience.

159 No More Sleepless Nights Graci G Department of Psycho-Social Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Chicago, IL, USA When patients are diagnosed with cancer, they enter a new and frightening realm of experience. This change in status, and the diagnostic and treatment protocols are accompanied by many symptoms, including alterations in sleep patterns. Sleep disturbance is three times more common among cancer patients and may be chronic in the form of hypersomnia or insomnia. The primary objective of this presentation is to educate health care professionals about the etiology and risk factors for disturbed sleep and how to evaluate and manage cancer-related sleep disorders. Psychological, behavioral and pharmacological approaches to the management of sleep disturbance will also be reviewed. The overarching objective of treating sleep difficulties is to improve daily functioning and increase quality of life ratings. Evaluation of sleep disturbance is seriously neglected by health care professionals and

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questions regarding sleep functioning must be implemented in our clinic practice. Cancer patients face many challenges; sleep problems do not have to be one of the necessary consequences associated with the cancer experience.

160 The Role of Cognitive Behavior Therapy in Symptom Management Hardie J Department of Psycho-Social Oncology, Robert H. Lurie Comprehensive Cancer Center, S. Antonio, TX, USA Symptoms and diagnoses of depression and anxiety are prevalent in a cancer population. Rarely are patients questioned about emotional functioning during clinical visits. Yet, depression and anxiety can interfere with, but are not limited to treatment compliance, immune functioning, and negatively influence sleep functioning and quality of life ratings. Clinical criteria for both depression and anxiety diagnoses can often mimic side effects of treatment. For example, fatigue, sleep disturbance, anhedonia, loss of appetite, etc. This presentation focuses on how to utilize cognitive behavioral therapy techniques in a cancer patient population. Cognitive therapy (CT) is premised on the notion that how one thinks largely determines how one feels and behaves. Cognitive and behavioral methods are used to challenge and modify dysfunctional thoughts and beliefs. This therapy is a ‘collaborative process of empirical investigation, reality testing, and problem-solving between therapist and patient. The patient’s maladaptive interpretations and conclusions are treated as testable hypotheses.’ Challenging and changing negative and distressful thoughts can be a very positive and much needed therapeutic alliance for cancer patients.

brief series of interventions aimed at addressing primary supportive issues will be offered. Physical issues of pain management, dyspnea and insomnia will be addressed. The application of self-hypnosis techniques will be highlighted with emphasis on controlling the subjective interpretation of pain. The ability of hypnosis to impact the patient’s ability to calm their fears and anxieties will be discussed; referencing pertinent literature. Particular attention will be placed on the value of hypnosis in enabling an individual to access inner capacities for creating psychological quiescence and physical comfort. For a suffering cancer patient, relief that comes from within can provide a much-needed experience of personal efficacy and strength.

162 Integrative Psychopharmacology for Symptom Management Passik SD Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, USA Dr Passik will address the role of pharmacotherapy in the treatment of anxiety, depression and other symptoms in cancer patients. The use of anxiolytics, anti-depressants and neuroleptics for psychological and physical symptoms will be discussed; referencing the empirical and clinical literature. Particular focus will be on the principles guiding antidepressant selection based on the ‘side effect minimization’ vs ‘side effect mobilization’ approach. Clinical trials of antidepressants will be reviewed. Novel approaches to pharamacotherapy and strategies for combining drug and psychosocial interventions will be highlighted. Finally, early intervention and prophylactic approaches to symptom management will be addressed.

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Symposium Pediatric Psycho-Oncology

Hypnotic Interventions in Supportive Cancer Care Marcus J Cancer Therapy & Research Center, S. Antonio, TX, USA

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Dr Marcus will address the role of hypnotic interventions for supportive care for cancer patients. The use of hypnosis can impact the patient and the family on many levels. Hypnosis is offered to the patients in conjunction with traditional supportive care. A description of a

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The Meaning of Resiliency in Long Term Survivors From Childhood Cancer Through Their Narratives Spinetta JJ Department of Psychology, San Diego State University, San Diego, CA, USA Can the fact of having had cancer in one’s childhood actually be helpful rather than harmful for the survivors’ growth into adulthood? Is it

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possible that our long-term survivors might be better adapted and adjusted than their peers, and better prepared to face adult challenges? Is there a point in our dealings with the survivors of teenage cancer, as pediatric health care professionals and parents, when we can help them shift from their view of cancer as a disease for which they have been successfully treated, to viewing the cancer as an opportunity for life-sustaining growth and learning? The long-term survivors themselves will formulate their responses to these questions through personal narratives submitted to the Psychosocial Committee of the International Society of Pediatric Oncology (SIOP). Survivors from all over the world are submitting a summary in a narrative form of how they as young adults view themselves after their childhood cancer experience, and what relevance that past experience has had on their current functioning. The narratives will be an expression of the long-term survivors’ feelings and views in approaching adult life in terms of schooling, professional life, family life, and social relationships after the cancer. The presentation will be a summary and overview of the narratives, leading to suggestions on what our role might be as pediatric health care professionals and parents in helping the survivors move toward that positive vision and growth.

164 How To Help Parents and Children Tell Doctors Their Problems: The Role of Narrative Based Medicine Caprino Da, Massimo LMa, Wiley TJb a Pediatric Hematology and Oncology, Istituto Giannina Gaslini, Genoa, Italy; bScientific Direction Istituto Giannina Gaslini, Genoa, Italy Appropriate patient management increasingly requires physicians to complement their clinical skills with approaches that consider the individual’s personal coping with the disease. Helpful to the building of the relationships among patients, their families and health care givers that underlie these approaches are the notions of narrativebased medicine. The study of narrative provides a framework for a holistic approach to the patient’s problems allowing an understanding of the illness context that is difficult to achieve by other means. We report the experiences of four adults who had only recently learned that they had been childhood cancer patients. These cases provide telling

Copyright # 2006 John Wiley & Sons, Ltd.

examples of situations that might have been averted if reflective communication and exchange, i.e. key concepts of the narrative-based approach, had been used among the patient, family and caregivers during the original illness. Our findings uphold the introduction of principles of narrative medicine, in addition to communication skills, relational aspects, and ethics, into pediatric practice, particularly in those specialties faced with high risk patients.

165 Adolescents and Cancer: Discrepancies in Appearance and Insight Massimo La, Caprino Da, Wiley TJb a Pediatric Hematology and Oncology Istituto Giannina Gaslini, Genoa, Italy; bScientific Direction Istituto Giannina Gaslini, Genoa, Italy We present the analysis of three short stories, originally collected for our hospital’s journal, written by three very positive-minded girls suffering from cancer. Writings emerging from these settings have proven both significant and indicative of the patient’s perception of the disease and the associated hopes and fears. The three adolescents seemed to have achieved adjustment, good control, confidence in hospital staff, and were optimistic about the future. By contrast, their stories reveal their fears and their need for learning how to cope with the disease, and in this context the process of writing might be regarded as therapeutic. Adolescent patients need both information about their condition and the time and space to elaborate their reactions and emotions. Stories can provide valuable keys that allow us to know whether or not errors in understanding are a cause of distress, whether he or she feels alone and whether an atmosphere filled with love, security, hope, honesty needs to be created and nurtured.

166 When A Child Dies Jankovic M Department of Paediatrics, University of MilanBicocca, San Gerardo Hospital, Monza, Italy ‘What really matters in life/not so much being able to/it. What really counts/being able to ‘embrace’/ moment when it finishes’ (Veronica, 13 yrs) Who is a terminally ill child? He is not dying, he is a child arrived to a phase of life where death is

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close and cure is no longer possible. This phase could last months. He doesn’t need either ‘therapeutical renouncing’ or ‘ruthless obstinacy’ approach. It is not easy to properly consider both sentences (Veronica’s poem and the terminally ill child’s definition) but it is essential for building up the most appropriate modality to assist a child and the family in the palliative and terminal phase until death. The main purpose remains the control of both physical and psychic pain and discomfort and to turn any experience into solidarity. Data about our activity in Monza will be presented in detail. We absolutely should take into account that assisting a terminally ill child is a ‘process’ where discontinuity of a ‘curative’ treatment of any other type of treatment leads to nonimmediate acceptance by family and therefore a palliative therapy is needed. Only ‘giving something’ the beginning of the acceptance phase on respect of the quality of life of the child could start. Time, accompanying, devotion are essential steps, strictly tightened, in this process. How we can accomplish? (1) listening to the child; (2) not forgetting the siblings; (3) accompanying the parents; (4) involving the family doctor or paediatrician; (5) understanding the Society who try to help them. It is really true that the dying child is able to remain close to us for encouraging our fight against cancer. Symposium Space, Light, Colors: Architectural Environment and Quality of Life in Cancer Patients

167 The Influence of an Artistic Ward Design on the Wellbeing of Cancer Patients at the Division of Oncology at the Medical University of Graz Andritsch E, Dietmaier G, Bauernhofer T, Samonigg H Department of Internal Medicine, Division of Oncology, Medical University of Graz, Austria The purpose of this study is to evaluate the question ‘does the artistic redesign of an oncological ward have an influence on the well-being of cancer patients?’ Therefore, a total of 261 patients were assessed pre- and post-reconstruction of the oncological ward of the Medical University Clinic in Graz by Friedensreich Hundertwasser (93 patients before, 81 patients immediately after and 87 patients ten years after the redesign) to describe the influence of depression (Zerrsen Depression Scale, PD-S), quality of

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life (Spitzer Index), and perceptions of the ward design (semi-structured interview) on well-being (Zerrsen Mood Scale, Bf-S). A factor analysis of the semi-structured interview yielded four factors further assessed with a MANOVA showing that patients interviewed post redesign reported more positive effects of the ward design (F2;227 ¼ 384:274; p50.001). In addition, they were more content with treatment and medical care (F2;227 ¼ 20:103; p50.001), more positive in their emotions and thoughts regarding illness (F2;227 ¼ 8:600; p50.001) and placed greater importance on the fixtures (F2;227 ¼ 6:067; p ¼ 0:003) than patients interviewed before the redesign. In a regression analysis depression, the impact of ward design, quality of life, gender, emotions and thoughts regarding illness, age and education predicted well-being with an R2 of 0.469; p ¼ 0:050: These results indicate possibly that the physical surrounding, in which patients are treated, are among other aspects important factors for patients and that not only depression and quality of life influence the well-being of the patients.

168 Health Benefits of Healing Environment Del Nord R Faculty of Architecture, University of Florence, Italy In this lecture a review of evidence for benefits of nature, daylight, fresh air, and quiet in healthcare settings and the impact of new technology on the planning of healthcare facilities will be presented.

169 An Artist, an Oncologist, a Patient}a Dialogue Heller Aa, Bauernhofer Tb,, N.Nc a Artist, Vienna; bDepartment of Internal Medicine, Division of Oncology, Medical University of Graz, Austria; cPatient In this special dialogue, different aspects concerning the needs of cancer patients will be highlighted and the essential elements of care possibly affecting the physical, emotional and social wellbeing and the healing process will be discussed. The main focus will be on the influence of the environment in which patients and their families are living and in which they are treated. What are the different and shared points of view of an artist,

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an oncologist and in particular of a patient diagnosed with cancer? Which inputs will we get for our daily work in the bio- psycho-social care of our cancer patients and for ourselves as professionals and as human beings?

170 Space Light, Colours. Architectural Environment and Quality of Life in Cancer Patients Samonigg H Department of Internal Medicine, Division of Oncology, Medical University of Graz, Austria Best medical treatment for cancer patients is the basic requirement in oncology. As it is known, that the diagnosis of cancer means for the affected patients a life threatening situation, the surrounding, in which patients are treated, is a possibly potential factor in the healing-process and has to be considered in an holistic, patient centered treatment. It can be hypothesized that these patients are influenced at least in part by the design of the ‘healing space’ and its effect on the relation of hospital environment and personal perception of health. The idea to redesign the ward of the Division of Clinical Oncology at the Department of Internal Medicine of the Medical University of Graz, Austria is based on the hypothesis, that an artistic design created by F. Hundertwasser improves the well-being and the quality of life of inpatients. The design of this ward should symbolize for patients in a life threatening situation, that there is still spiritedness. A comment of a patient about the new designed ward was ‘to come here is like coming home and it makes it easier to endure all the burden of my cancer and it gives hope to me’ is representative for our aim of the artistic redesigning of the ward. Symposium Breast Cancer and Women Workers Protection (supported by Europa Donna)

171 Life, Feelings, Work After Mastectomy: The Results of a Social Research on Italian Women After Breast Cancer Finzi E Astra Ricerche, Milan, Italy This research presents the results of a wide research on women’s life-experiences after mas-

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tectomy; it was realized with the co-operation of some of the most important medical oncology centres. The study, based on strictly anonymous, self-filled questionnaires, considers women’s condition after mastectomy under various aspects: family, social relationships, work, leisure activities. The study is not focused on diagnosis, therapies, etc. but on operation’s psychological and social after-effects. It is probably the first study of its kind which has been conducted on a wide scale in Europe.

172 Medical Rehabilitation of Breast Cancer Patients in Germany: Conditions and Predictors of Return to Work Koch U, Mehnert A Institute of Medical Psychology, HamburgEppendorf University Medical Center, Hamburg, Germany PURPOSE: The presentation reports results of a current study that was initiated in 2004 and was commissioned by a large German financer of the rehabilitation of cancer patients in Germany (Arbeitsgemeinschaft fu¨r Krebsbeka¨mpfung Nordrhein-Westfalen). The identification of psychosocial and medical factors associated with patients’ ability to return to work is becoming an important research field with regard to social reintegration of patients. The objective of this study is to examine the process of returning to work and to analyse predictors for occupational reintegration. METHODS: 750 breast cancer patients principally capable of work were asked to complete pre- and post-rehabilitation as well as one year follow-up validated measures of distress, mental and physical health, psychological, medical as well as socio-economical and occupational variables (77% participation rate). RESULTS: Sixty-nine percent of participants returned to work within the first year following cancer rehabilitation. Those patients were younger, had a higher educational level and a higher net income. Differences in stage of breast cancer were not found. Patients who did not manage to return to work had more medical complications and hospital stays, had higher levels of pain, anxiety and depression, took more analgesics, barbiturates and psychotropic drugs and used more often psychosocial counseling. However, strong predictors for occupational reintegration were a positive

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appraisal of the resumption of work and one’s subjective ability to work. CONCLUSION: The results help to understand the different reasons why patients do not return to work and to provide suggestions for occupational and psychosocial interventions. Some health policy related aspects are discussed.

173 Psychological Aspects and Social Support Once Back To Work After Breast Cancer Scaffidi E Psycho-Oncology Unit, European Institute of Oncology, Milan, Italy Returning to work can be perceived by the woman who has had breast cancer both as a great opportunity and, on the other hand, as an unbearable obligation which is not possible to overcome. The lecture will give an overview of the different conditions to be faced by women who have had breast cancer when they decide to come back to work. Also to be taken into consideration, are some of the different variables which are able to influence a woman’s perception of this critical moment and which greatly influence her physical, psychological and social recovery. The analysis of her personal significance of the disease, her actual self-perception and self-efficacy, the response received from her working environment, her health conditions, family, colleagues and managers support, other people’s feelings about cancer in general and her own situation in particular make a difference and can lead to two different scenarios.

174 Breast Cancer Advocacy, Work and Corporate Social Responsibility Segatti A Europa Donna – Forum italiano O.N.L.U.S., Milan, Italy Every year in Italy 30,000 women are diagnosed with breast cancer. Many of these are professional women, with considerable experience in the business environment. Suddenly they are thrust into the position of having to reconcile the time demands of their illness and care, inner life changes and self-image issues with the time demands of economical productivity. A further problem in many cases arises for women who,

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after their breast cancer diagnosis, are no longer able to carry out their normal work duties and are faced with a virtual deskilling and professional retraining. Finally, the worst scenario}and cases are not so rare as one might imagine}can involve episodes of mobbing and job dismissal for cause. Faced, as we are, with a world of work that is becoming more and more precarious, demanding and feverish, one is compelled to ask: is it is possible to reconcile the time spent on one’s inner life and life-changing needs with the time demands imposed by the job market? This time, for an employer, incurs economic costs calculated on the basis of person’s hourly productivity. If a company is to be socially responsible, it means seeing beyond compliance with legal requirements with a view to finding a means of reconciliation between two different needs which society and mature democracy cannot disregard. A society where Time is the most precious property. Symposium Efforts of Psycho-oncology in Turkey

175 The First Years in an Institutional Organization in Psycho-oncology: Ankara Oncology Training and Research Hospital, Psycho-oncology Unit Iren Akbiyik D Psychiatry Ankara Oncology Research and Training Hospital, Ankara, Turkey Although the developments in both oncology and psychiatry in their own perspectives separately were rapid and important, the collaboration of these two disciplines for shared aims did not go by the same speed and success until the last decade in Turkey. Following the earlier efforts in university hospitals, Psychiatry Clinic of Ankara Oncology Hospital, established in 2002, is the first one among Turkish Ministry of Health hospitals aimed to serve for mainly cancer patients. The aim of this presentation is to introduce the short history of establishment of Psycho-Oncology Unit in Department of Psychiatry in Ankara Oncology Research and Training Hospital and discuss about the difficulties and advantages of multidisciplinary approach for a biopsychosocial help to cancer patients. The ongoing research projects, collaborative practice with other disciplines and organizations such as social work faculties, NGOs, governmental and political institutions, local managers, etc., and targets of the unit for the future will be mentioned.

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176 Feedbacks From a Training Programme to Medical Faculty Students For Appropriate Approaches to Cancer Patients Okyayuz U Psychiatry Ankara University, Medical School, Ankara, Turkey This presentation mentions how medical students evaluate the 50 minutes lasting lesson in Ankara University, Medical Faculty, Department of Psychiatry, titled ‘Approach to cancer patients and their families’. The total number of students were 576, attending to the lessons in groups of 9–30 people in each and changing every two weeks. The students were asked to write about their expectations and suggestions about the content of lesson in the end of every session, without giving their names. When the matters discussed in the first session were usually more about loss, coping with lost and the difficulties faced during the illness, at the end, after feedbacks given, it was concluded that ‘giving the bad news’ was one of the most important subjects about which the students experience difficulty and are curious for the appropriate approach.

177 Efforts of Psycho-oncology in Turkey: Psychosocial Distress in Turkish Cancer Patients Ozalp E Psychiatry Clinic, Ankara Oncology, Research and Education Hospital, Ankara, Turkey Even though distress was common among cancer patients, it went unrecognized by oncology professionals. Because of the necessity of rapid screening for distress in cancer patients, the distress thermometer (DT) was developed (1). The advantages of this tool is its brevity and acceptability for people because of the fact that it is less stigmatizing. We aimed to investigate distress impact on oncology patients in Turkey by using the DT. One hundred and eighty two cancer patients completed the DT, and Hospital Anxiety and Depression scale (HADS), The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30 version 3.0). Our results prove that the DT is an effective scale to discriminate between cancer patients with and without clinically significant distress. Scores on the DT were moderately correlated to the HADS (p50:01) and EORTC QLQ-C30. Based on the

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significant correlations, we conclude that the distress thermometer has acceptable criterion validity, and psychological distress, anxiety, and depression have a negative impact on the quality of life of cancer patients. Finally its brevity and good performance suggest that the Distress Thermometer is an effective tool for routine screening in our clinical oncology settings. Reference: Roth AJ, Kornblinth AB, Batel-Copel L, Peabody E, Scher HI, Hlland JC. 1998. Rapid screening for psychological distress in men with prostate carcinoma: a pilot study. Cancer 82: 1904–1908.

178 Cancer and Depression: Neuropsychoendocrinological and Neuropsycho-immunological Point of View Soygur H Psychiatry, Ankara Oncology, Research and Training Hospital, Ankara, Turkey Since about 2000 years, beginning by Greek physician Galen, the presence of a relationship between cancer and depression is searched and discussed. The comorbidity of cancer and depression is known to be frequent. There is strong evidence that depression continuing after the diagnosis of cancer could cause the rapid clinical worsening of illness. Although there are many sources showing the relation between depression and rapid progression of cancer, it is still unclear how to distinguish the physical burden due to the tumor and vegetative symptoms of depression. A number of studies were reported about the neurochemical, neuroendocrine, neuroimmun and neuroanatomical alterations in major depression. However, only very few of these alterations have been systematically investigated in cancer patients with major depression. This presentation, regarding the results of a research conducted in Ankara Oncology Hospital, Department of Psychiatry, targets to evaluate the neuropsychoendocrine and neuropsychoimmune changes in depressed cancer patients and reviews whether the mentioned relationship could be used for new opportunities for treatment protocols. Symposium When a Child with Cancer Dies (symposium in Italian Language)

179 The Emotional Experience of the Dying Child’s Parents Massaglia P

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Pediatrics Department, Child Neuropsychiatry Section, University of Turin, Turin, Italy PURPOSE: Over the past 25 years medical progress in childhood cancer treatment has improved the quality of life, while reducing the mortality to 25%. Nowadays the care provided is more focused on the survival. However a great number of families still has to face child’s death. Parents’ feelings are illustrated in order to help health professionals in offering a global care. METHODS: At Turin University Department of Pediatric Oncology since 1982 psychological support has been provided both to children and to parents from the diagnosis (120 new cases every year). Usually dying children are hospitalized during the last few days, according to family requests: interviews and observations are regularly carried out. RESULTS: The child’s end of life is an unexpected event for parents, even after a long treatment. They feel an unspeakable suffering, made of pain, despair and anger. Child’s death seems unnatural and unacceptable, moreover after years of extraordinary close relationship and of continuous efforts in gaining every possible normal developmental step. Death anxieties become concrete; impotence feelings are tremendous; loneliness looks boundless and endless. Towards their child parents fluctuate between the desire of stopping his/her suffering and the need of maintaining the contact, even though listening to child’s talks about live and death constitutes an unbearable experience. CONCLUSIONS: Caring staff has to be trained in developing adequate enough attitudes in communicating (recognizing the uncertainty at diagnosis), in supporting family resources during treatment and in accompanying parents in the last period (sharing their feelings with respect and availability).

180 Extra-Hospital Support In Pediatric Hematology and Oncology Dufour M, Mangini I, Giuffra` E A.B.E.O. (Associazione Bambino ematopaticooncologico), Italy Deliberately implemented a home care program to allow children undergoing treatment to remain in their own families, thereby introducing an element of normalcy and emotional stability. With 80% of families of children with cancer and blood diseases from outside the region, temporary housing alone

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is not ABEO’s only concern: also entailed are the planning of daily lives, financial circumstances, emotional needs, entertainment, integration into new settings, school, legal and paperwork issues, stimuli for cultural and social growth. ABEO now counts on the commitment of 40 trained volunteers who, following an orientation phase flanked by an ‘elder’, render their services throughout a network of ABEO housing units and other reception facilities (the Red Cross, religious organizations). This fragmented operating context has encouraged a flexible and articulated organizational structure, which is nonetheless supervised by three figures: an Association reference officer, ever-present on the hospital floor, who gathers families’ appeals and indications from the hospital; a coordinator who assigns tasks to volunteers based on personal predispositions and one requests from both the family and the caregivers; a psychologist who meets monthly with volunteers for support, to stimulate communication and share experiences and to elaborate novel approach strategies. These efforts are appreciated by families, who feel themselves surrounded by a network of friends. Key to this process is the constant availability of psychological intervention for both the child and the family throughout all treatment phases.

181 The Sanitary Operators’ Troubles and Resources in the Life’s End Situations in Evolutive Age Papini M, Tringali D, Biagini E, Bargellini F Department of Child Neuropsychiatry, University of Florence, Florence, Italy This research concerns practices and attitudes of the Sanitary Staff and Voluntary assistance group in life’s end situations in growing age and has been realized at paediatric oncology and domiciliary assistance Department of Genova’s Gaslini Hospital (March–November 2005). After discussing the praxis of groups and the research’s finality with the staff, a series of individual interviews based on a 6 open answer questions set has been made by research’s group. The results have been given back to the interviewed operators (19 hospital and 11 domiciliary) through staff meeting. Strong emotional participation is common for both groups: ‘Every time is as our own child died’. The difference is the approach to the situation. For the question: ‘Which are the greatest troubles you find handling the last 24 hours of children’s

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life?’ 8 of 21 answers of the sanitary group underline difficulties in the relationship with patient’s parents while the presence of voluntary and domiciliary group is precious in supporting patient’s family because it relieves the feelings of medics and hospital nurses: ‘Working in hospital is heavier than in patient’s houses’. In hospital department, a terminal child forces to protect the other patients from the tragic situation while at patient’s house the accommodation permits the necessary discretion to the child and his family. The study has contributed to improve a praxis of emotional sharing in both groups and to give them tools to become aware of the level of mourning’s elaboration. Symposium Needs and Concerns of Informal Cancer Carers: The Differential Experiences of Women and Men

182 Cancer Caring, Sexuality, and Negotiating a Sense of Self in Intimate Relationships Gilbert E Gender Culture and Health Research Unit: PsyHealth School of Psychology, University of Western Sydney, Penrith South DC, Australia PURPOSE: It is well established that cancer and cancer treatments can have an important affect upon the sexuality, sexual functioning, relationships, and sense of self of a person with cancer. How cancer carers in a couple relationship with a person with cancer experience the impact of their partner’s cancer and the impact of their caring responsibilities, on their own sexuality and intimate and sexual relationship, has, however, been under-investigated. This paper explores the interpretations of, and meanings given to, sexuality and intimacy by cancer carers in couple relationships, and how these interpretations a nd meanings shape, or lead to a negotiation of, sexual subjectivity. METHODS: Semi-structured in-depth interviews were conducted with a volunteer sample of twenty adult cancer carers in a couple relationship with a person with cancer, living in New South Wales, Australia. Interview themes included: ‘changes to the intimate/sexual relationship’; ‘feelings about the intimate/sexual relationship’; ‘feelings about the caring role’; and ‘couple communication about sexuality/intimacy’. RESULTS: Grounded theory was used in the analysis of the data, and the findings read through

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a post-structural theoretical frame. Results show that cancer, and being a cancer carer, impacts upon carers’ sexual subjectivity, and the expression of sexuality/intimacy within couple relationship more broadly. If, following cancer, couples are unable to engage in their usual repertoire of sexuality/intimacy, alternative ways of being intimate/sexual are often negotiated. CONCLUSION: Recognising the carer and the person with cancer as jointly active participants in the cancer experience can have positive benefits for the couple relationship.

183 Psychological Distress, Social Support and Unmet Needs in Ovarian Cancer Caregivers: How Caregiver Needs Differ from Patient Needs Price Ma, Butow Pa, Grivas Da, Webb PMb, Loos Cb a Medical Psychology Research Unit, School of Psychology, The University of Sydney, Sydney, Australia; bQueensland Institute of Medical Research, Australia PURPOSE: There is increasing recognition of the importance of providing support for cancer caregivers, with evidence that caregivers can be as distressed as the patients themselves. More recent research has indicated that caregivers also have high levels of unmet needs. The aim of this study is to examine baseline levels of psychological distress, social support and unmet support needs of caregivers of women with ovarian cancer. METHODS: Women with ovarian cancer, and their caregivers, participating in a populationbased longitudinal quality of life and psychosocial study, complete questionnaires at three monthly intervals. RESULTS: 284 caregiver-patient pairs reported similarly elevated levels of psychological distress (p ¼ 0:31), while caregivers reported significantly lower social support than patients (p50:001). Of note, the correlations between caregiver-patient pairs on measures of psychological distress (r ¼ 0:30) and social support (r ¼ 0:31) were significant but modest. The four most severe unmet needs endorsed by caregivers were also the most common, and similar to those reported by patients. These were: managing their own concerns about recurrence, reducing stress in the patient’s life, fear about the patient’s deterioration, and looking after their own health. Over 30 percent also endorsed needs unique to their caregiver role, including, making decisions about

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their own life and balancing their own and the patients’ needs. CONCLUSIONS: Caregivers and patients reported many unmet needs. For caregivers, some unmet needs were similar to those of patients while others were specifically related to their caregiver role. Relationships between caregiver specific unmet needs, social support and psychological distress are discussed. Funded by the Cancer Council NSW and Queensland Cancer Fund (Grant No. RG36/05).

184 Gender Differences in the Experience of Cancer Care: A Comparison of Male and Female Cancer Carers Living in NSW Sandoval Ma, Ussher JMa, Butow Pb a Gender, Culture and Health Research Unit: PsyHealth School of Psychology, University of Western Sydney, Penrith South DC 1797, Australia; bMedical Psychology Research Unit, School of Psychology, The University of Sydney, Sydney, Australia PURPOSE: There is now consistent evidence that informal cancer carers experience high rates of anxiety and depression, in many instances higher rates than those experienced by individuals with cancer. Research has consistently reported that women cancer carers are at higher risk of depression and anxiety, are more likely to be the sole care-giver, and also report more unmet needs, than male carers. However, there is no in-depth research, to date, examining the mechanisms by which gender is a factor in predicting negative outcomes for cancer carers, and no research comparing support needs of male and female carers. This is the purpose of this study. METHOD: A combination of quantitative and qualitative methods were used to examine the experiences and needs of women and men who are primary carers for a person with cancer, living in NSW. Self-report questionnaires were completed by 50 cancer carers (35 women and 15 men), examining: anxiety, depression, burden of care, self-silencing, self-efficacy, empowerment, and psychosocial needs. RESULTS: Women cancer carers reported significantly higher levels of anxiety, depression, greater burden of care in relation to schedule disruption, and a greater number of unmet psychosocial needs. Men reported significantly higher self-efficacy, and there was no gender difference in empowerment. Both men and women

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cancer carers report higher levels of self-silencing than the general population. CONCLUSION: The implications of these findings for the prevention and amelioration of carers distress is discussed, in relation to the support needs identified by both male and female carers.

185 Connecting Carers Online Sundquist Ka, Pearce Ab a The Cancer Council NSW, Woolloomooloo, Australia; bGender Culture and Health Research Unit: PsyHealth School of Psychology, University of Western Sydney, Penrith South DC, Australia PURPOSE: To provide cancer carers access to information, support and resources to assist them in their caring role. METHODS: Using facilitatorled Internet technology, an online psycho-educational support program is delivered to small closed groups of participants in their home, or wherever they have Internet access. The ‘Online Collaboration’ approach combines telephone group conferencing and online learning. One and a half hour sessions are provided over a 6-week period. Topics include coping and communication strategies, enhancing physical and emotional wellbeing, information and links to cancer and community support networks. The facilitator guides participants through sessions using screen-based graphics and IP (Internet protocol) voice conferencing. A participant may speak at any time by ‘requesting the microphone’. A package of information, activity sheets and guidelines for keeping a reflective journal is sent prior to the commencement of each group. An e-Link newsletter is sent to the participants that summarises key points after each session. RESULTS: A pre and post evaluation using a mixed methodology assessed the extent to which the program objectives were met. On completion of the program, carers were given the option of participating in the Cancer Council’s Telephone Support Program and encouraged to join a Cancer Carer Support Network. CONCLUSIONS: Recruiting carers to an online psycho-educational support program is a challenge, requiring familiarity with the technology, and a time commitment. Evaluation of the pilot programs indicates that flexibility in the delivery of the program needs to be considered. ACKNOWLEDGEMENTS: NSW Health Carers Grant Program.

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186 The Gendered Nature of the Caring Role: SelfPolicing Practices on the Part of Male and Female Cancer Carers Ussher J, Sandoval M Gender, Culture and Health Research Unit: PsyHealth School of Psychology, University of Western Sydney, Penrith South DC, Australia PURPOSE: The purpose of this study was to examine gender differences in subjective experiences of informal cancer caring within an in depth qualitative framework, in order to provide insight into gender differences in the impact of the caring role. METHOD: Semi-structured interviews were conducted with 30 carers, 15 men and 15 women, asking about positive and negative aspects of the caring role and unmet support needs. Thematic discourse analysis was led to interpret the responses. RESULTS: Negative aspects of the caring role reported by men were their own emotional reactions, and difficulties with emotional aspects of caring. Women reported anger and frustration, having no time for themselves, helplessness and over-responsibility, as well as finding it difficult to ask for or accept help. Men and women were equal in their reports of positive aspects of care, including love, finding strength in ones self, and being closer to the person with cancer. CONCLUSION: It is argued that experiences of informal cancer caring are tied to dominant constructions of gender and ethics of care which circulate in contemporary Western culture. Women’s experiences are associated with ‘self-policing’ practices which result in self-silencing, over-responsibility, the internalisation of problems, self-sacrifice, and absence of self care. In contrast, men often repudiate caring roles as ‘feminine’, and thus the emotional aspects of care are resisted, or are difficult to manage. The implications of these findings for understanding gender differences in cancer carer depression and anxiety, unmet needs, and burden of care, are discussed. Symposium Prostate Cancer and Rene´ Descartes: The Complexity Of Decision Making (supported by Europa Uomo)

187 Decision-Making: A Psychologist’s Perspective Gray R

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Consultant Psychologist Sunnybrook and Women’s College Health Sciences Centre, Faculty of Medicine, University of Toronto, Toronto, Canada Health-related decision-making is complex and most complex in relation to ‘preference sensitive’ decisions, where treatment effectiveness, benefits and harms are not straightforward. This happens with prostate cancer. This presentation reviews; }how psychological theories and research are guiding decision-making investigation and action for men with prostate cancer;}the limitations of these approaches and how they tend to obscure the influence of relationships, power, values, emotion and gender on decision-making. Scientific attempts to understand decision-making have tended to be based on presumed rationality. Research attention has been focused on the individual in isolation or in relationship with physician and stressed the quality of treatment information for making decisions. Interventions work on communicating complex issues simply, differentiating the risks and benefits of different treatment options. Despite the important progress, the approach is incomplete. Men with prostate cancer face important decisions, including: which anti-cancer treatment to choose; which treatment, if any, to choose for post-treatment sexual dysfunction. Patient’s relationships with the treatment team and his family will be discussed. Also discussed will be the ways in which power operates to control and direct conversations between health professionals and patients. Masculinity shapes how men are willing and able to make health decisions. Avoidance of vulnerability and fear of loss of status are both features of hegemonic masculinity, relevant to how decisions get made about prostate cancer and related sexual dysfunction. Key role of values for patients and health professionals will be considered.

188 Decision Making (DM) in the Multidisciplinary Clinic (MDC) Valdagni R, Donegani S, Spatuzzi A Prostate Programme, National Cancer Institute, Milan, Italy PURPOSE: The therapeutic decision is considered as the ultimate act of the DM process. In prostrate cancer (PC) multiple treatment options at equal efficacy make DM process more difficult. Milan National Cancer Institute has started the MDC to

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manage this multifaceted disease. METHODS: The MDC based on institutional diagnostic and therapeutic guide-lines consists of; Recording of patient’s history and clinical examination (urologist, radiotherapist and psychologist); Psychological counseling to assess quality of life; Multidisciplinary case discussion (urologist, radiotherapist, psychologist and medical oncologist, without the pt) to define the optimal individual therapy(ies). Communication of the proposed therapy/ ies and their potential side-effects to the patient. Clinical cases are presented in weekly case discussions when the adherence of the proposed recommendations to institutional guidelines is checked. RESULTS: The MDC appears to facilitate the DM process. Clinicians’ perception: chance to solve difficulties and share the responsibilities within the team, possibility to decide in a shared responsibility system; Patients’ perception: more complete and clear information; possibility to choose the clinician one feels at ease talking to; possibility to be holistically taken care, even in one’s emotional domain. CONCLUSIONS: Due to the complexity of PC management, the MDC appears to satisfy both patients and clinicians. The more the group is willing to accept the different voices emerging from the MDC, the more the patients’ needs will be listened to and met. ACKNOWLEDGMENTS: The psychological support to PC patients is supported by a grant from Fondazione Monzino, Milan.

189 Facing Illness Levi della Torre S National Cancer Institute, Milan, Italy Health can lull a person in a comfortable delusion of a quasi-parallel life among mind, psyche and body. Otherwise, illness or ‘falling hostage of the body’ could suggest the need of one’s mind to transcend the body, both as a means to resist suffering and to project oneself into the future, to make treatment meaningful. On the contrary, convalescence and recovery, returning to a relatively normal situation, require to work for a reconciliation between mind and body, the psyche accepting its partially impaired physical condition. In involving patients in the decision-making process, an excess of responsibility leaves them in a state of loneliness and anxiety, easily making patients addicts of the psycho-physical suffering

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due to illness or treatment. The opposite is the over-trusting approach, and it is especially true with doctors. It turns the medical professionals into scapegoats of treatment. In fact, if treatment is satisfactory but not definitive, the minds of the patients will be channeled to the painful relief to be sought in recrimination rather than in reconciliation with their new state. The painful change in the hierarchy of values attributed both to objects and to the symbolic constellations underlying the self and one’s view of the world can play a decisive role in encouraging a quest for a new meaning, the targets of a changed life.

190 Decision Making: The Patient’s Perspective Van daele H Oncology Centre Antwerpen, Antwerpen, Belgium There is a great deal of research concerning the psychology of cancer in general. Many studies identified distress, cancer-specific anxiety, altered body image, and uncertainty about the future, in cancer patients. The result is a loss of quality of life. Coping strategies are important: (1) avoiding coping strategies predicts poor adjustment; (2) cooperative (active participating) coping helps the cancer patient: patient and health care workers are partners in the healing process. Cooperative coping with prostate cancer during the total course of the disease will be reviewed:1. the ‘healthy’ person discovers the first symptoms (information -> decision making); 2. the diagnosis: consultation of a multidisciplinary group of health professionals; eventually 2nd (and 3rd) opinion (new information -> decision making); 3. the period of treatment (new information -> decision making); 4. the period of convalescence (new information -> decision making); 5. life after prostate cancer: quality of life (new information -> decision making). Sources of information: family doctor, specialists, nurses, psychologist(s), social worker(s), the internet, support networks, telephone help-lines, role of patients’ groups, and so on. CONCLUSION: There is a need for more information and an increased awareness of prostate cancer in men (and in women). The patient must understand his illness, must know the implications of the different treatments, must realize how to achieve a desired quality of life, etc. All this implies joint decision making (patient– health care workers).

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Symposium Mechanisms of Cognitive Dysfunction After Chemotherapy (supported by Hurricane Voices, USA and Susan G. Komen Foundation, USA)

191 Mechanisms Of Cognitive Dysfunction After Chemotherapy}Genetics of Cognitive Decline Ahles TA Centre for Psycho-Oncology Research, Memorial Sloan Kettering Cancer Center, New York, USA Genetic factors may determine which subgroup of cancer patients are vulnerable to cognitive decline post-chemotherapy. Genes related to neural repair and neurotransmitter activity have been hypothesized as important candidates. Research from the Dartmouth group demonstrated that long-term cancer survivors with at least one E4 allele of APOE scored significantly lower on the visual memory (p50:03) and the spatial ability (p50:05) domains and tended to score lower on the executive functioning (p50:08) domain as compared to survivors who did not carry an E4 allele, potentially due to reduced neural repair capabilities in E4 carriers. Survivors treated with chemotherapy who carried the Val allele of Catecholo-methyl transferase (COMT) scored significantly lower on the California Verbal Learning Test (p50:04) and the spatial ability domain (p50:01) and tended to score lower in the verbal ability (p50:08) and verbal learning (p50:08) domains as compared to survivors who were Val negative. Val carriers metabolize dopamine more efficiently than Met carriers resulting in less dopamine in frontal cortex. We have expanded our panel of genes to include additional repair and neurotransmitter polymorphisms and polymorphisms associated with blood brain barrier transport (i.e. reduced capacity to pump chemotherapy out of the brain may be associated with a higher dose of chemotherapy), DNA repair mechanisms (i.e. reduced capacity to repair DNA damage postchemotherapy may cause greater neural damage), and cytokine response (i.e. an increase in proinflammatory cytokines associated with chemotherapy may cause greater neural damage).

192 Evidence for Persistent Cognitive Deficits in Breast Cancer Survivors Treated with Adjuvant Chemotherapy from Neuropsychological and Neurophysiological Studies Kreukels BPC, Schagen SB, Van Dam FSAM

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Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands Cognitive deficits and abnormalities in brain functioning are reported in a number of studies in women with breast cancer treated with adjuvant chemotherapy. In this presentation we will discuss evidence for cognitive deficits in breast cancer patients treated with chemotherapy from both neuropsychological and neurophysiological studies. In a series of studies we examined breast cancer patients treated with chemotherapy neuropsychologically with a standard battery of tests one year after completion of therapy. Their performance was compared to that of healthy controls. Four years later, breast cancer patients were examined neurophysiologically. Neurophysiological assessment included quantitative EEG, an auditory oddball task and a visual information processing task with concurrent EEG registration. In the neuropsychological as well as the neurophysiological study, patients were interviewed regarding cognitive complaints as experienced in daily life, anxiety, depression and fatigue. Results will be presented of these neuropsychological and neurophysiological studies. In addition, neurophysiological data of patients classified as cognitively impaired at neuropsychological assessment will be compared with those of patients that were not-impaired. Converging evidence from neuropsychological, neurophysiological and self-reported measures will help us to define specific neurocognitive profiles associated with specific chemotherapeutic regimens.

193 Mechanisms of Cognitive Dysfunction After Chemotherapy: Introduction Tannock IF Princess Margaret Hospital and University of Toronto, Toronto, Canada The presentation will provide a brief overview of larger studies, which indicate that chemotherapy can lead to cognitive impairment in a subset of cancer patients, and thereby impact on their quality of life and functional ability. The present symposium will explore possible mechanisms that may underlie cognitive impairment. These include: changes in sex hormones induced by chemotherapy, induction of various inflammatory cytokines, increased micro-coagulation in cerebral vessels, and genetic predisposition. There are also com-

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plementary studies of functional brain imaging in subjects who have received chemotherapy and in control subjects who have not, and ongoing studies using animal models. The rational design of management strategies for cancer patients who have experienced change in cognitive function requires insight into underlying mechanisms.

194 Cytokines and fMRI in Patients with Cognitive Impairment After Chemotherapy Vardy J Princess Margaret Hospital and University of Toronto, Toronto, Canada There is evidence that some patients suffer cognitive impairment after adjuvant chemotherapy (CTh) for cancer and it may be sustained. Cytokines have been associated with cognitive dysfunction. The Toronto group have evaluated cognitive function and cytokine levels in two studies: (1) a prospective, longitudinal study in colorectal cancer (CRC) and (2) a breast cancer (BC) study exploring underlying mechanisms with blood tests and functional imaging. All patients underwent neuropsychological (NP) testing with traditional tests and CANTAB, a computerized NP battery. Pts completed concurrent questionnaires for fatigue and QOL (FACT-F), anxiety/ depression (GHQ), and perception of cognitive function (FACT-COG). Serum levels of 10 cytokines (IL-1,-2,-4,-6,-8,-10,-12, TNF, IFN, GMCSF) were measured using a LiquiChipTM assay. Blood tests evaluated sex hormones, coagulation factors, cytokines, and apolipoprotein genotype. Cytokines were elevated in patients with CRC and BC, (in healthy people they are generally undetectable). On preliminary data there was no association of cytokines with NP test scores, FACT-COG, fatigue, QOL, time from surgery, or anxiety and depression. In the BC study CTh pts had decreased activation in fMRI compared with non-CTh pts and there was an association with decreased frontal lobe activation in pts selfreporting cognitive impairment. There was increased self-report of cognitive impairment in CT vs non-CT patients in both studies but no association between objective testing and subjective cognitive impairment.

195 Chemotherapy Associated Cognitive Dysfunction Wefel JS

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M.D. Anderson Cancer Center, University of Texas, Huston, USA Cancer survivors are increasingly concerned about possible cognitive sequelae associated with chemotherapy (coined ‘chemobrain’ or ‘chemo fog’). The incidence of cognitive decline associated with chemotherapy is unknown, but has been reported to occur in 17–75% of patients. Alterations across a variety of cognitive domains including verbal memory, non-verbal memory, information processing speed, attention, executive function and visuospatial function have been reported. However, these findings have been inconsistent, which may be due in part to methodological differences across trials. Two prospective, longitudinal trials examining cognitive function in women with breast cancer who received standard dose chemotherapy have been completed at M.D. Anderson Cancer Center. Results of these trials demonstrated that approximately one-third of women with breast cancer exhibited cognitive impairment prior to the initiation of chemotherapy most commonly in the domains of verbal learning and memory. During or shortly following chemotherapy approximately two-thirds of women with breast cancer exhibited a decline from their baseline level of performance. This decline was seen most commonly in the domains of learning and memory, executive function, attention and information processing speed. In a subset of women who experienced a treatment associated cognitive decline, and underwent re-evaluation approximately one year after cessation of chemotherapy, approximately one-half experienced some recovery of cognitive function while approximately one-half exhibited stable cognitive impairments. Potential mechanisms of baseline and treatment related cognitive impairment including mood, clinical and demographic characteristics will be discussed. Symposium Patient’s Awareness of Death and Prognosis

196 Spirituality and Fear of Death and Dying Bauer Sa, Wittmann Mc, Vollmer TCb a Department of Psychiatry, Regional Hospital BKH Landshut, Landshut, Germany; bDepartment of Psychiatry, University of California San Diego, La Jolla, USA; cDivision of Psycho-Oncology,

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Department of Internal Medicine III, University of Munich}Grosshadern, Munich, Germany PURPOSE: A secondary analysis of the data of the TPSCT study designed to describe the prognostic awareness of curatively treated cancer patients is presented here to illuminate the impact of spirituality on fear of death and dying that can be experienced among patients facing a lifethreatening illness. METHOD: In a prospectivecontrolled trial 91 in-patients with hematological malignancies and 31 in-patients with a benign skeletal dysfunction were included in this study. Fear of Death and Dying was measured with the self-rating questionnaire FVTS, Spirituality with the Functional Assessment Of Cancer Therapy (FACIT). Moreover, the Freiburg Questionnaire of Coping with Illness (FQCI) and the one-item tool Religious Practice in Daily Life (SOC) was employed. RESULTS: Compared to the control, patients with hematological malignancies (PHM) had significantly higher fear of death and dying. Within the PHM group, those who reported to be engaged in the topic independently of their diagnosis and had dealt with it already before their illness, had significantly less fear of death and dying than patients who started thinking of it when facing the cancer diagnosis. The most intriguing result was that this effect of a reduced fear only occurred in patients who dealt with the topic in combination to a certain religious practice in daily life. CONCLUSION: Only subjects using their faith independently from a life-threatening illness to cope with thoughts of death and dying are effective in using spirituality as a supportive resource to cope with a cancer diagnosis.

197 ‘If Walls Could Talk’}The Willingness of Talking About Death and Dying and Its Association to Space Awareness in Patients with Cancer Koppen Ga, Vollmer TCb a GemArch, Office for Architecture, Mathenesserdijk 396A2, 3026 GV Rotterdam, The Netherlands; b Division of Psycho-Oncology, Department of Internal Medicine III, University of Munich} Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany PURPOSE: Between the years 2002–2004, 120 qualitative outpatient interviews were conducted within the psycho-oncology council center at the University Hospital in Munich GH. The aim of

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the pilot-study, supported by the BMAS was to provide a safe setting in which cancer patients felt comfortable to talk about death and dying within the first unknown confrontation. METHOD: A play-card introduced the topic of death. It was given to the patients at the start of the semi-structured interview together with other theme-cards. The interview rooms were randomly changed. RESULTS: While 90 patients took the opportunity to voluntarily speak about death and dying and even contributed in estimating their remaining time on a ‘clock of life’ after receiving the card, 1/3 of the test persons declined to even touch the subject. The additional assessment of psychological distress pointed out that specifically these 30 patients showed the highest distress values. Furthermore, results indicate that the ‘willingness of talking about death’, facing a life threatening illness, was significantly associated with the space, the ‘safe setting’, in which the patients were interviewed. CONCLUSION: The architecture of a cancer patient’s environment plays an important role in addressing severe topics and burdening themes. To understand this highly important association and to investigate its potential of creating useful interventions, the research project ‘sickness of space’ will start in October 2006 at the Art Academy in Munich.

198 Peaceful Awareness of Terminal Illness Prigerson H, Ray A Center for Psycho-Oncology and Palliative Care Research, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA PURPOSE: This study of 286 advanced cancer patients recruited as part of the multi-site longitudinal, NCI, NIMH funded Coping with Cancer (CWC) study sought to examine correlates and outcomes of peaceful awareness of terminal illness. METHOD: Patients who reported having a sense of inner peace most of the time and who indicated that they were terminally ill were compared to patients who were not ‘peacefully aware’ of their prognosis on a wide variety of sociodemographic and psychosocial measures. RESULTS: Peacefully aware subjects were significantly less terrified and sad, more likely to have end-of-life conversations with their doctors and want fewer heroic measures performed compared with patients who were aware but not peaceful.

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Caregivers of peacefully aware patients were more likely to report that a doctor was always present for the patient, that a doctor had spoken with the patient about treatment preferences and, when bereaved, the caregivers reported fewer regrets about the care they had personally provided the patient, were marginally more likely to say the death was peaceful as opposed to violent, had better self-rated health, were less ‘down in the dumps’ and had lower rates of Panic Disorder. CONCLUSION: Results indicate that peaceful awareness confers several advantages to patients and their caregivers both before and after the patient’s death, and that it is associated with discussions with their physicians about their treatment preferences. Consequently, peaceful awareness appears to be a worthwhile, modifiable goal of end-of-life care for advanced cancer patients.

199 Risks and Benefits of Terminal Illness Acknowledgement Ray A, Prigerson H Center for Psycho-Oncology and Palliative Care Research, Department of Medical Oncology, DanaFarber Cancer Institute, 44 Binney Street, Boston, MA, USA PURPOSE: This study of 285 advanced cancer patients recruited as part of the multi-site longitudinal, NCI, NIMH funded Coping with Cancer (CWC) study aimed to explore the potential risks and benefits of terminal illness acknowledgment. METHOD: Patients who reported being ‘terminally ill’ were compared with those who did not on sociodemographics, psychological distress, mental health service use and advance care planning. RESULTS: 26.7% of the advanced cancer patients reported being ‘terminally ill’. These patients were more likely to feel ‘sad,’ ‘terrified,’ ‘nervous and worried’, yet were not more likely to meet DSM-IV criteria for Major Depressive Disorder (MDD) or Generalized Anxiety Disorder (GAD), or access to mental health services. They also had an increased desire for death that remained significant when adjusting for physical symptoms, but not when adjusting for psychosocial symptoms. They had higher rates of completing DNR orders, Living Wills and Durable Power of Attorney declarations, decreased interest in aggressive end-of-life care and increased rates of advance care discussions with

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their physician. CONCLUSION: These results show that acknowledgment of ‘terminal illness’ leads to better preparation for death, yet also results in heightened need for clinical attention to patients’ mental distress at the realization that death is approaching.

200 Death Awareness and Mental Health in Curatively Treated Patients Vollmer TCa, Wittmann Mb a Division of Psycho-Oncology, Department of Internal Medicine III, University of Munich Grosshadern, Munich, Germany; bDepartment of Psychiatry, University of California San Diego, La Jolla, USA PURPOSE: To determine whether the death awareness has an impact on mental health and is associated with depression and depressive coping. METHOD: Between 2003 and 2005 68 inpatients with AML, ALL and NHL treated with curative intention, and 33 control inpatients with benign skeletal dysfunction participated in the present prospective exploratory study. Assessment occurred within the first week of admission and was repeated after the first staging. Self-rating questionnaires were employed to assess mental health, coping strategies and death awareness (Subjective Estimation of Sickness and Death (SEKT) Scale). RESULTS: Patients with hematological malignancies felt significantly closer to death than members of the control group. Subjective closeness to death was significantly associated with depressive coping, depression, and anxiety at both assessment points. CONCLUSION: The prevalence of subjective awareness of death and its impact on emotional morbidity were largely confirmed, proving the burden of subjective closeness to death on a clinically relevant level within the group of curatively treated patients with hematological malignancies. Symposium A Portrait of a High Risk Breast Clinic Team

201 Cancer Genetic Counseling Seldon JL UCLA Jonsson Comprehensive Cancer Center, Division of Cancer Prevention and Control Research, Los Angeles, CA, USA

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The genetic counselor works as a member of the health care team, providing information and support to patients who have family members with cancer who may be at risk for inherited conditions. Genetic counseling is the process of communicating genetic, medical, and scientific knowledge into understandable and practical information for the patient. The genetic counselor identifies families at risk, investigates the problem present in the family, interprets information about the disorder, analyzes inheritance patterns and risks of recurrence, tests the patient for appropriate genetic analysis, and reviews available options with the patient. The genetic counselor discusses the risks, benefits and limitations of cancer predisposition testing for appropriate patients. Genetic testing for cancer predisposition genes remains very complex and personal. There are many pros and cons to testing that need to be addressed. Genetic test results, whether positive or negative, can have profound effects on individuals and their families. If positive, individuals may be able to choose medical management options that can detect cancer earlier, or reduce the risk of developing cancer in the first place. Genetic counselors guide individuals and families through this process.

202 A Portrait of a High Risk Clinic Team: The Nutritionist’s Role Duvall K Department of Family Practice, David Geffen School of Medicine, UCLA, Los Angeles, USA The mission of the Revlon/UCLA Breast Center High Risk Program is to provide a close surveillance and educational program for women who are at high risk for developing breast cancer. An important portion of the educational component is an individualized risk reduction strategy through diet and lifestyle modification, both of which may significantly lower risk. For each woman, a brief medical history is taken including past medical history, family history and current medications. Particular attention is paid to personal and family history of cancer. Breast health history is collected in detail, including results from imaging studies, biopsies and any genetic testing that has been done. A Gail Model Risk Assessment Score is generated from a handheld calculator. The Body Mass Index (BMI) is determined. A comprehensive nutritional evaluation is then

Copyright # 2006 John Wiley & Sons, Ltd.

conducted. This includes a discussion of the individual’s weight history and any eating disorder issues, both past and present. An overview of macronutrient and micronutrient profile of the diet is obtained. Particular focus is placed upon phytonutrients, fat consumption, fat profile and appropriate distribution of calories. Other dietary components important in cancer risk such as soy and alcohol are specifically addressed. The level of physical activity is assessed including aerobic and anaerobic. Obesity and sedentary lifestyle are known risk factors for breast cancer. Recommendations for weight management and exercise are made when indicated. A body composition analysis to determine lean body mass, percent body fat and basal metabolic rate may be scheduled if necessary.

203 A Portrait of a High Risk Clinic Team Goldman, S UCLA School of Medicine, Los Angeles, CA, USA The UCLA Breast Center High Risk Program is for women who are at risk for breast cancer because they have family history, are positive for one of the BRCA genes or have been diagnosed with Atypical Ductal Hyperplasia (ADH) or Lobular Carcinoma In Situ (LCIS).The program is multi-disciplinary in that each patient is seen by several clinicians. An oncologist, a psychologist, a nutritionist, a geneticist, and a nurse practitioner rotate through the patient’s room, focusing on their specialty. The nurse practitioner is the pivotal clinician as she orients each patient to the clinical setting and sets the tone of the visit. She assesses the anxiety level of each patient by interviewing the patient, gleaning information as to their lifestyle. In many cases, the patient has lost a family member to breast cancer, thus, grief reactions are significant to watch for. The patient’s history is presented to the other clinicians, setting the tone for appropriate interventions. Additionally, the nurse practitioner teaches self-breast examination, and counsels the patient as to the proper imaging (mammogram, ultra-sound, MRI, etc.). Many women are frightened of the breast exam. It is vital to assist the patient in feeling comfortable with their body and to explain the rationale for necessary testing. Finally, the nurse practitioner ‘wraps up’ the visit by reviewing the importance of follow-up and setting the parameters for future visits and surveillance.

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204 A Portrait of a High Risk Clinic Team Wellisch DK Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine UCLA, Los Angeles, USA The UCLA Breast Center High Risk Clinic is for women who are at risk for breast cancer because they have a family history (a first degree relative), are positive for one of the BRCA genes, or have been diagnosed with a non-malignant breast condition. In this multi-disciplinary program, each patient is seen by several specialties, including: an oncologist, a genetics counselor, a nurse practitioner, a nutritionist, and a psychologist. The psychologist sees all new and follow-up patients on their visits. For the new patients, the psychologist performs a lengthy baseline interview. This interview explores many areas of development and lie experiences including: family health histories, history of breast cancer(s) in the family, reaction(s) to breast cancer(s), family mental health histories, coping patterns of the patient, patient psychotherapy history, patient concerns about vulnerability to breast cancer, and expectations about the program. The psychologist in this baseline interview attempts to assess the patient so as to: (1) Do treatment planning with the clinic team, and (2) Refer, if necessary, for psychotherapy and/or psychopharmacologic medication outside the clinic. The psychologist also sees every patient upon follow-up. This is usually a briefer interview and is focused to facilitate compliance with clinic regimen and goals for the patient. Such goals might include weight loss, exercise adherence, or alcohol management. Concurrent Symposia

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PURPOSE: Many things correlate with caregiver quality of life, yet we know little about what mediates such correlates (particularly in advanced cancer). We examined the mediating effect of coping styles in the relationship between caregiver load and caregiver burden and disruptiveness. METHODS: Data from baseline measures for caregivers of advanced lung, breast, and prostate cancer patients were used to examine the mediating effects of coping styles on caregiver load (demands) and burden (subjective impact) and disruptiveness (lifestyle interference). RESULTS: Caregivers were primarily female, spouses, Caucasian, with mean age of 56.3. Two coping styles were found as possible mediators. Self-distraction correlated with caregiver load (r ¼ 0:22), burden (r ¼ 0:47) and disruptiveness (r ¼ 0:41), p50:01: Planning correlated with caregiver load (r ¼ 0:25), burden (r ¼ 0:38) and disruptiveness (r ¼ 0:19), p50:01: The correlation between caregiver load and burden (r ¼ 0:35; p ¼ 0:000), decreased when controlling for self-distraction and planning (r ¼ 0:22; p ¼ 0:001). The correlation between caregiver load and disruptiveness (r ¼ 0:41; p ¼ 0:000) was minimally decreased when controlling for these coping styles (r ¼ 0:36; p ¼ 0:000). Regression models of caregiver load, self-distraction and planning, along with caregiver age, accounted for 34% of the variance in caregiver burden and 28% in disruptiveness. CONCLUSIONS: While caregiving demands disrupt the caregiver’s lifestyle seemingly regardless of coping style, coping styles can impact one’s subjective sense of burden accompanying such demands. Understanding mediating effects of specific coping styles will better inform development of interventions aimed at enhancing caregiver coping. ACKNOWLEDGEMENTS: Supported by National Cancer Institute, 1 P50 CA095817-01A1; National Institute of Nursing Research, R01 NR008260-01.

205 Effect of Coping Style on the Relationships Between Caregiver Load and the Experience of Burden and Disruptiveness for Caregivers of Advanced Cancer Patients Bernard-DuBenske LLa, Gustafson DHa, Cleary JFb a Center of Excellence in Cancer Communication Research, University of Wisconsin, Madison, USA; b Departments of Oncology and Palliative Care, University of Wisconsin Comprehensive Cancer Center, Madison, USA

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206 The Hidden Morbidity in Cancer: Spouse Caregivers Braun Ma, Rydall Ab, Walsh Ab, Mikulincer Mc, Rodin Gb a Psycho-Oncology Unit, Sharett Institute, Hadassah Medical Center, Jerusalem, Israel; bPsychosocial Oncology and Palliative Care Program, Princess Margaret Hospital, University Health Network, Toronto, Canada; cDepartment of Psychology, Bar-Ilan University, Ramat-Gan, Israel

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PURPOSE: The study assesses the psychological distress among spouse caregivers of advanced cancer patients and the factors associated with it by examining the relative contribution of relational variables (attachment style and marital satisfaction) to spouse caregivers’ depression. METHOD: 101 patients with advanced gastrointestinal or lung cancer and their spouse caregivers were recruited for the study. Measures included Beck Depression Scale, Memorial Symptom Assessment Scale, Caregiving Burden Scale, Experience in Close Relationship and ENRICH Marital Satisfaction Scale. RESULTS: 38.6% of the caregivers reported significant symptoms of depression compared to 21.8% of their ill spouses (p50:0001). In a hierarchical regression of caregiver’s depression, spouse caregiver’s age and patient’s cancer site were entered in the first step, objective caregiving burden in the second, perceived caregiving burden in the third, spouse caregiver’s attachment scores in the fourth and marital satisfaction in the fifth step. The final model accounted for 39% of the variance, with caregiving perceived burden (beta ¼ 0:34; p5 0:01), patient’s depression (beta ¼ 0:24; p50:05), caregiver’s anxious attachment style (beta ¼ 0:22; p50:05) and marital satisfaction (beta ¼ 0:20; p50:05) being identified as significant contributors. CONCLUSIONS: The current study identifies spouse caregivers of patients with advanced cancer as a high-risk population for psychological distress, even more so than the patients themselves. Relational variables play an important role in the explanation of spouse caregiver’s depression including dispositional variables, such as attachment style, and specific relationship variables, such as marital satisfaction.

207 Family Carer Quality of Life: Relationship to Carer Optimism, Sense of Self-Efficacy, and Sense of Preparedness to Provide Care to Terminally Ill People with Cancer Cohen SRa, Fyles Gb, Leis Ac, Viol Rd, Porterfield Pe a Oncology and Medicine McGill University, Montreal, Canada; bPalliative Care British Columbia Cancer Agency for the Southern Interior, Kelowna, Canada; cEpidemiology and Community Health University of Saskatchewan, Saskatoon, Canada; d Medicine Queen’s University, Kingston, Canada; e Palliative Care Vancouver Hospital and Health Sciences Centre, Vancouver, Canada

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PURPOSE: To elucidate the relationship between the quality of life (QOL) of family carers and their optimism and senses of self-efficacy and preparedness to provide care. METHOD: Carers of people with 3–6 months prognosis were recruited from palliative care inpatient, outpatient, and home care services in 5 Canadian cities. Every 2 weeks until the patient’s death, they completed a measure of their QOL (Quality of Life in LifeThreatening Illness}Family Caregiver). At the time of entry to the study they also completed measures of optimism, self-efficacy and preparedness for caregiving. The latter was completed again whenever the patient’s cognitive or physical status deteriorated. RESULTS: One hundred and seventeen patient–carer dyads and 57 carers alone were recruited and completed the questionnaires. Eighty-four dyads and 40 carers alone completed the questionnaires on at least 2 occasions, and 57 and 30, respectively, completed the questionnaires on 3 or more occasions. Data analysis is underway. CONCLUSIONS: The strength and direction of the relationship between carer optimism and sense of self-efficacy and their QOL as the patient approached death will inform us as to whether optimism and self-efficacy might serve as predictors of which carers are at risk for experiencing poor QOL. If there is a strong relationship between carer preparedness to provide care and QOL, this would suggest that it is worthwhile to design interventions to allow them to feel more prepared, and to study whether such interventions increase their QOL.

208 Psychosocial Adjustment of Partners of Patients Facing Prostate Cancer Couper Ja, Bloch Sa, Kissane Db, Love Ac, Macvean Md a Department of Psychiatry, University of Melbourne, Melbourne, Australia; bDepartment of Psychiatry & Behavioral Sciences Memorial Sloan Kettering Cancer Center, New York, USA; cSchool of Psychological Science La Trobe University, Melbourne, Australia; dCentre for Behavioural Research in Cancer The Cancer Council Victoria, Melbourne, Australia PURPOSE: An observational study of 103 patients diagnosed with early and advanced stage prostate cancer and their partners from time of diagnosis to six months later was performed and the results have been submitted by the first author

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as a doctoral thesis. METHODS: Patients and partners were administered CIDI (for DSM-IV mood disorder diagnoses), Brief Symptom Inventory, Dyadic Adjustment Scale, Family Relationship Index, and partners were administered Ways of Coping Checklist. RESULTS: At time of diagnosis partners had higher levels of psychological distress than patients and rates of DSM-IV depression and anxiety twice that of general female community. Over the six months, patients’ level of psychological distress increased significantly and partners’ level of marital satisfaction decreased significantly. Maladaptive coping of avoidance and blaming the self in partners at the time of diagnosis predicted higher levels of partner distress six months later. No significant difference in psychological well-being was found comparing couples facing early and advanced cancer. CONCLUSIONS: When confronted with the diagnosis of prostate cancer, early or advanced, it is the partners who initially demonstrate distress. Over time the patients become more distressed and the partners become more dissatisfied with their relationship. Maladaptive coping styles in partners predicted poorer psychological function later. A brief couple-focused psychosocial intervention to address these issues and to prevent poor psychosocial outcomes for couples facing prostate cancer is proposed.

209 Caregivers Do Not Realize Their Own Elderly Cancer Patients’ Needs for Information Giacalone Aa, Salamini Rb, Tirelli Ua a Medical Oncology, National Cancer Institute Centro di Riferimento Oncologico, Aviano, Italy; b Epidemiology Unit, National Cancer Institute Centro di Riferimento Oncologico, Aviano, Italy PURPOSE: Information helps individuals to cope with the disruption of quality of life following diagnosis and treatments for cancer. Although population is growing older, only few studies focused on the information needs of senior cancer patients and, in authors’ knowledge, none studied what caregivers know about patients information needs. METHODS: Between June 2004 and February 2005, 112 elderly cancer patients (age >¼ 65 years) admitted for staging procedure at the National Cancer Institute}Aviano, Italy, with a first diagnosis of tumour and treatments’ naı¨ ve, and their caregivers, were enrolled in our

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study. Prior to treatments, both groups were asked to fill in a self-administered questionnaire appropriately developed to explore the patient’s information needs and their information-seeking behaviours. Patients also completed the Psychological Distress Inventory. RESULTS: Caregivers, usually females (71.4%), children (44.6%) or partners (41.1%), believed elderly patients preferred to receive partial information by the oncologists and have poor information-seeking behaviours. Apparently, elderly patients (mean age 72 years, and mean PDI 26.1) answered similarly, but when matched with their own caregivers, the k statistic analysis showed unsatisfactory agreement (k50:20) for the information needs and very poor agreement for the information-seeking behaviours. CONCLUSIONS: Caregivers’ misunderstanding about information needs of their patients we have pointed out was due to their protective behaviours that trouble the patient-to-caregiver relationship. Interventions to help elderly patients express their unmet needs and to improve the patient-to-doctor-to-caregiver communication about cancer, are necessary.

210 Sense of Coherence and Distress Among Cancer Patients and Their Spouses Gustavsson-Lilius Ma, Julkunen Ja, Keskivaara Pa, Hietanen Pb a Department of Psychology University of Helsinki, Helsinki, Finland; bFinnish Medical Journal, Helsinki Finland PURPOSE: According to Antonovsky’s salutogenic theory strong sense of coherence (SOC) promotes health in stressful situations, such as a serious illness. There is, however, surprisingly little information on the SOC-distress association in cancer patients and their spouses. The aim of this study was to clarify these issues. METHODS: The associations between SOC (OLQ-12), depression (BDI-14) and anxiety (EMAS-State) were studied in 123 cancer couples. The data was collected with self-report questionnaires at the time of diagnosis, 8 and 14 months after that. The predictors of follow-up distress and possible mediators of the cross-lagged longitudinal data were analysed with path analyses. RESULTS: No gender differences in the patient study variables were found, but wives had statistically significantly more distress symptoms than husbands. Distress decreased and

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SOC increased in both patients and in spouses during the follow-up. As expected, strong SOC was associated with less distress. Furthermore, baseline distress partially mediated the impact of SOC on 14 month follow-up distress. Also, patient and spouse distress and patient and spouse SOC were associated 14 months after the diagnosis. CONCLUSIONS: The results supported Antonovsky’s theory. Strong SOC protected from the development of distress in cancer couples. Contrary to Antonovsky’s assumptions, SOC was not a stable disposition. Since patients’ and spouses’ variables were related to each other, special attention should be given to cancer patients’ spouses, especially wives’, psychological wellbeing in clinical practice. ACKNOWLEDGEMENTS: The Cancer Society of Finland.

211 Adult Attachment and Spousal Cancer Caregiving Kim Ya, Carver CSb a Behavioral Research Center American Cancer Society, Atlanta, USA; bDepartment of Psychology University of Miami Coral, Gables, USA PURPOSE: How caregivers relate to care recipients can affect how well care is provided. We conceptualized the relationship of spousal caregivers via adult attachment theory and examined how attachment qualities of caregivers related to level of caregiving involvement and difficulties in caregiving. Gender differences in the associations were also explored. METHODS: From participants in ACS Quality of Life Survey for Caregivers, 400 spousal caregivers provided valid data for the study variables. RESULTS: Findings from multivariate general linear modeling indicated that how often caregivers provided various types of care was a joint function of attachment orientation and gender. In contrast, the difficulty caregivers experienced in providing care related directly to attachment, without moderation by gender. CONCLUSIONS: Our findings suggest that ineffective caregivers of cancer patients, who can be identified by their attachment orientation, would benefit from educational programs to improve their caregiving skills and to encourage them to utilize resources from other family members or community. ACKNOWLEDGEMENTS: This study was funded by the American Cancer Society National Home Office, intramural research.

Copyright # 2006 John Wiley & Sons, Ltd.

212 Guide-lines for the Psychological Intervention in Pediatric Onco-hematology Disease Di Giuseppe Sa Pierani Pb, Carloni Ic, Albano Vb, Coppa GVc a Psycologist psychoterapist; bMedical manager; c SOD and Pediatric Department Director, Polytechnic University of Marche, Pediatric OncoHematology Center, Children Hospital ‘G.Salesi’ PURPOSE: The authors describe their experience developing the guidelines of the psychological intervention in Onco-Hematology Pediatric environment. METHODS: (1) The observation of medic and paramedic context, referring to psychological affects and relational and communicative dynamics of the sanitary e´quipe. (2) Observation of the ‘doctor–patient’ relationship that in pediatric environment has the specific characteristic of being mediated by adults. (3) Observation of co-stress factors and the life-events that take place subsequently or parallel to event disease. RESULTS: All this work ended up with the definition of the following guide lines: (a) to guarantee the psychological attendance from the beginning of the child and family ‘oncological course’, that means the communication of the diagnosis (Regional Law N.133, 25.5.1993) till the total recovery; (b) to point out the associated psychological needs of the family and patient, and moreover the economic needs; (c) to point out the co-stress factors and to elaborate the integrated social-sanitary assistance with the other experts of the field. CONCLUSIONS: It has been reached an elevated qualitative standard in the ‘total care’ project of the pediatric cancer, that means integrating the cure of the body with the psychological affects of both the sanitary e´quipe and sick children and parents.

213 Communicating with Children about Cancer Friedsam Ja, Sundquist Ka, O’Reilly Ab, Robinson Ec, Turner Jd a Cancer Information and Support Services The Cancer Council NSW, Sydney, Australia; bCansupport Sydney Australia; cPam McLean Cancer Communication Centre, Sydney, Australia; d Department of Psychiatry University of Queensland, Queensland, Australia PURPOSE: Research indicates that parents underestimate the effect their cancer experience

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has on their children, and that there are few Australian specific studies or resources on this topic. To address the lack of psycho-educational and support services, The Cancer Council NSW, The Pam McLean Cancer Communications Centre and Cansupport worked together to develop an innovative project responding to the needs of families. The project aimed to develop psycho-educational resources and support programs for parents, children, and health professionals to assist families in communicating about cancer. METHODS: Parents were recruited to participate in pilot psycho-educational communication skills training programs using the telephone group-counselling medium as a model to meet parental needs. Qualitative data from the programs, and from other parents with cancer, informed the development of a new resource ‘When a parent has cancer: how to talk to your kids}a guide for parents with cancer, their families and friends.’ RESULTS: Evaluation of the pilot program indicated that participants found this an extremely helpful and supportive program, with an improvement in levels of perceived confidence in talking to their children. There has been an overwhelmingly positive response to the new written resource from families affected by cancer, medical and school professionals. CONCLUSIONS: The results of this multifaceted and innovative project offer a number of insights for clinicians dealing with families affected by a cancer diagnosis. It reinforces the need for open, honest and age appropriate parental communication, and psychosocial support for families affected by a cancer diagnosis.

214 Models of Psychological Intervention for Parents of Children with Oncological Disease Guarino Aa, Lopez Eb a School of Psychology,, University of Rome ‘La Sapienza’, Rome, Italy; bItalian Society of PsychoOncology- Lazio Section, Rome, Italy The death of a child is one of the greatest tragedies in a parent’s life and has shattering effects on the family system, nevertheless there isn’t a word for naming parents that lose a son. Considering too individual differences, the ways for facing the mourning are influenced from the circumstances of death, from the exchanged gestures and the uttered words of the preceding moments. Sense of guilt and doubt of having made all possible are

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accompanied to fear for forgetting the dead child. The parents suffer both for losing their son and for the deprivation of the son’s meaning for themselves: the child death constitutes the loss of a part of themselves and their own identity. A review of the concepts about the process of mourning elaboration}process that needs a deep restructure of the inner world of the individual}is proposed in this work following various theoretical guidelines (psychoanalytic theories, attachment theory, existential approaches, systemic theories, model of psychosocial transition) and beginning from a mourning definition as a whole of individual and social behaviors regarding the loss of a meaningful person. This work analyzes the influence both of the society meaning of death and mourning and of the social and religious rituals. Considering the whole of these factors, some proposals of intervention are comparatively assessed: self-help groups, support groups and individual interventions of accompanying interventions. Finally, a section is dedicated to preventive interventions feasible during the terminal phase of life of children with oncological disease.

215 How Do Adolescents Perceive Their Physical and Psychological Status Five Years After the Completion of Their Treatment Oppenheim Da, Brugieres Lb, Antoni Gc, Dauchy Sd, Hartmann Ob a Unite´ de Psycho-oncologie et De´partement de Pe´diatrie, Institut Gustave Roussy, Villejuif, France; bDe´partement de Pe´diatrie, Institut Gustave Roussy, Villejuif, France; cDe´partement de Statistiques, Institut Gustave Roussy, Villejuif, France; dUnite´ de Psycho-oncologie, Institut Gustave Roussy, Villejuif, France OBJECTIVE: To gain a better understanding of the future of adolescents treated for a cancer. METHODS: A questionnaire was sent to all adolescents (13–18 years old) treated in our hospital 5 years ago. Questions concerned their physical and psychological status, sequels sustained, what bothers them, whether they or their parents felt fragile, whether they wanted psychological support or medical information or an interview. RESULTS: 93 subjects; 61% answered. 3 items were significant: they have no health problems (74%) but physical sequels (69%), they wish to receive medical information (90%) concerning their illness, their present status, having

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children in the future. Eight requested an interview. The major points addressed were: treatment was a trying experience (8), they felt lonely (they could not easily explain their feelings and be understood) and ambivalent about psychological support (7); the first year following treatment was hard (7), they felt different from before and from others (6); fatigue and visible sequels which attract the attention of and questions from others bothered them (6). They would appreciate group discussions and psychological support during treatment and during the first year following therapy (6). Sexuality was difficult (they were ashamed of their body, feared being rejected or loved for pity) (5). CONCLUSION: As the majority of adolescents are cured without major sequels, greater attention should be directed at ‘minor’ sequels which can markedly impair the quality of life of adolescents: fatigue, solitude, visible sequels, sexuality, feeling different from before and from others. Study supported by a Grant 2002-11 IGR.

216 Ayrton Senna Play-Room: Assessing Its Performance Perina EMa, Ferrer ALb, Aflalo Cb, Lisboa Cb, Andrade Ca a Mental Health Department, Boldrini’s Children Hospital and State University of Campinas, Campinas, Brazil; bPlay-Room, Boldrini’s Children Hospital, Campinas, Brazil PURPOSE: The team in charge of the Therapeutical Play-Room Ayrton Senna, from the Boldrini’s Children Center, in conjunction with the Escola Oficina Lu´dica, assessed its activities in order to know their impact regarding: the effect on the hospital routine and the effect on the patient’s ability to handle stress and pain. METHODS: The qualitative and quantitative investigation was carried out by individual interviews. Overall 20 children, 20 teenagers, 30 parents, 25 professionals, 16 volunteers and 3 staff members answered them. RESULTS: The interviews indicated that 100% of the people know the play-room, 90% of patients and relatives usually spend time in the play–room while waiting for an appointment, 88% of the hospital professionals feel that today the hospital is not a place of pain and agree that the patients are more willing to return because of the play–room. The play–room existence has promoted a substantial change of mood amongst the patients who are

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more calm, happy and helpful with treatment. CONCLUSIONS: The assessment indicated that the joyful play–room and artistic activities have affected the patient’s treatment, mostly by distracting them, improving their emotional condition, as well as reducing their stress. 84% of the professionals observed that the patients diverted the focus from their pain, whenever there was amusement and affection.

217 Active Music Engagement and Coping Behaviors in Children with Cancer Robb SLa, Clair AAb, Watanabe Mc, Monahan POd, Azzouz Fd a Conservatory of Music University of Missouri Kansas City, Kansas City, MO, USA; bSchool of Fine Arts University of Kansas, Lawrence, KS USA; cHematology-Oncology Phoenix Children’s Hospital, Phoenix, AZ USA; dDepartment of Medicine Indiana University, Indianapolis, IN, USA PURPOSE: Research supports the need for interventions that increase use of active coping strategies. The purpose of this multi-site study was to determine the efficacy of an active music intervention to modify frequency of engagement behaviors in hospitalized children with cancer. METHODS: An experimental-control group design was used to examine behavioral responses of participants to three environmental conditions. Behaviors examined included positive facial affect, active engagement, and initiation. Eighty-two patients, ages 4–7, participated in the study. All participants were receiving inpatient cancer treatment; English was their primary language. Participants were assigned to one of three conditions, active music (AM; n ¼ 27), music listening (ML; n ¼ 28), or books-on-tape (BT; n ¼ 28). Conditions were videotaped to facilitate behavioral data collection using time-sampling procedures. RESULTS: Statistical analyses indicate that the AM condition resulted in the highest mean frequency score for positive affect, active engagement, and verbal initiation. After adjusting for baseline difference, a repeated measures ANCOVA indicated that mean scores for positive affect and active engagement were significantly higher in the AM condition when compared with ML and BT. The repeated measure ANCOVA for gestural, verbal, and combined initiation indicated no significant differences among the three conditions

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for verbal initiation; scores for gestural initiation were significantly higher in the ML condition; AM and ML resulted in significantly higher combined initiation compared to the BT condition. CONCLUSIONS: This study supports the use of the AM intervention to modify affect and increase active behavioral engagement during hospitalization.

218 Behavioural and Emotional Problems in Children Treated for Brain Tumours: A Three Year Prospective Study Stargatt Ra,b a Australian Centre for Neuropsychological Studies, Murdoch Children’s Research Institute, Melbourne, Australia; bDepartment of Psychology, Royal Children’s Hospital, Melbourne, Australia PURPOSE: Children treated for brain tumours display a range of neurological and psychosocial problems. This study examined the behavioural and emotional impact of tumour and treatment in children with posterior fossa and supratentorial tumours during the three years following diagnosis. METHOD: Thirty-five children with posterior fossa tumours [PF] and 21 children with supratentorial tumours [ST] aged 4–16 years were recruited between 1999 and 2002 from the Royal Children’s Hospital, Melbourne, Australia. The children were assessed as soon as possible after diagnosis and at 12, 24 and 36 months following. RESULTS: Both tumour groups experienced heightened behavioural disturbance at the time of diagnoses compared with the normative data. Behavioural disturbance increased over the first year and was maintained during the follow-up period on several measures. Maladaptive behavior disturbance, reduced participation, school and social problems were most common during the follow-up period. CONCLUSIONS: Behavioural and emotional outcomes were multi determined with a range of individual child [age and general level of adaptive behaviour] medical [tumour location, treatment and length of stay], psychosocial [SES and burden of illness] and environmental factors [family conflict, family intimacy and parenting style] influencing outcomes. The difficulties experienced by these children and their families have specific implications for management and rehabilitation. ACKNOWLEDGMENTS: Financial support was provided by the Murdoch Children’s Research

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Foundation, The Bluey Day Foundation and the Besen Foundation.

219 Quality of Family Life for Children with Cancer: Canada and USA Witol Aa, Wagner Bb, Papsdorf Mc a Northern Alberta Children’s Cancer Program Stollery Children’s Hospital, Alberta, Canada; b Aflac Cancer Center & Blood Disorders Services Children’s Healthcare of Atlanta, Atlanta, USA; c Centre for Community Child Health Research British Columbia Research Institute for Children and Families, Vancouver, Canada PURPOSE: Few cross-country studies of Quality of Life for children with oncologic conditions have been conducted. This study assessed emotional support needs, community resources, and travel demands in 166 children in Alberta, Canada and 72 children in Atlanta, Georgia. METHODS: Four standardized questionnaires were administered: PedQL, Family Support Scale, Family Needs Questionnaire, and the Questionnaire on Resources and Stress. All patients were treated following standard COG protocols. Statistical analyses were conducted using ANOVAs and chi square tests. The sites were compared on demographic data and the primary dependent measures. RESULTS: Canadian families rated the overall importance of support and the amount of support they received more highly than the US families. However, no other differences between the two sites were found and data were pooled. Emotional and resource needs differed across diagnoses, treatment phase, and perceived difficulty of commute. Children with brain tumors reported higher physical limitations, poorer social functioning, and higher life span care demands. Among families of children on treatment, the difficulty of the commute made little difference in terms of needs, resources, and functioning. However, among families of off-treatment children, an easy commute was associated with more met needs, fewer limits on family opportunities, a lower personal burden, better social functioning, and fewer communication difficulties than a more difficult commute. CONCLUSION: Increasing psychological and social support to families of children with brain tumors and providing intervention prior to transition off-treatment may help to improve quality of life, reducing long-term burden and psychological distress.

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220 The Impact of Infertility on the Transition to Adulthood for Teenage Cancer Survivors Crawshaw MAa, Glaser Ab, Hale Jc, Sloper Pd a Social Policy & Social Work, University of York, York, England; bYorkshire Regional Centre for Paediatri Oncology & Haemataology Leeds Teaching Hospitals NHS Trust, Leeds, England; cInstitute of Child Health Newcastle upon Tyne Hospitals NHS Trust, Newcastle, England; dSocial Policy Research Unit, University of York, York, England PURPOSE: Despite growing awareness of the longer term side effects of cancer, there is limited research into the impact of teenage cancer-related infertility and none identified into the impact of infertility on negotiating the transition to adulthood. This exploratory qualitative study was designed to contribute to understanding this experience. METHODS: 40 male and female cancer survivors (age at diagnosis 11–20; at interview 16–30) were recruited to take part in single semistructured interviews. Thematic analysis was undertaken using AtlasTi software. RESULTS: Preliminary analysis suggests: Significant impact on some males and females, some of which is gender and age specific. Strong support for being informed about infertility from diagnosis onwards and for professionals to raise related issues routinely and directly. Respondents were, on the whole, less willing to talk about infertility than cancer with friends, partners and family members. Females more likely to have thought about alternative routes to parenthood and to have received offers to donate eggs and act as surrogates than were males. Impact of infertility changed, for some, as treatment ended, as the transition to adulthood was negotiated and as peers started childbearing. Multi-disciplinary services during treatment, immediate and longer term follow up often poor in their attention to infertility related matter. Fuller findings will be included in the conference presentation. CONCLUSIONS: For some teenage cancer survivors, cancer-related infertility has a significant impact. Professional services are lacking in their attention to this. ACKNOWLEDGEMENTS: The study was funded by The Candlelighters Trust, UK.

221 Art Therapy to Support Children During Bone Marrow Transplant

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Favara Scacco CC, Caldarella A, Italia S, Pace P, Bonanno A Hematology-Oncology, Azienda Ospedaliera Policlinico, Catania, Italy Children undergoing bone marrow transplant (BMT) take at least 21 days for recovery. Interaction is restricted to staff and one parent at the time. To the physical discomfort, an emotional turmoil is added due to isolation and limited activities/stimulations. To release}diminish anxiety, maintain cognitive processes and relational capacities active, we started a psychoemotional support program through Art Therapy (AT). Being flexible, multimodal approach, AT is adequate for hospital settings. Through creative modalities, AT facilitates the release of overwhelming emotions allowing continuity in the psychoemotional growth. PATIENTS AND METHODS: From March 2000 till May 2004, we treated 34 children aged 1–14. AT techniques were offered, before the transplant to give information to make BMT a predictable, less anxiety-provoking experience and, during the transplant to offer a daily psychoemotional support with: landscape. A detail of a landscape drawing was daily produced. Giving the child a goal to reach his motivation was constantly activated. Puppets were created with sterile clothes, allowing children’s sense of confidence as well as the elaboration of emotional nodes and aggressiveness. Medical play: On a cloth doll children could utilize medical instruments to experience control among illness: an opportunity to exchange roles, from being ‘persecuted’ to become ‘persecutor’. Collage: Cutting, to release anxiety and then gluing, to engage a sense of integration. Communication: Children are involved in a creative communication to keep mastering their relational capacities. RESULTS: Children’s majority required the psychologist’s presence during BMT and expressed satisfaction for the products they realized overcoming solitude and boredom, anxiety and range. Parents recognized in AT a way to help them feel active and useful in their children’s wellbeing.

222 The Effect of Family Environment on Adolescents’ Well Being When a Parent Has Cancer Gazendam-Donofrio SMa, Hoekstra HJb, van der Graaf WTAc, van de Wiel HBMd, HoekstraWeebers JEHMa,d,e

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Psychosocial Services University Medical Center Groningen, University of Groningen, Groningen, Netherlands; bSurgical Oncology University Medical Center Groningen, University of Groningen, Groningen, Netherlands; cMedical Oncology University Medical Center Groningen, University of Groningen, Groningen, Netherlands; dHealth Psychology University Medical Center Groningen, University of Groningen, Groningen, Netherlands; e Supportive Care Comprehensive Cancer Center North Netherlands, Groningen, Netherlands PURPOSE: Having a parent with cancer can have an enormous impact on the family environment. Family environment could have a protective affect on how adolescents function. METHODS: 138 patients, 114 spouses, and 221 adolescents filled in the Dutch version of the Family Environment Scale 1–5 years after patient’s diagnosis. Information regarding adolescents’ functioning was gathered from parents using the Child Behavior Checklist (CBCL) and from the adolescents themselves using the Youth Self-report (YSR). Family members’ scores on family environment were compared to Dutch norms. We calculated correlations between (discrepancies in) family environment and adolescents’ functioning. RESULTS: Parents in families with cancer scored significantly higher than the norm on expressiveness, social behavior, and organization, and lower on control and conflict. Adolescents reported scores similar to their parents; they additionally scored higher than the norm on cohesiveness. Significant correlations were found between family relationships (cohesiveness, expressiveness, conflict and functioning according to both parents and adolescents (r ¼ 0:17 to r ¼ 0:37). Family structure (organization, control) correlated with the parents’ reports on adolescents’ functioning (r ¼ 0:16 to r ¼ 0:21), but not with adolescents’ self-reports. Parent–child discrepancies were only related to dysfunction according to the adolescents. CONCLUSION: A family with cancer, 1–5 years after diagnosis, seems to have a more positive family environment than families with healthy parents. Family environment appears to be related to how adolescents of a parent with cancer function. Family relationships appear to have a more protective affect than family structure.

223 Adolescent/Young Adult Cancer Weekend Retreat: Evaluation of an Inaugural National Program

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Rutledge Ra, Walker Tb, Eaton Gc a Department of Radiation Oncology, Dalhousie University, Halifax, Canada; bEastwind Stress Reduction Clinic, Halifax, Canada; cRealtime Cancer, St. John’s, Canada PURPOSE: Adolescents and young adults (AYA) appear to suffer high levels of psychosocial distress when facing a cancer diagnosis. Little is known about their unique stressors and the types of psycho-oncology programs most effective at addressing their needs. This presentation overviews these issues and describes the format and evaluation of a national weekend retreat. METHODS: Twenty-eight participants (25 with various cancer diagnosis, 3 supporters) aged 17–31 from seven provinces attended a 3-day residential retreat. The program consisted of supportive–expressive group therapy, mindfulness-based stress reduction and informal activities. Attendees generated their own small group topics and completed self-administered questionnaires at the end of the weekend. RESULTS: 26 of 28 attendees completed the evaluation questionnaire. The average score for the entire weekend was 9.4 out of 10. Sharing their cancer story in the large group (9.8/10) and talking about fears and hopes (9.5/10) rated highest. The general comments were overwhelmingly positive and included the theme of ‘not feeling so alone’ at the end of the weekend. The topics identified as most important to address by the attendees included Fertility, Self-image, Financial Dependency, Embarrassing/Humorous Moments, Relationships, Loss of Dreams/Redirection of Life, The Road Ahead, and Late Effects. CONCLUSION: The weekend retreat appeared to be a highly successful and an effective format for addressing the unique psychosocial needs of AYA cancer survivors. Further research is necessary in how to best support the often isolated members of this group.

224 The Influence of Childhood Adversity on the Ability to Obtain Support from Clinical Staff After Diagnosis of Breast Cancer Salmon Pa, Clark La, Krespi Ra, Hill Jb, Holcombe Cc a Clinical Psychology, University of Liverpool, Liverpool, UK; bPsychiatry, University of Liverpool, Liverpool, UK; cLinda McCartney Centre, Royal Liverpool, University Hospital, Liverpool, UK

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PURPOSE: Patients undergoing the crisis of diagnosis and treatment for breast cancer need to form trusting and supportive relationships with clinical staff. However, adverse childhood experiences damage the ability to form supportive relationships as adults. We therefore tested the prediction that childhood abuse and lack of parental care would reduce patients’ experience of support from clinical staff caring for them around the time of diagnosis and surgical treatment. METHOD: Women with primary breast cancer (N ¼ 355) two-four days after surgery (mastectomy or wide local excision) self-reported recollections of childhood sexual, physical and emotional abuse and parental care, current perceived social support, support experienced from the surgeon and breast and ward nurses, and current emotional distress. Logistic regression analyses and covariance structure modeling tested the dependence of perceived professional support on childhood abuse and care, current social support and, as covariates, emotional distress and age. RESULTS: Good professional support was experienced most by patients who recalled no abuse and currently good social support generally. Professional support was also associated with recalling good parental care, but this relationship was mediated by the association of parental care with general social support. CONCLUSIONS: Patients’ ability to obtain and experience support from clinical staff at the time of diagnosis and surgical treatment for breast cancer is influenced by their experience of close relationships in childhood. Lack of parental care compromises adult supportive relationships in general. Abuse specifically reduces support from clinical staff. ACKNOWLEDGMENTS. The study was supported by CRUK.

225 Impacts of a Camping Experience for Children With Cancer Versus Their Siblings Wellisch DKa, Belin TRa, Weinstein Ka, Wiley FMb, Crater Bc a Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, USA; bPediatrics, David Geffen School of Medicine at UCLA, Los Angeles, USA; cCamp Ronald Mcdonald for Good Times, Los Angeles, USA PURPOSE: To evaluate the impacts of a summer camping experience on children with cancer and their siblings in terms of affective reactions and

Copyright # 2006 John Wiley & Sons, Ltd.

retaining a sense of pleasure in the experience over time. METHODS: Design: Patients and siblings were assessed prior to camp(baseline), at end of camp(follow up-1), and again 4–6 months later (follow up-2). INSTRUMENTS: Children’s Depression Inventory (affect), Youth Self Report Scale(social competency), and Things You Did At Camp (activities and satisfaction). RESULTS: 66 children were assessed, including 31(47%) patients and 35(53%) siblings. Ages ranged from 7 to 17 years. 19(61%) of patients had leukemia or lymphoma and 12(39%) had solid tumors. Marked changes in affective symptoms were shown for patients(improved) but not for siblings. These changes for patients were not present immediately after camp but were significant when measured 4–6 months later. Both patients and siblings reflected the same positive memories and pleasure in camp activities over time, and these did not fade for either group over time. 12 campers (18%) indicated suicidal ideation. They did well at camp and presented no special management issues. CONCLUSIONS: The camping experience affected patients differently than siblings, reflecting improved mood in patient’s but not in siblings. This, however was not immediate for patient’s but was a delayed reaction. Camper’s with suicidal ideation did well with the experience and presented no special management problems. Pleasure with camp activities was equal for patients and siblings.

226 Evaluating the Impact of Chronic Illness Using the Impact on Family (IOF) Scale Williams Aa, Williams PDb, Piamjariyakulb, Cabanela RLa, Bruggeman SKa a Health Care Policy & Research, Department of Health Sciences Research, Mayo Clinic Rochester, MN, USA; bKansas University School of Nursing, Kansas University Medical Center, Kansas City, KS, USA PURPOSE: Study purposes were to: (1) validate the 15-item Revised Impact on Family (IOF) scale (Stein & Jessop) and (2) examine whether IOF scale means were similar for families with children having a diagnosis of cancer, cystic fibrosis, diabetes, spina bifida, or developmental disabilities. The earlier 22-item IOF was found to have poor psychometric properties (Williams et al., Journal of Pediatrics, 2003). IOF mean scores of mothers grouped by the 5 diagnoses are compared

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to assess whether a ‘noncategorical approach’ to family intervention, suggested by IOF developers, is supported by no statistically significant differences between means and variances. METHODS: The psychometric properties of the Revised IOF scale were examined using factor analyses and Item Response Theory (IRT), n ¼ 252 families. Comparisons of IOF mean scores of grouped subjects were done using ANOVA. RESULTS: Exploratory factor analysis and confirmatory factor analysis identified a single factor (47% of the variance) with factor loadings similar to those reported by Stein and Jessop (2003). The IRT analysis showed that 11 of the 15 items had alphas greater than 1.00 with good item characteristic and item information curves. The ANOVA showed no differences among the Revised IOF scores of the 5 groups. CONCLUSION: The validity and reliability of the Revised IOF scale are strongly supported. Study findings also suggest that a noncategorical approach to the psychosocial concerns of families may be possible, even if illnesses, disabilities, and treatments differ. The new IOF is user friendly, and may be usable in clinic settings.

227 Symptom Monitoring and Dependent Care During Cancer Treatment of Children Williams PDa, Schmideskamp Jb, Ridder ELb, R. Williams ARc a Professor, University of Kansas School of Nursing, Kansas City, KS, USA; bAdvance Practice Registered Nurse, Kansas University Medical Center, Kansas City KS; USA; cChair, Division of Health Care Policy & Research, Mayo Clinic, Rochester, MN, USA PURPOSE: This pilot study reports (1) on-going efforts to modify the Therapy Related Symptom Checklist (TRSC) for children (called the TRSCC) and (2) caregiver strategies used to alleviate symptoms of children during chemotherapy. The TRSC has been used to monitor adult oncology patients’ symptoms by self-report; TRSC scores correlate highly with both the Karnofsky scale and FACT-G (r > 0:60). The TRSC-C is now being piloted for use with children. METHODS: The TRSC-C contains changes in vocabulary, presentation of items, and item response choices. This piloted study involved 11 parent/caregiver–child dyads. Mean age of the child in each dyad was 10.4 years (SD 6.1). Male children were 45% of

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study sample. Strategies in which the caregiver and child engaged to alleviate symptoms (dependent care) were recorded by researchers. The Karnofsky scale was completed by clinicians for each child. FINDINGS: Parents/ caregivers were able to use TRSC-C with their children to record symptoms. No difficulties were encountered in completing the symptom checklist. The TRSC and Karnofsky scores were inversely related, as expected. All children reported experiencing nausea. Symptoms rated as ‘very severe’ were feeling sluggish (fatigue), pain, hair loss, fever, sore mouth, sore throat, difficulty swallowing, and loss of appetite. Care strategies that helped alleviate symptoms were distraction, massage, mouth rinses, and vitamins. Some children received medications for pain, nausea, and vomiting. CONCLUSION: Systematic assessment of symptoms with TRSC-C can help clinicians identify and prioritize interventions. Dependent care strategies help reduce reported symptom concerns.

228 The Expressive Activities: A Different Way of Communication Cini Ra, Dolcetti Gb, Nirensztstein Sc, Mulinacci Ed, Bassanese Ne a Expressive Activities Vice-President Associazione ‘La Finestra’, Firenze, Italia; bExpressive Activities CRION- CSPO, Firenze, Italia; cExpressive Activities CRION – CSPO, Firenze, Italia; dDH Oncologico ASL 10}Ospedale S. M. Annunziata, Firenze, Italia; eDH Oncologico ASL 10}Ospedale Careggi, Firenze, Italia The communication illustrates the activity of the Voluntary Association ‘La Finestra’ that provides workshops of expressive activity and of nonconventional therapy offered to oncology patients, families and operators in this area. The Association has developed his activity at the Oncological Day Hospital of S.M.Annunziata Hospital of Ponte a Niccheri (Bagno a Ripoli}Firenze) providing groups of Music Therapy of body consciousness by using the Feldenkrais method, and of visualisation and expressive activities with colours and creations. Those groups have been attended by oncology patients followed by the DH with the participation of the ASL 10 of Florence. Since May 2005 the Association promotes Music Therapy and Expressive Activities workshops for the CRION (Oncological Rehabilitation Center)

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of Florence. In particular, regarding the technique of the expressive activities, we have collected some work in CDs done by the patients, through which we can better understand the sense of this activities and individuate the contents that stand out in this group experience. Here we expose the reasons of this choice, the methods of treatment, with the results until know reached, and at the end the future expectations of the Association in collaboration with CRION.

229 Does a Knowledge of Prognosis Influence the Will to Live and Willingness to Have Treatment of Ovarian Cancer Patients? A Longitudinal Study Clavarino Aa, Webb Pb, Doecke Jb, Loos Cb, Green Ab a School of Population Health University of Queensland, Brisbane, Australia; bCancer and Population Studies Group Queensland Institute of Medical Research, Brisbane, Australia PURPOSE: Ovarian cancer commonly has a poor prognosis. This study examines the effect of patient perceptions of information provided by doctors on will to live and willingness to have treatment among ovarian cancer patients. METHODS: Prospective study of ovarian cancer patients; a group of newly diagnosed women (n ¼ 74) and a group of women who had relapsed (n ¼ 48), were followed at approximately monthly intervals. The data presented here are for the first year of followup. All women were asked their perception of what the doctor told them about prognosis (curable, not curable, no discussion of curability, don’t know). They were also asked questions about their will to live, and willingness to have treatments. RESULTS: Initial repeated measures analysis showed that both will to live and willingness to have treatments changed over time. After adjusting for covariates there was no significant difference between groups on will to live. However, relapsed patients were significantly less willing to have treatments (p ¼ 0:046). When women were grouped on the basis of perception of prognosis, women who reported being informed their cancer was incurable reported a significantly lower will to live and willingness to have treatment over time than did women in the other three groups (respectively p ¼ 0:019 and p ¼ 0:031 after adjustment for covariates). CONCLUSIONS: What doctors say about prognosis may have a continu-

Copyright # 2006 John Wiley & Sons, Ltd.

ing influence on willingness to live and have treatment. The findings raise questions about the nature of discussions of prognosis and truth telling.

230 Patient Preference for Prognostic Information After Potentially Curative Esophagectomy De Haes Ha, Franssen SJa, Lagarde SMb, Van Werven JRb, Smets EMAa a Medical Psychology Academic Medical Centre Amsterdam the Netherlands; bSurgery Academic Medical Centre Amsterdam The Netherlands INTRODUCTION: After potentially curative esophagectomy, over 60% of esophageal cancer patients die of a recurrence. When respecting their autonomy, patients should be informed about disease and prognosis. Still, some may not prefer to receive such information. This study’s aim was to investigate preference for prognostic information among patients undergoing esophagectomy and to identify factors predicting such preference. METHODS: Consecutive patients having undergone potentially curative esophagectomy over the past two years without evidence of recurrence were approached by mail. Clinical characteristics were collected from records. Socio-demographic characteristics, trust in doctors (TRUST), anxiety and depression (HADS) were assessed using a written questionnaire. Predictors were established in multivariate analyses. RESULTS: Of 109 eligible patients, 83% returned the questionnaire. Most (92%) wanted to know their general prognosis. Not wanting information was unrelated to clinical characteristics (tumor stage, complications), but was related to having less trust (p ¼ 0:02). Only 76% wanted to know their chance of recurrence within one year. Not wanting information was related to having less trust (p ¼ 0:03) and depression (p ¼ 0:02). Most patients (67%) want their doctor to initiate discussion of prognosis, others prefer to initiate discussion themselves or not to address prognosis. This was again related to having less trust (p ¼ 0:03). CONCLUSIONS: After esophagectomy, most patients prefer to know their prognosis. Less patients wanted information when getting more specific. Interestingly, wanting prognostic information was not related to clinical, but rather to psychological factors. Future studies should address tailoring information to individual patients’ needs.

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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231 Physicians Needs: Can We Talk About Them? Greco M, Brunelli C, Tamburini M Psychology Service, National Cancer Institute, Milan, Italy PURPOSE: In literature little is said about physician needs, being attention mainly focused on the bourn-out syndrome or on communication skills. The present study is aimed at developing a new instrument to evaluate the physician needs in his daily working activity. METHODS: After open and semi-structured interviews and pretesting carried out with physicians, the Needs Evaluation Questionnaire-Medical Doctor (NEQMD) was developed. It covers four areas: relationship with patient, with institution, with team, with oneself. The need for each statement (item) is the difference between current and desired state, both measured on 0–10 scale. The final version was administered to the medical staff of the National Cancer Institute of Milan for validation. RESULTS: 264 physicians compiled the NEQ-MD (90% compliance). Construct validity examined through multitrait scaling analysis confirmed the presence of four scales: relationship with the patient, collaboration with the patient/family, relationship with the institution, relationship with the e´quipe. Both test–retest reliability and internal consistency of the scales emerged showed to be good, with intraclass correlation coefficients ranging from 0.83 to 0.59 and Cronbach alpha values from 0.72 to 0.83. The institutional items showed the highest level of needs while the lowest ones are concentrated in the areas of relationship with the patient and with oneself. CONCLUSIONS: The NEQ-MD showed to be a valid and reliable instrument to be used by the oncological institutions with two important expressed aims: to know physician needs in order to satisfy them and to work on his wellness and human formation.

232 Meaning of Hope and Preferences for Communicating Hope in the Prognosis in the Metastatic Cancer Setting Hagerty RGa, Butow PNa, Ellis Pb, Pendlebury Sc, Lobb EAd a Medical Psychology Research Unit, University of Sydney, Sydney, Australia; bDepartment of Medical Oncology, Regional Cancer Centre, Ontario,

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Canada; cDepartment Radiation Oncology, Royal Prince Alfred Hospital, Sydney, Australia; dCentre for Cancer and Palliative Care, Edith Cowan University, Perth, Australia AIM: To explore preferences among patients with a diagnosis of incurable metastatic cancer for hope-giving behaviours when discussing prognosis, the meaning of hope in this context and patient’s own definition of hope. PARTICIPANTS: 126 recently diagnosed metastatic cancer patients attending follow-up appointments with one of 25 oncologists at 12 outpatient clinics. METHOD: A review of the literature of the meaning of hope in the cancer setting was conducted. Patients completed a survey eliciting preferences including for what type and manner of presentation by their oncologist they would find most and least hope giving when discussing prognosis; their definition of hope and general influences of feelings of hopefulness. RESULTS: It was found that the concept of hope has been difficult to define and measure. 78% of participants wanted their prognosis given in an ‘optimistic’ way and 97% in a ‘realistic’ way. Of three hope components identified; the most strongly endorsed style was the ‘Expert/positive/ collaborative’ approach. The most common definitions of hope described by participants were related to the themes of quality of life and the setting and achievement of personal goals and the least common were the themes of treatment or cure. CONCLUSIONS: Hope is a difficult concept to define and measure. The majority of patients reported prognostic information delivered in a realistic, individualised and expert manner was most hope-giving. Patient definitions of hope were most often related to quality of life, and the setting and achievement of personal goals.

233 To Communicate With the Patient: Putting the Subjective Experience of the Doctors in the Spotlight Katz Ma, Cestelli Ca, Miccinesi Gb a Psychology Center for Study and Prevention of Cancer, Florence, Italy; bEpidemiology Center for Study and Prevention of Cancer, Florence, Italy PURPOSE: To offer a training model to communicate in an oncological setting, which educates the doctors to be aware of their own emotions by means of putting the subjective experience of the

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doctors in the spotlight and utilising the group of peers as a resource. METHODS: 61 doctors were proposed for the training by 65 directors of oncology, haematology and radiotherapy units. They came from various regions of Italy and were distributed into six groups. The training lasted 8 months, with an initial two-day residential meeting and 4 successive four-hour bimonthly meetings. Problems related to the clinical practice were shared and discussed by the group according to a revised version of the Buckman protocol, and specific objectives were worked on by each doctor throughout the process. The impact of the training is described through quantitative and qualitative data. RESULTS: The participating doctors were classified according to their answers to a questionnaire on communicative style, derived from that proposed by the Emanuels in 1992. The questionnaire was administered at the beginning and at the end of the training. 41 doctors who were classified as ‘paternalistic’ at the beginning moved towards a more psychological style during the process, as did the 21 ‘advocates of patient autonomy’ (30 and 55% at the end, respectively). The qualitative analysis confirmed the impact that the relationship with the patient had on the doctor and the importance of sharing this with peers. CONCLUSIONS: To communicate is not only a matter of communicative skills. The doctor’s ability to be in tune with the relational needs of the patient is positively influenced by means of realizing the impact of that relationship on the doctor in the context of the group of peers. ACKNOWLEDGEMENTS: The study was made possible thanks to the sponsorship of TEVA PHARMA.

234 Factors Influencing Physicians’ Detection of Cancer Patients’ and Relatives’ Distress: Can a Communication Skills Training Program Improve Physicians’ Detection? Merckaert Ia,b, Libert Yc, Delvaux Na,d, Reynaert Ce, Razavi Da,b a Internal Medicine Institut Jules Bordet, Brussel, Belgium; bPsychosomatics and Psycho-Oncology Research Unit Universite´ Libre de Bruxelles, Brussel, Belgium; cHuman Ressources Institut Jules Bordet, Brussel, Belgium; dPsychology Unit Hopital Erasme, Brussel, Belgium; eClinique de Mont Godinne Universite´ Catholique de Louvain, Mont-Godinne, Belgium

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PURPOSE: The purpose of this study was to assess the impact on physicians’ assessment of patients’ and relatives’ distress of participation to six 3-hour consolidation workshops (CW) following a 2.5-day communication skills basic training program (BT) and to investigate communication factors associated with physicians’ detection distress. METHODS: Physicians, after the BT, were randomized to CW or to a waiting list. Interviews with a cancer patient and a relative were recorded. Physicians’ detection of patients’ and relatives’ distress was measured through computing differences between physicians’ ratings of patients’ and relatives’ distress (VAS) and patients’ and relatives’ self-reported distress (HADS). Communication skills were analyzed according to the CRCWEM. RESULTS: Mixed-effects modeling of physicians’ detection of patients’ distress showed a positive group by time effect in favor of physicians who were randomized into the consolidation workshops. Physicians’ detection of patients’ distress was associated negatively with patients’ distress, positively with physicians’ concurrent use of psychological assessment skills and of supportive skills, and negatively with physician’s use of general assessment skills. Mixedeffects modeling of physicians’ detection of relatives’ distress showed meanwhile no significant group by time effect. Physicians’ detection of relatives’ distress was associated negatively with relatives’ distress and with physicians using general assessment skills. CONCLUSION: Consolidation workshops following a 2.5 day basic training program are needed in order to improve physicians’ detection of patients’ distress in threeperson interviews. Results of this study indicate moreover the need to further improve physicians’ detection of relatives’ distress.

235 Coping Strategies in Long-term Cancer Survivors Zucca AC, Boyes AW, Girgis A, Lecathelinais C Centre for Health Research & Psycho-oncology, The Cancer Council NSW, University of Newcastle & Hunter Medical Research Institute, Newcastle, Australia PURPOSE: Coping strategies are important factors governing the relationship between cancer-related challenges and their impact on psychosocial outcomes. Long-term cancer survivors continue to face many challenges in their daily lives, yet little is known about coping in this

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population. This presentation reports on the prevalence and predictors of coping strategies, and the relationship between coping and psychosocial outcomes in long-term cancer survivors. METHODS: A population-based sample of 863 cancer survivors five to six years post-diagnosis returned a survey assessing psychosocial sequelae, coping strategies and patient, disease and treatment characteristics. Coping strategies were assessed via the 29 item mini-Mental Adjustment to Cancer scale, which consists of five subscales: Helpless/Hopelessness, Anxious Preoccupation, Fighting Spirit, Cognitive Avoidance and Fatalism. RESULTS: Helpless/Hopelessness was the least used coping strategy with 49% of survivors scoring zero on this subscale. The most commonly used coping strategies were fighting spirit (mean ¼ 56:9 units) and fatalism (mean ¼60:0 units). Logistic regressions identified a number of consistently significant predictors of coping strategies including age, employment status, treatment ever received and social support. All coping strategies were consistently associated with poor psychosocial outcomes, including the subscale fighting spirit, which is typically associated with good psychosocial outcomes. CONCLUSIONS: Survivors continue to engage in cancer-specific coping strategies years after diagnosis. Consistently significant predictors of coping suggest there are specific groups of survivors at risk of negative outcomes who can be identified early and offered support. Possible interpretations for the association between engaging in fighting spirit and experiencing poor psychosocial outcomes will be discussed.

236 Prioritization of Elder-Specific Coping Issues Faced By Seniors With Cancer Boyle DA Gero-Oncology & Survivorship Nursing Studies Program Banner, Good Samaritan Medical Center Phoenix, AZ, USA In developed countries globally, the elderly bear a disproportionate burden of cancer. More than 60% of all malignancies occur in those over age 65 years. This subset also represents the largest developmental cohort of cancer survivors. Yet older adults have systematically been ignored in research initiatives targeting physical, psychosocial and familial sequelae of cancer. Similar to the young, the elderly have unique age-specific issues

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that directly impact coping with a potentially lifethreatening illness. These issues effect coping across the entire cancer trajectory. However, in the absence of investigation into gero-oncology indices of distress, evidence-based interventions are lacking. Generic assessment and diagnostic scales are frequently utilized to measure psychosocial needs in the older adult with cancer. Yet, these scales may lack sensitivity to capture agespecific domains of concern to the older adult and their family. This presentation will delineate findings from instrument design relative to the ‘Elder Coping With Cancer Scale (ECCS)’. This tool addresses thematic domains pertinent to the older adult facing cancer extrapolated from the literature. These major domains include cumulative loss, depression, cognitive and neurosensory changes, isolation, ageism, caregiving burden, social support network changes, functional decline, cumulative anxiety, spirituality, and survivor guilt. Results of pilot testing and psychometric analyses will be shared based on sampling from community-based cancer settings. The ultimate goal of this tool’s development is to create an agesensitive, reliable assessment measure that can be used to serially screen for psychosocial issues across the entire cancer trajectory.

237 Social Adjustment in Chinese Women Following Breast Cancer Surgery Fielding Ra,b, Lam WWTb,c, Chan Md, Or Ad a Community Medicine, The University of Hong Kong, Hong Kong, SAR; bCentre for PsychoOncology Research & Teaching University of Hong Kong, Hong Kong, Hong Kong, SAR; cThe Nethersole School of Nursing, Chinese University of Hong Kong, Hong Kong, Hong Kong, SAR; d Breast Centre, Department of Surgery, Kwong Wah Hospital, Hong Kong, Hong Kong, SAR PURPOSE: To describe the course of social adjustment among Chinese women following breast cancer surgery and to identify factors predicting the adjustment. METHODS: Prospective study of 405 Chinese women assessed at 3 days, one-month, four-months, and eight-months following breast surgery on measures of treatment decision making difficulty (TDMD), self-efficacy (GeS), optimism (C-LOT-R), consultation satisfaction (C-MISS-R), expectancy-outcome incongruence (E-OI), social adjustment (SAS) physical (PD) and psychological distress (CHQ-12).

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RESULTS: 303 women completed all data collection. With the exception of the subscale measuring Attractiveness & Sexuality (AS), the subscales of SAS}Family Relationship, Self-image, Relationships with Friends, and Social Enjoyment showed significant changes over time. Self-image (F ¼ 3:58; df 2, p ¼ 0:029) and Social Enjoyment (F ¼ 26:89; df 2, p50.001) improved whereas Family Relationship (F ¼ 26:19; df 2, p50.001) and Relationships with Friends (F ¼ 3:61; df 2, p ¼ 0:028) declined significantly over the illness trajectory. One-month social adjustment (Adjusted R2 ¼ 0:23) was predicted by baseline psychological distress, self-efficacy, consultation satisfaction, and optimism; four-months social adjustment (Adjusted R2 ¼ 0:27) was predicted by psychological distress, self-efficacy, consultation satisfaction, optimism, and E-OI; eightmonths social adjustment (Adjusted R2 ¼ 0:17) was predicted by psychological distress, selfefficacy, physical symptom distress, and TDM difficulties. CONCLUSION: Self-image and enjoyment of social activity improves over the 8 months post-surgery. Social relationship however declines over time, probably from a peak around the time of diagnosis. Women distressed at Baseline are at increased risk of poor social adjustment following breast cancer surgery for up to 8 months thereafter.

238 Predictors of Psychosocial Outcomes and Supportive Care Needs in Cured Cancer Survivors Hodgkinson Ka, Butow Pb, Hunt GEa, Wain Gc a Department of Psychological Medicine, University of Sydney, Sydney, Australia; bMedical Psychology Research Unit, University of Sydney, Sydney, Australia; cDepartment of Gynecological Cancer, Westmead Hospital, Westmead, Australia PURPOSE: The population of cancer survivors continues to increase, although our understanding of psychosocial adaptation and supportive care needs following active treatment is limited. METHODS: A prospective study was conducted to identify predictors of psychological outcomes and needs in newly diagnosed cancer patients who were expected to survive >1 year. Patients completed self-report measures of demographic, disease and psychological variables within 6 months of diagnosis (Time 1), 6–12 months post diagnosis (Time 2), and at 12–24 month follow-up (Time 3). Survivors’ care needs were assessed at

Copyright # 2006 John Wiley & Sons, Ltd.

follow-up to facilitate the formulation of empirically based clinical care recommendations. RESULTS: 409/640 patients participated at Time 1 (64% response rate), 322/409 at Time 2 (79% response rate), and 279/365 at Time 3 (76% response rate) (some participants did not complete at Time 2 but completed at Time 3); 256 patients completed all 3 assessments and were included in the analysis. 35% of participants had been diagnosed with breast cancer, 24% with prostate cancer, 26% with gynecologic cancer and 15% with other disease sites; 67% were female. Depression, anxiety, posttraumatic stress disorder, adjustment to illness, perception of life threat, relationship functioning and quality of life over the first year of survival will be presented. Predictors of psychosocial distress and care needs at follow-up will be identified. CONCLUSIONS: Findings will be discussed in relation to theoretical models of adaptation and service needs. ACKNOWLEDGEMENTS: This research was supported by the NHMRC and NSW Institute of Psychiatry, Australia.

239 Is it Hopelessness or a Hopeless Prognosis: Quantitative and Qualitative Findings on Hopelessness in Individuals with Advanced Cancer Nissim R, Rodin G Psychosocial Oncology and Palliative Care Program, Princess Margaret Hospital, Toronto, Canada INTRODUCTION: A diagnosis of terminal illness in often labelled as one with a ‘hopeless prognosis,’ where there is ‘no hope’ for cure. Thus, it is often assumed that an individual who has a terminal illness would, by default, endorse hopelessness. We sought to clarify the construct of hopelessness in the context of advanced cancer using a mixed-method approach. METHODS: Data were collected from 318 outpatients with stage IV gastrointestinal and lung cancer, attending Princess Margaret Hospital in Toronto, Canada. All participants (n ¼ 318) completed the Beck Hopelessness Scale (BHS; Beck et al., 1974) as part of a questionnaire battery assessing psychosocial adjustment to metastatic cancer. A sub-sample (n ¼ 20), with a range of hopelessness scores, was recruited for a qualitative (grounded theory) interview study. RESULTS: Results of the quantitative study indicated that majority of participants maintained optimism, with 24%

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reporting elevated levels of hopelessness (BHS > 8). However, a qualitative investigation revealed important within-group differences between individuals with comparably elevated BHS scores; distinguishing between loss of hope, and readjustment of hope to a poor medical prognosis. This finding inspired a factor analysis of the BHS in our sample (WLS, Promax), which identified a two-factor solution, distinguishing between two elements: The first is a sense of resignation and ‘giving-up’; the second is negative expectations for the future. CONCLUSIONS: The qualitative analysis and subsequent quantitative factor analysis both highlighted the difference between awareness of a ‘hopeless’ prognosis and feeling a psychological loss of hope and helplessness.

240 Hopelessness In Turkish Cancer Inpatients: The Relation Of Hopelessness With Psychological And Medical Outcomes O¨nen Serto¨z O¨a, Kuzeyli Ya, Yasemin Mb, C¸ic¸ek Lb, Uyar Mc a Psychiatry, Ege University School of Medicine, Zmir, Turkey; bInternal Medicine, Ege University School of Nursing, Zmir, Turkey; cAnesthesiology and Reanimation, Ege University School of Medicine, Zmir, Turkey OBJECTIVE: The aim of the study was to evaluate the relation between hopelessness and psychological–medical outcomes of cancer inpatients. METHOD: Total of 95 patients with cancer recruited to current study. Beck Hopelessness Scale (BHS), Hospital Anxiety Depression Scale (HAD) were used. RESULTS: Mean age of the sample was 47.64  1583 years. Sixty one percent of the patients were taking opiate analgesic medication for their pain. Fifty nine (62.1%) patients had metastasis and 60% of the sample had stage four disease. Patients who have pain had advanced disease by means of disease stage and occurrence of metastasis than the ones who have no pain (respectively, p ¼ 0:019; p ¼ 0:030). Levels of hopelessness, and anxiety were statistically higher in patients with pain than the patients without pain (p ¼ 0:047; p ¼ 0:016) but no difference was found in terms of depression (p ¼ 0:052) and duration of illness (p ¼ 0:665). Positive correlation was found between hopelessness and anxiety (r ¼ 0:645; p50.001), hopelessness and depression (r ¼ 0:721; p50.001) but not between hopelessness and pain severity (rs ¼ 0:179;

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p ¼ 0:08), hopelessness and duration of illness (r ¼ 0:055; p ¼ 0:598) and hopelessness and disease stage (rs ¼ 0:278; p ¼ 0:06). To determine the effect of depression and anxiety on hopelessness regression analysis was performed. Depression level was found to affect hopelessness (t ¼ 4:633; p50.001). CONCLUSION: Depression seems to be the major factor that affects hopelessness in cancer inpatients.

241 Prospective Evaluation of the Psychological Well Being in Patients with Locally Advanced Rectal Cancer Treated with Neoadjuvant Radio-chemotherapy and Surgery Serpentini Sa, Belluco Gc, Zotti Pd, Del Bianco Pb, Pucciarelli Sa a Dipartimento Scienze Oncologiche e Chirurgiche, Clinica Chirurgica, II Azienda Ospedaliera/Universita` di Padova, Padova, Italy; bServizio Sperimentazioni Cliniche e Biostatistica Istituto Oncologico Veneto di Padova, Padova, Italy; c Dipartimento di Salute Mentale ULSS 18 di Rovigo, Rovigo, Italy; dDirezione Sanitaria Istituto Nazionale Tumori, CRO Aviano (PN), Italy PURPOSE: Complementary radio–chemotherapy regimen in combination with surgery is always more frequently used in the treatment of rectal cancer patients. This approach seems to improve the prognosis but the impact of this strategy on the quality of life (QoL) and on the intestinal and sphincteral functioning of treated patients is still unknown. The aim of the present study is to prospectively evaluate the changes in the psychological well being in patients with rectal cancer, who received radiochemotherapy (RCT) followed by curative surgery. METHODS: This is a prospective multicenter observational study ongoing since April 2003. The instrument used is the Psychological General Well-being Index; it is administered 5 times: T0, at diagnosis; T1, between the 2nd and 3rd week following RT–CT treatment; T2, T3 and T4, at 6–12–24 months after surgery, respectively. RESULTS: Up to now, we have enrolled 141 patients (mean age: 62.7, range age: 29–84) with 141 T0, 118 T1 and 70 T2 questionnaires available. The anxiety score shows a significant improvement following RT–CT treatment (p ¼ 0:0102) and at 6 months after surgery (p ¼ 50:0001) versus basal evaluation; depressed mood and well-being result significantly better at T2 (p ¼ 0:0196; p ¼ 0:0023); vitality

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decreases after RT–CT treatment (p ¼ 0:0069). Finally, the overall index score results significantly higher at 6 months after surgery (p ¼ 0:0286) versus basal score. CONCLUSIONS: The results of this study indicate that the patients with rectal cancer treated with RCT and surgery present a significant improvement of psychological wellbeing 6 months after surgical intervention.

ment introduce a wide range of stressors, that extend well beyond depression and emotional distress}the most commonly identified problems. Inasmuch as stressors compromise psychological well-being and usually precede onset of depression, it would be useful to screen broadly for such exposures and to introduce psychosocial treatments when patients are still at risk. ACKNOWLEDGEMENTS: Funded by Canadian Institutes of Health Research.

242 Epidemiology of Cancer-Related Stressors in Headand-Neck vs Other Cancers Devins Ga,b,c, Lebel Sa,c, Wong Aa,c, Mah Ka, Lee Rd,e a Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, Toronto, Canada; b Ontario Cancer Institute, Toronto, Canada; c Faculty of Medicine, University of Toronto, Toronto, Canada; dNursing Hamilton Health Sciences Centre, Hamilton, Canada; eNursing University of Toronto, Toronto, Canada PURPOSE: To examine the frequency of exposures to diverse cancer-related stressors and identify patient, disease, and contextual factors associated with their distribution. METHODS: 470 cancer outpatients (N ¼ 252 head and neck; 218 other cancers) completed the Cancer-Related Stressors Checklist, a self-report instrument that taps exposure to 8 domains of cancer-related stressors-disease and treatment; existential; interference with life; interpersonal; lack of information; stigma; subjective distress; and uncertainty} and measures of emotional distress, happiness, and illness intrusiveness. RESULTS: Exposures to cancer-related stressors varied widely across domains: uncertainty and interpersonal stressors occurred most frequently; existential, lack of information, and stigma occurred least frequently. These differences varied significantly as a function of cancer type, ethnicity (Western-born Caucasians vs Asian-born Chinese), sex, employment status, and occurrence of non-cancer stressful life events. Overall, exposures to cancer-related stressors differed with age, education, and number of cancer sites (all ps50.05). Exposures did not differ significantly with marital status, living arrangements, income, new vs recurrent disease, or complexity of treatment. Exposures to cancerrelated stressors correlated significantly with emotional distress, happiness, and illness intrusiveness. CONCLUSIONS: Cancer and its treat-

Copyright # 2006 John Wiley & Sons, Ltd.

243 What Factors Predict Discomfort Associated with Arm Complications After Breast Surgery? A Survey of Women Patients in Japan Horn S, Ingham R, Tsuchiya M Faculty of Medicine, Health and Life Sciences, School of Psychology University of Southampton, Southampton, UK PURPOSE: The aim of this study was to develop a new measure, and use it to examine the relationship between reported discomfort associated with lymphoedema and potential predictors among women with breast cancer in Japan. METHOD: A new questionnaire in Japanese was developed: discomfort was assessed using five point faces scales. The face validity and repeatability were examined (1). Factor analysis on the faces scales extracted one factor (67% of the variance). A cross sectional mail survey was conducted in Japan using the new questionnaire. Of 380, 165 women with breast cancer completed questionnaires. 156 participants’ data were eligible for an analysis. ANALYSIS: Bivariate analyses were performed to examine any differences between the total scores and socio-demographic, breast cancer treatment-related, and clinical history factors. After confounding factors and moderators were checked, Multiple Regression Analysis (MRA) stepwise was performed. RESULTS: The bivariate analyses yielded 4 variables with significant effects on discomfort: information giving at diagnosis, information giving after surgery, loss of strength, and poor range of motion. After MRA, 2 variables, information giving at diagnosis and loss of strength, explained 17% of the variance (F ð2; 91Þ ¼ 9:87; p50.05). CONCLUSION: The results show that reported dissatisfaction with information giving at diagnosis and loss of strength were associated with severe physical discomfort.

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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244 Perceived Barriers in Treatment Decision Making Among Chinese Women Diagnosed with Breast Cancer Lam WWTa,c, Fielding Rb,c, Chan Md, Or Ad a The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong; bDepartment of Community Medicine, The University of Hong Kong, Hong Kong, Hong Kong; cCentre for Psycho-Oncology Research & Teaching, The University of Hong Kong, Hong Kong, Hong Kong; d Department of Surgery, Kwong Wah Hospital, Hong Kong, Hong Kong PURPOSE: To identify barriers Chinese women encountered in making breast cancer treatment decision and to examine impacts on treatment outcome satisfaction and psychological distress. METHODS: Of 430/529 eligible Chinese women undergoing breast cancer surgery in one of six Hong Kong government hospitals, 367 (91%) completed an interview within 1 week after surgery (baseline) and a follow-up interview at one-month post-surgery. At baseline, participants reported barriers in treatment decision making (TDM), satisfaction with consultation, and perceived confidence in making the right decision. At follow-up, participants were assessed on psychological distress (Chinese Health Questionnaire-12) and perceived treatment outcome. RESULTS: The three most common barriers in TDM perceived by women were (1) not knowing what questions to ask in discussing treatment options with the surgeon (44%), (2) not knowing how to ask questions (43%), and (3) not able to think clearly (31%). Compared to women reporting high or complete confidence in having made the right treatment decision, women reporting less confidence reported significantly higher perceived barriers in TDM (p50.001). Perceived barriers in TDM also associated with less satisfaction with consultation (r ¼ 0:30; p50.001), perceived poor treatment outcome (r ¼ 0:32; p50.001), and higher psychological distress (r ¼ 0:34; p50.001). CONCLUSION: Inability to ask questions and think clearly hinder women’s ability in making breast cancer treatment decision, which in turn leads to poorer outcome satisfaction and greater psychological distress. Helping women formulate, or identifying common key questions should help reduce some TDM barriers. ACKNOWLEDGEMENTS: Supported by Grant 213022 from the Hong Kong Government Health

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Care Research Fund and from the Hong Kong Cancer Fund.

245 Lay Theories of Healthy Individuals About Cancer}A Transcultural Comparison Muthny FA, Bermejo I Department of Medical Psychology, University Clinics of Muenster, Muenster, Germany INTRODUCTION: There is a general consensus that subjective theories of illness have some influence on patients’ compliance as well as on the use and the success of medical treatment. While it is generally assumed that lay theories on health and illness differ cross-culturally there are still hardly any empirical findings regarding the extent of these differences nor are there sufficient recommendations towards provision and design of medical treatment. METHOD: Different European cultures were compared with respect to their corresponding views on health and illness, especially with respect to cancer (228 Germans, 103 Spaniards, 100 Greeks and 83 Norwegians). The questionnaire mainly included subjective ratings of the likelihood getting cancer, causal attributions, control beliefs and ratings of treatment effectivity. RESULTS: Cancer patients have illness-related subjective theories, but also healthy individuals do. These theories somehow differ between cultures}even within Europe. The comparison of the four countries shows no significant difference in subjective cancer risk. Greeks and Germans stress the psychoetiology of cancer, Spaniards and Norwegians the somatic causes. People in Spain show the strongest beliefs in treatment efficacy, Greeks the least. Germans expect that internal control beliefs will influence the course of cancer, Norwegians particularly focus on progress of medicine. Finally, it will be discussed what possible implications these cultural differences might have for the German and European health system, especially with regard to medical treatment programmes as well as preventive measures in an increasingly multicultural society.

246 Cancer Patient’s Multiple Needs: Survey During Chemotherapy in Four Medical Oncology Units (MOU) in Cosenza County Piattelli A, Bosco A, Mastroianni CM, Palazzo S

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Oncology Department, Mariano Santo Hospital, Cosenza, Italy In four MOU in Cosenza (Italy) we have evaluated multiple needs of cancer patients during chemotherapy, to increase the knowledge and the attention of the Health Organizations (HO) and to promote in the oncology network the multidisciplinary culture of the care. 195 patients were evaluated simultaneously during one week. The Holland self-assessment screening tools was used (NCCN, v.1.2005), for measuring distress through (1) practical, (2) family, (3) emotional, (4) spiritual/religious concerns and (5) physical problems. Median age was 58 (range 19–84); The main group 44,1% was represented by over 60 years old (yo) patients. The patients were heterogeneous in terms of diagnosis and illness status. Data were analyzed with the SPSS program, (v. 11.5). Section (1) 45.5% of patients had transportation problems, 24.8% with work/school and 26.7% had economic problems; Section (2) 28.6% had problems in dealing with children and 32.1% in dealing with partner. Section (3) 15.5% of patients experienced depression, 14.8% fears, 21.8% nervousness, 18.6% sadness, 21.8% worry; Section (4) 11.5% had fatigue; 8.9% sleep problems. Total level of distress was > 6.91 until 30 yo patients and 55.52 in patients over 60 yo. Results were presented in a press conference in local HO and Scientific Oncologist Society and published in a booklet. Dates make clear that cancer patients during chemotherapy have a prevalence of practical, emotional, and relationship problems instead of treatment and illness related problems, and suggests to the HO a multidisciplinary health team and social service to satisfy their complex needs. Thanks LIONS CLUBS INTERNATIONAL.

247 Cultural Influences on the Practice of Psychosocial Oncology in China: Current Status and Future Directions Tang La, Bultz BDb, Zhang ZWc, De Grout Jb a Department of Psycho-Oncology Beijing Cancer Hospital, Beijing, China; bDepartment of Psychosocial Resources Tom Baker Cancer Centre, and Faculty of Medicine, University of Calgary, Calgary, Canada; cSecretary-General of Chinese Anti-Cancer Association (CACA) SecretaryGeneral of Chinese Anti-Cancer Association (CACA), Beijing, China

Copyright # 2006 John Wiley & Sons, Ltd.

OBJECTIVE: To describe and provide an understanding of how the Asian culture affects the practice and development of Psychosocial Oncology in China. METHODS: Using PubMed, a selective literature review of both English and Chinese language articles was undertaken, to explore the effects of Chinese culture on the practice of psychosocial oncology. The articles were analyzed for themes. RESULTS: The literature review contributed to information describing China’s traditional and changing culture and societal values, views of disease and of cancer, perspectives on death and dying, attitudes to providing cancer-related information to patients and families, the current status of psychosocial oncology in China and suggestions for future directions. Although the Asian values of collectivism, the importance of the family, and of ‘protecting’ the one who is ill remain important, some tensions between traditional Chinese values, current psychosocial research findings, and future directions for psychosocial oncology in China exist. CONCLUSIONS: China has made much progress in developing a national strategy for cancer treatment and prevention that includes attention to psychosocial needs. Health professionals and researchers in China are seeking to enhance collaboration with colleagues from the international psychosocial oncology community of scientists, educators, and clinicians. IPOS is considered an important link to facilitating the growth and development of psychosocial oncology in China.

248 New Directions in Psycho-oncology in North Kerala Venkateswaran Ca, Kumar TMb a Department of Psychiatry, Amrita Institute of Medical Sciences, Kochi, Kerala, India; bConsultant in Liaison Psychiatry, Liaison Psychiatry Service, Becklin Centre, Leeds, UK India, with a population of over a billion people, with varying social, cultural and geographic characteristics has real problems in meeting the health care needs of such a large mass, particularly, the poor in rural areas. Substantial developments have been made in various aspects of health care including the provision of cancer care but the present scene shows that around 2.5 million persons have cancer at a given time. Almost 80% of them reach hospitals in advanced stages of disease. Palliative care as such is in the

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process of establishing itself as an essential specialty and it is of no surprise that psychooncology is a small specialty and not yet accessible to many. In psycho-oncology research interest has been active since the 1970s but only a few organized clinical services exist. PURPOSE: To develop a culturally and socio-economically appropriate and acceptable system of care addressing psychosocial issues along with long-term care needs against the background of the growth of Palliative care as a community movement in Northern Kerala. METHOD: This model is based on integrating training, clinical services and research activities that are linked at several levels, involving volunteers in the community. Training programs on communication skills, psychosocial issues in cancer, psychological interventions, research activities on screening tools, initiating clinical services have been the initial steps. RESULTS: Improvement in areas of awareness, identification of psychosocial issue, establishing core groups and specialists within teams, developing curriculum, initiating continuous training programs and research projects.

249 Concurrent Validity of the Distress Thermometer with Other Validated Measures of Psychological Distress Adams CAa,b, Carter GLa,b, Clover KAa,b a Psycho-Oncology Service, Newcastle Mater Misericordiae Hospital, Newcastle, Australia; b Centre for Mental Health Studies, University of Newcastle, Newcastle, Australia PURPOSE: Clinical practice guidelines recommend routine screening for psychological distress in cancer patients. This study examines the validity of the single item Distress Thermometer (DT) against the Hospital Anxiety and Depression Scale (HADS), the Somatic and Psychological Health Report (SPHERE}12), and the Kessler Psychological Distress Scale}10 (K10), all of which have established cut-off scores. METHODS: Subjects (n ¼ 350) were patients attending a major regional cancer centre in NSW, Australia. Measures of evaluation and agreement were calculated using the DAG-STAT program. HADS probable anxiety (HADS-A), probable depression (HADS-D), and total score (HADS-T), SPHEREPSYCH, SPHERE-SOMA and K10 provided the ‘gold standards’. RESULTS: Sample; mean age 60 years (SD ¼ 12), 47% (n ¼ 165) female, 61%

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(n ¼ 214) on active treatment. ROC curve analyses of DT scores yielded significant (p50.001) area under the curve estimates relative to HADS, SPHERE-PSYCH, and K-10 indicative of good overall accuracy. A cutoff score of 4 for the DT had acceptable sensitivity (0.84–1.0), specificity (0.58–0.71), positive predictive value (0.16–0.58), negative predictive value (0.90–1.0), and reasonable Kappa’s (slight to moderate agreement) relative to the other measures scores except SPHERE-SOMA. CONCLUSIONS: The DT is a useful single item screen for psychological distress in cancer patients. Its agreement with other widely used measures is acceptable. It is more accurate in identifying psychological than somatic distress. Scores under four can be used with confidence to rule out psychological distress.

250 Using Different Screening Modalities to Assess for Anxiety and Depression Amongst Cancer Patients Chauhan Da, Sharpe La, Clarke Sb, Thewes Bc, Rickard Jc a School of Psychology, University of Sydney, Sydney, Australia; bDepartment of Medicine Concord Hospital, Sydney, Australia; cDepartment of Medical Oncology, Prince of Wales Hospital, Sydney, Australia PURPOSE: Patients diagnosed with cancer experience varying levels of psychological distress, with research indicating that upto 50% of patients experience psychological disorders such as anxiety and depression. With increasing awareness and implementation of psychosocial care within oncology health care settings arises a need for brief and valid screening measures. Currently self report questionnaires are the most common screening tool used in oncology services. The current study investigates the validity of the Vulnerability Index (VI), comprised of risk factors to psychological distress, as a screening tool to identify patients with clinically significant anxiety and depressive disorders (clinician administered and self report). METHODS: Ninety-four patients, over 18 years, diagnosed with breast cancer and patients with colorectal cancer participated in the current study. All participants were recruited following surgery. Participants completed other questionnaires frequently used to identify distress (HADS, Distress Thermometer; SPHERE) and a self report version of the VI. They also participated in a structured clinical interview and clinician administered VI.

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RESULTS: Results from the breast cancer patients indicated that the clinician-administered VI was significantly correlated with a diagnosis of anxiety and depression suggesting viability of the risk factors approach. Further data on the reliability and validity of the VI as well as its sensitivity and specificity with colorectal cancer patients will be presented. CONCLUSION: The risk factors approach is a brief way of screening for psychological distress. If found to be valid and cut-offs established, it will assist oncology staff in easily identifying patients likely to be in need of psychological interventions. ACKNOWLEDGEMENT: Cancer Research Fund at the University of Sydney and the Australian Rotary Health Research Fund.

251 Could the SPHERE Substitute for the HADS as a Screening Questionnaire for Referral to a PsychoOncology Clinical Service Clover Ka,b, Carter GLa,b, Adams Ca,b a Psycho-Oncology Service, Newcastle Mater Hospital, Newcastle, Australia; bCentre for Mental Health Studies, University of Newcastle, Newcastle, Australia PURPOSE: The purpose of this study was to explore whether the Somatic and Psychological Health Report (SPHERE) could be substituted for the Hospital Anxiety and Depression Scale (HADS) as a screening tool. The SPHERE screens for common mental disorders and is derived from the General Health Questionnaire (the PSYCH subscale) and the Schedule of Fatigue and Anergia (the SOMA subscale). METHODS: A crosssectional survey of 350 oncology outpatients from a regional cancer hospital in Newcastle, Australia. Measures of agreement with 95% confidence intervals (95% CI) were calculated. HADS probable anxiety (HADS-A), probable depression (HADS-D) and either disorder (HADS A/D) were the ‘gold standards’. RESULTS: Sample: mean age 60 years (SD ¼ 12); 53% male; 61% currently undergoing treatment. HADS scores indicated probable anxiety in 19% and probable depression in 10% of patients (24% had either). On the SPHERE, 32% scored positive on the PSYCH and 54% scored positive on the SOMA. ROC analysis demonstrated significant (p50.001) areas-under-the-curve and a best cutoff of 3+ for the PSYCH. The PSYCH had substantial agreement with HADS-A (kappa ¼ 0:66 (0.56–

Copyright # 2006 John Wiley & Sons, Ltd.

0.75), sensitivity ¼ 0:88 (0.77–0.95), specificity ¼ 0:88 (0.84–0.92) and HADS-A/D. However, agreement with HADS-D was only fair. The SOMA performed poorly against the HADS. CONCLUSIONS: The PSYCH scale is a reasonable substitute for the HADS in this setting with the advantage of fewer questions and free availability. It performed better for anxiety than depression as measured by the HADS.

252 The HAD-S Cut-Off Score In Spanish Cancer Sample Costa Ga, Gil Fa, Salamero Mb, Sa´nchez Nb, Sirgo Ac a Unit of -Oncology, Duran i Reynals Hospital, Barcelona, Spain; bService of Psychology, Psychiatric Institute Hospital Clinic, Barcelona, Spain; c Oncology Deparment, Sant Joan Hospital, Reus (Tarragona), Spain PURPOSE: The HAD-S is currently being used as a screening instrument for assessment of anxiety and depressive symptomatology in cancer patients. The usefulness of HAD-S as a screening instrument for psychological distress depends on the desired cut-off point chosen. METHODS: In order to test the specificity and sensitivity of the HAD-S, Receiver Operating Characteristic (ROC) analysis was performed in order to choose an optimal cut-off point in a sample of 196 cancer out-patients. The cut-off score shows the specificity and sensitivity of psychological instrument. In this study, the main goal is to determine this cut-off point in the total score HAD-S, as a measure of psychological distress, and in each HAD-S subscales (anxiety and depression).We have used the Structured Clinical Interview (SCID) as the standard measure, which determines the possible psychiatric disorder. RESULTS: The sample (N ¼ 196) has a mean age of 54.1 years (s.d. 11.7), and 50.8% of the subjects are female and 49.2% male. The cancer diagnosis are: digestive 24%, breast 20.4%, respiratory 19.2%, genitor-urinary 15.6%, lymphatic and haematology 13.6%, orally and pharynx 3.6%. There are documented metastasis in 18.4% of the patients, 31.2% in loco-regional, 37.2% in local, and 13.2% have no-solid tumour. The prevalence of psychiatric disorders assessed by the SCID was 31% patients. The cut-off and their specificity and sensitivity for the HAD-S will

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be presented in the meeting. CONCLUSION: The HAD-S appears to be a good screening instrument for clinical symptomatology in ambulatory cancer patients.

253 Distress in Men with Prostate Cancer: Modelling the Influence of Somatic Symptoms, Daily Functioning, Coping and Social Support Voerman Ba, Garssen Ba, Fischer Ma, van Andel Gb, Visser Aa a Helen Dowling Institute, Centre for Psychooncology, Utrecht, The Netherlands; bOnze Lieve Vrouwe Gasthuis, Utrecht, The Netherlands PURPOSE: Testing, in a cross-sectional design, the predictive power of somatic symptoms, limitations in daily function, social support and coping styles on distress level. METHODS: Participants were 238 prostate cancer patients in all stages of the disease. Patients filled in a series of standardised questionnaires on psychological distress, health-related quality of life, social support and coping. Various models were tested using path analysis (SEM). RESULTS: Pain, fatigue, bowel problems and insomnia were the strongest predictors for limitations in daily function and distress. Impairment in daily function in turn, predicted high stress levels. Insomnia and fatigue were directly related to distress. The effects of insomnia, pain and bowel problems on distress were (also) mediated through a decline in daily function. Other prostate specific symptoms than bowel problems, such as urinary incontinence and erectile dysfunction had no significant relationship with daily function and distress. Social support appeared to be an important distress-reducing factor. Fatigue and bowel symptoms predicted less social support, which implies another indirect path to increased distress levels. Coping style played a minor role. CONCLUSIONS: The experience of pain, fatigue, bowel problems and insomnia in prostate cancer predicts high levels of distress, directly or indirectly through impairments in daily function and/or lowered levels of social support. Urologists should inform their patients about the effects of treatments, not only on prostate specific symptoms but also on general symptoms, such as fatigue, and on daily functioning. Interventions can be developed targeting daily functioning and social support enhancement in order to reduce distress.

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254 UK Validation of the Distress Thermometer Gessler SFa, Lowe Jb, Daniells Eb, Jones Lb, Tookman Ab a University College Hospital, Gynaecological Cancer Centre, University College Hospitals, London, UK; bMarie Curie Palliative Care Research Unit, Royal Free Hospital, London, UK PURPOSE: Following the recommendation of the National Institute for Clinical Excellence (NICE) for the National Health Service for England and Wales that the psychological state of all patients with cancer should be assessed at key points in the patient journey, the distress thermometer appears ideal for such a wide scale implementation, but requires local norms. This study aims to validate the DT against measures recognised and used in the UK, assess its ability to monitor change over time and assess its acceptability to patients. METHODS: 293 eligible out-patients from oncology clinics at two inner London hospitals are being recruited to complete a battery of questionnaires consisting of the DT, the HADS, the GHQ-12 and the Brief Inventory Symptom 18. They also answer two questions about depression and complete an acceptability questionnaire. Participants are followed up at 4 and 8 weeks. Data will be analysed by constructing a ROC curve and comparing a range of possible scores on the DT with established cut-off scores for identifying clinically significant psychological distress. RESULTS: This study is still recruiting and expects to report by July, when final results can be reported. ACKNOWLEDGEMENTS: This study is funded by Marie Curie Cancer Care.

255 Defining the Construct of ‘Distress’ in Cancer: Development and Validity of the Distress Inventory for Cancer Version 2 Thomas BCa, Thomas Ib, Nanda MVc, Nair MKd, Pandey Me a Department of Psychosocial Oncology, Tom Baker Cancer Centre, Calgary, Canada; bDepartment of Psychology, University of Kerala, Trivandrum, India; cDepartment of Futures Studies, University of Kerala, Trivandrum, India; dS.U.T. Institute of Oncology, Sree Utharadom Thirunal Hospital, Trivandrum, India; eDepartment of Surgical

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Oncology, Institute of Medical Sciences, Banares Hindu University, Varanasi, India PURPOSE: For the past two decades, psychosocial oncology research has increasingly focused on ‘distress’ in the cancer patient. Several studies have shown the detrimental effect of distress on patient behaviour in contexts ranging from cancer screening, clinical trials to treatment and medical outcomes. However, there is a concern that are we asking the right question? Some studies conceptualise distress as synonymous with anxiety and/or depression. Others, incorporate anxiety and depression in distress. Alternatively, could these be mutually exclusive? We present the revised version of the Distress Inventory for Cancer (DIC2), and its reliability and validity in the light of above argument. METHODS: The standardisation sample consisted of 520 cancer patients that were administered the draft distress inventory as well as the Functional Assessment of Cancer Therapy} General (FACT}G). An additional 240 patients were assessed by DIC2, FACT}G and HADS. Internal consistency was measured with the Chronbach’s alpha. Chi-square, odds ratio and binary logistic regression were used to establish the validity. RESULTS: The internal consistency, and construct, convergent/divergent validity of the global distress measure (DI 2) provided evidence that the construct of ‘distress’ as defined by us is distinct from clinical anxiety and/or depression. The DIC2 also demonstrated a predictive function of future negative clinical behaviour, knowledge of which may facilitate better intervention triage. CONCLUSIONS: The DIC 2 is a psychometrically defined tool to measure ‘distress’ in the cancer patient the tool shows high internal consistency and validity. ACKNOWLEDGEMENT: This work comprises part of the doctoral (Applied Science) work of Thomas BC, ‘Modelling Distress in Cancer patients: A Psycho-Futuristic Approach’ submitted to the University of Kerala, India, in August, 2005. Thomas BC, was awarded runnerup position for Hiroomi Kawano New Investigator’s Award, for an early part of this work at the 6th World Congress of Psycho-Oncology, Banff, Alberta, Canada, 2003. The HADS is under copyright and the publisher is: nfer-Nelson, The Chiswick Centre, 414 Chiswick High Road, London W4 5TF, UK, http://www.nfer-nelson. co.uk. Permission was obtained for its translation and use, the translation were approved by the

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copyright owners after examining the back translations. The authors wish to acknowledge the support of Dr Rajan B, Director, Dr Ramadas K, Additional Professor, Dr Rajnish RK, Assistant Professor, Division of Radiation Oncology, and Dr Hussain BM, Assistant Professor, Division of Medical Oncology, Regional Cancer Centre, Trivandrum, for their help.

256 The Cancer Genetic Service Needs and Preferences of Men with a Family History of Prostate Cancer Gaff CLa,b, Cowan Rb,c, Meiser Bd,e, Lindeman GJb a Institute of Medical Genetics, Cardiff University, Cardiff, UK; bFamilial Cancer Centre, The Royal Melbourne Hospital, Melbourne, Australia; c Paediatrics, The University of Melbourne, Melbourne, Australia; dMedical Oncology, Prince of Wales Hospital, Sydney, Australia; eSchool of Psychiatry, The University of New South Wales, Sydney, Australia PURPOSE: Three models of cancer genetic services exist in Australia: genetics-led, oncologyled and multidisciplinary. Men have a lower uptake of cancer genetic services but their needs and preferences have not been ascertained and the utility of existing cancer genetic service models for men with a familial risk of prostate cancer is not known. We sought to determine the information and support needs of these men. METHODS: 504 unaffected men with a family history of prostate cancer (n ¼ 280; 59% response rate) were ascertained through their participation in prostate cancer research studies and administered a survey by post. RESULTS: A third of respondents had 2 or more affected relatives. Twenty-two percent of all respondents felt extremely concerned about their family history of prostate cancer and a substantial proportion (60%) reported having insufficient information about their prostate cancer risk. The majority indicated interest in obtaining information about risk management (94%) and personal risk (93%), although most (56%) preferred to receive information related only to positive outcomes. There was relatively less interest in obtaining peer or professional support. Health professionals, especially urologists, were the preferred source of information and there was considerable interest in a multidisciplinary service approach, which was significantly associated with the number of affected relatives (OR ¼ 1:94; 95% CI 1.18,2.08; p50:002). CONCLUSIONS: A

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multidisciplinary risk information and management service would be the preferred approach for men with a family history of prostate cancer.

257 Genetic Testing and Beyond: Distress and Support Needs of Affected Cancer Patients from HNPCC Families Keller Ma, Jost Ra, Sattel Ra, Schroeter Ca, Jung Cb a Division of Psychooncology, Psychosomatic Medicine, University Hospital Heidelberg, Heidelberg, Germany; bDepartment for Human Genetics, University Hospital Heidelberg, Heidelberg, Germany PURPOSE: Although affected patients play a crucial role in the course of genetic testing for a hereditary cancer predisposition (HCP), their psychosocial condition has attracted only little attention. The study aims to investigate the impact of HCP on patients; beliefs and psychosocial distress from a multi-generation perspective. METHODS: 141 affected patients’ of HNPCC families were consecutively recruited from a comprehensive cancer family clinic and investigated prospectively during the course of genetic testing, up to 2 years after disclosure of test results. Assessment consisted of semi-structured interviews, standardized (HADS, IES) and studyspecific questionnaires. The differential impact of past and present experiences on illness representation and distress specific to HNPCC was analysed using regression analyses. RESULTS: Previous experiences with cancer and cancer-related death in the family, and patients personal illness experience predict the level of worry about the future of their offspring. Past and present experiences, and worry about the future were all found to contribute to patients’ level of distress (50% expl. variance). Although information of a positive mutation result did not result in itself in elevated distress in the majority of patients, distress increased remarkably with the occurrence of recent cancer diagnoses or deaths in the family. CONCLUSION: A multi-generation perspective is needed to capture the psychosocial complexity in HNPCC families, with a particular focus on affected patients. Continuing family-centred support beyond genetic testing seems a promising means to assist families in coming to terms with the familial condition, in mobilising their resources and in enhancing communication.

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258 Timing and Use of a Decision Aid for Genetic Testing for Hereditary Breast/ovarian Cancer Risk Meiser Ba,b, Wakefield Ca,c, Homewood Jc, Kirk Jd, Tucker Ka a Psychosocial Research Group, Prince of Wales Hospital, Sydney, Australia; bSchool of Psychiatry, University of New South Wales, Sydney, Australia; c Department of Psychology, Macquarie University, Sydney, Australia; dFamilial Cancer Service, Westmead Hospital, Sydney, Australia PURPOSE: A decision aid (DA) was designed to assist women deciding about genetic testing for breast/ovarian cancer risk. METHODS: Two randomised controlled trials of the DA were conducted to evaluate the DA, each with 120 women. Trial 1 provided the DA to women after genetic counselling, but before receipt of test results, while Trial 2 used the DA as a communication aid during the first consultation with a genetic counsellor. RESULTS: Trial 1 is complete, and showed that the DA reduced decisional conflict in women who did not give blood at their first genetic counselling consultation. Providing the DA after the consultation was not as helpful to women who did give blood on the day of their consultation, with the DA group showing an increase in decisional conflict. Trial 2 is ongoing, but preliminary results suggest that using the DA during the consultation reduced decisional conflict for both groups of women: those who did and those who did not give blood during their consultation. CONCLUSIONS: While patients may change their mind about receiving genetic test results, it seems that decision aids for genetic testing need to be utilised before the point that the patient feels they have made a decision about genetic testing.

259 Psychological Impact and Preventive Strategies Following Genetic Testing for BRCA1/2 Mutations Perry Sa, Evron Eb, Stemmer Sa, Taob Ec, Papa Md a Davidoff Center Petach, Tikva, Israel; bInstitute of Oncology Assaf, Hrophea, Israel; cInstitute of Genetic Beilinson Hospital Petach, Tikva, Israel; d Surgery Department Sheba Medical Center, Ramat-Gan, Israel PURPOSE: To evaluate the emotional response to genetic testing and the risk reduction strategies of

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healthy carriers of BRCA1/2 mutations and of cancer patients with and without a mutation. PATIENTS AND METHODS: The study groups included 40 cancer patients who tested positive for a BRCA mutation, 40 cancer patients who tested negative for a mutation and 32 healthy BRCA carriers. Genetic testing was performed between 1998 and 1999 in 3 hospitals in Israel. A semistructured interview and 3 self-report questionnaires were used to assess the participants’ emotional responses to the genetic information and their subsequent use of preventive measures. RESULTS: Most women (82%) were satisfied with their decision to take the genetic test. Mild psychological distress was found in both carrier and non-carrier cancer patients. More Avoidance and Intrusion thoughts were associated with having cancer rather than with the genetic information. Avoidance and Intrusion related to positive test results were similar in healthy carriers and in carrier cancer patients. About half of the eligible carriers underwent preventive oophorectomy during the study period, but none of them opted for prophylactic mastectomy. CONCLUSIONS: Genetic testing for BRCA mutations is perceived as valuable by women at high risk for HBOC and is not associated with major psychological distress. Unlike other groups of BRCA mutation carriers, none of the women in this study underwent prophylactic mastectomy, reflecting cultural and ethnic diversity.

METHODS: Women from 19 screening clinics participated in the study. Assessment was by postal questionnaire pre-screening, approximately 2 weeks, and 6 months post-screening result. Measures included cancer specific distress, perceptions of risk, appraisals regarding a family history of breast cancer, how individuals cope with their family history, dispositional optimism, attitudes about screening, and clinical/demographic variables. RESULTS: 2156 women, aged between 35 and 49 years completed the pre-screening questionnaire. 59% were classified as being at moderate and 41% at high risk. 20% were having their first mammogram on the programme. Multiple regression analysis suggested that cancer worry was most strongly associated with primary appraisals of high relevance and threat associated with a family history, avoidant coping, high perceptions of risk, low levels of optimism, and a negative attitude towards mammography screening. CONCLUSIONS: Cancer specific distress is most closely associated with the way women view and deal with their risk of developing breast cancer, as well as their general outlook on life. In addition, individuals with a positive attitude towards mammography screening are less distressed than individuals with more negative attitudes. Future prospective analyses will investigate whether distress changes over the course of the screening episode.

261 260 Factors Associated with Psychological Distress in Women Accepted on a Family History Mammography Screening Programme Watson EKa, Henderson BJb, Tyndel Sc, Brain Kd, Clements AMe a Primary Care, University of Oxford, Oxford, UK; b Institute of Medical and Social Care Research, University of Bangor, Bangor, UK; cPrimary Care, University of Oxford, Oxford, UK; dInstitute of Medical Genetics, University of Wales, Cardiff, UK; ePrimary Care, University of Oxford, Oxford, UK PURPOSE: A multi-centre cohort study is examining the psychological impact of mammography screening on women under-50 at increased risk of developing inherited breast cancer in the UK (PIMMS). The aim of the present paper is to explore concurrent associations between cancer specific distress and variables prior to screening.

Copyright # 2006 John Wiley & Sons, Ltd.

Psychosocial Consequences of Genetic Counseling for Colorectal Cancer: A Longitudinal Multi-center Study Bleiker E, Menko F, Sijmons R, Bro¨cker-Vriends A, Taal B, Kluijt I, Gerritsma M, Aaronson N The Netherlands Cancer Institute}Antoni van Leeuwenhoek Hospital, Department of Psychosocial Research and Epidemiology, Plesmanlaan, Amsterdam, Netherlands PURPOSE: The aim of this prospective longitudinal study was to investigate the extent to which levels of general and cancer-specific distress change over time as a function of genetic counseling. METHODS: Individuals at increased risk for Hereditary Non-Polyposis Colorectal Cancer (HNPCC) requesting genetic counseling in one of five Dutch family cancer clinics were invited to participate. Results reported here were obtained (1) just after the intake session, (2) after the release of the genetic test results, and (3)

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6 months later, and included questionnaires on general distress (MHI-5), and cancer-specific distress (IES). RESULTS: In total 349 individuals (84% response) returned a completed questionnaire following the first counseling session. Postgenetic testing and 6 month follow-up questionnaires were completed by 240 (69%) and 178 (51%) individuals, respectively. Fewer than 10% of counselees reported clinically significant levels of cancer-specific distress at the time of initial counseling, and this figure remained fairly stable through to the 6 months post-counseling assessment. Distress levels were not related significantly to genetic test results. The mean level of generalized distress was comparable to that of the general population. Approximately 20% experienced the genetic counseling as burdensome, but fewer than 5% expressed regrets about having undergone genetic counseling. CONCLUSIONS: Although a small minority of counselees had clinically significant levels of cancer-specific distress, the mean level of generalized distress was comparable to that of the general population. Genetic counseling and testing for HNPCC, provided in a professional family cancer clinic, does not significantly increase levels of psychological distress. ACKNOWLEDGEMENT: Dutch Cancer Society NKI 1998–1858.

262 Psychological Predictors of Increased Anxiety in Consulters During the Process of HNPCC Genetic Testing Hasenbring MIa, Elbert Ia, Deges Ga, Kunstmann Eb, Schulmann Kc a Medical Psychology and Sociology Ruhr}University of Bochum, Bochum, Germany; bHuman Genetics Ruhr-University of Bochum, Bochum, c Clinic of Internal Medicine Germany; Knappschafts Hospital Ruhr-University of Bochum, Bochum, Germany PURPOSE: Few prospective trials have tested the prospective validity of psychological factors in predicting high levels of anxiety in consulters during the phase of HNPCC genetic testing (Aktan-Kollan et al., 2001; Griz et al., 2005). This study aimed at an early identification of individuals with a high risk for increased anxiety following the first genetic counselling. METHODS: 181 consecutive consulters of a HNPCCrelated genetic counselling were investigated prior to the first contact, 2 weeks, 6 weeks, 18 weeks and

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54 weeks later on. Anxiety was assessed with the HADS, potential predictor variables were chronic daily hassles and resources (KISS-BelRes), coping style (IES), single items regarding worries about cancer, besides age, gender, and education. Statistical analysis included logistic regression analyses. RESULTS: Between 8 and 12% of the consulters showed high anxiety scores (HADS-Anxiety >10) at the different assessment points. Logistic regression analyses revealed chronic daily hassles and several worries regarding cancer susceptibility as highly significant predictors of increased anxiety during the course of genetic testing. CONCLUSION: Chronic stressors in several areas of daily life may enhance the risk for an increase of anxiety during HNPCC-related genetic testing. (The study was supported by the Deutshe Krebshilfe, FKZ: 70-3185).

263 Family History of Cancer and Body-Mass Index (BMI) Kim Ya, Kaw Ca, Pike Jb, Adams Hb a Behavioral Research Center, American Cancer Society, Atlanta, USA; bHealth Promotion, American Cancer Society, Atlanta, USA BACKGROUND: Research has found that being overweight accounted for 17% of cancer deaths in the USA, suggesting a significant association between BMI and cancer deaths. Although having a family history of cancer (FHCA+) is known to have an increased risk of developing cancer compared with persons without FHCA, the association between FHCA status and the degree to which FHCA+ individuals practice healthy lifestyles, remains unknown. METHOD: Data reported here are from the first cohort of baseline data collection of the ACS’s Health for Life Study. Currently, 413 participants voluntarily completed the baseline survey via the telephone. The FHCA status (58.4% FHCA+), age ðm ¼ 45 yrsÞ; education (51.3% less than college graduate), marital status (66.3% married), employment (89.8% employed), ethnicity (69.7% Caucasian; 17.2% African-American), current weight ðm ¼ 189 lbÞ; and height (m ¼ 66 inches) were assessed. BMI was calculated as a proxy of a healthy lifestyle. RESULTS: A hierarchical regression analysis revealed that BMI was inversely related to higher education (r ¼ 0:20; p50:001) but not significantly related to other demographic variables. FHCA status was a significant predictor of BMI

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(r ¼ 0:10; p50:05), controlling for the demographics. FHCA+ individuals had greater BMI than FHCA-individuals. Overall, 78.9% of the participants were overweight, which was more prominent among FHCA+ (82.2%) than FHCA- (74.4%; chi-square ¼ 3:62; p50:05). CONCLUSIONS: Our findings highlight the need for public education about obesity and special programs to promote healthy lifestyle among individuals with a FHCA. ACKNOWLEDGEMENT: This study was funded by the American Cancer Society National Home Office, intramural research.

264 What Do Men Want?: The Expectations of the Familial Cancer Clinic of Men from High Risk Breast Cancer Families Lobb Ea, Hallowell Nb, Pepall Ea, Kristjanson La, Meiser Bc a Western Australian Centre for Cancer & Palliative Care Edith Cowan University, Perth, Australia; b Public Health Sciences University of Edinburgh, Edinburgh, Scotland; cHereditary Cancer Clinic Prince of Wales Hospital, Sydney, Australia PURPOSE: This Australian study aimed to examine men’s expectations of the familial cancer clinic. METHODS: A self-administered questionnaire was completed by 220 men with a family history consistent with a dominantly inherited susceptibility to breast/ovarian cancer. RESULTS: Forty five percent (45%) of men had attended a family cancer clinic and 49% reported they had genetic testing. Men considered it most important to receive information about: cancer genes (97%), their own chance of developing cancer (87%); their daughter’s chance (90%), their son’s chance (80%), options for cancer prevention (82%), what to do for screening (83%) and the pros and cons of genetic testing (84%). Of less importance was: to talk about how it feels to have cancer in the family (67%), help to feel less anxious about cancer (58%); help to decide about genetic testing (68%), help to come to terms with own chance of developing cancer (64%), help to face fears about cancer (58%) and emotional support to cope with own situation (49%). The majority of men (93%) did not want assistance in telling family members a test result. 47% of men preferred a collaborative decision-making style and 38% preferred to make the decision themselves. 64% wanted as much information as

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possible and 36% wanted only information to deal with immediate issues. CONCLUSIONS: Men from high risk breast cancer families report lower expectations for emotional support from a familial cancer clinic and higher expectations for information. Implications for clinical practice will be discussed.

265 Prophylactic Mastectomy: Ambivalent Outcomes Patenaude AFa,b a Cancer Risk and Prevention Clinic, Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; bDepartment of Psychiatry, Harvard Medical School, Boston, MA, USA PURPOSE: As genetic testing for BRCA1/2 becomes more common, an increasing number of women are encouraged to consider prophylactic mastectomy (PM). PM has been shown to reduce breast cancer risk by 90% or more in mutation carriers, yet uptake in most studies is between 0 and 27%. Among women who do undergo surgery, few report regret, but 30–70% report dissatisfaction about the impact of surgery on their self-esteem, sense of attractiveness, and/or sexual functioning. For women considering PM, it can be difficult to merge these seemingly contradictory findings. METHODS: As part of a larger qualitative study of self-reported long-term outcomes of prophylactic mastectomy in 58 women with and without a prior cancer diagnosis, we isolated examples of the simultaneous reporting of both positive and negative psychosocial outcomes of PM in individual narratives. RESULTS: This presentation of narratives illustrating both positive and negative sides of individual women’s experiences and discussion of related psychosocial issues provides a more realistic view of the impact of prophylactic mastectomy than that available from other sources and suggests the need for research methodologies that capture diverse outcomes. CONCLUSIONS: This mode of presentation emphasizes the complexity of the decision to be undertaken and highlights the need for pre- and post-surgical psychological consultation. ACKNOWLEDGEMENTS: This work was supported by Grant RO3GH003051 from the Ethical, Legal and Social Implications Program of the National Human Genome Research Institute. The author also gratefully acknowledges the contributions of Sara Orozco Psy.D. and Elizabeth Gagliardi M.D. to this project.

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266 Illness Awareness of Patients in Hospice Raffaeli Wa, Andruccioli Ja, Montesi Ab, Rossi Ab a Hospice Infermi Hospital, Rimini, Italy; bHospice AUSL Cesena, Cesena, Italy Notwithstanding the diffuse belief that the patients should be given full information about their disease and prognosis, actually they know very little about it. AIMS: the purpose of this study was to evaluate the awareness of 100 patients (recovered in the Hospices of Rimini and SavignanoRubicone) about their diagnosis and prognosis. It was also investigated staff and relatives perception of patients’ awareness. METHODS: A semistructured interview was done by the psychologist to the patients, in order to evaluate their awareness about diagnosis and prognosis. Moreover a questionnaire was filled by the relatives and by the staff members (doctors and nurses) about their perception of patients’ awareness. RESULTS: In our sample there was a high percentage of patients with no diagnosis awareness and an even higher percentage of patients with no prognosis awareness. These results emerged from the evaluation of the psychologist and of other people involved in the study.

267 Death: Fear and Mind Attitude in Health Operators Luciano G, Rivieccio E, Boccia V, Rega R, Longo V Fisiopatologia, Terapia del Dolore e Cure Palliative A.O.R.N. ‘A. Cardarelli’, Naples, Italy PURPOSE: Death occurrence inspires deep reaction in every man, but in the field of Pain Therapy and Palliative Care it is necessary that each operator have known the necessity of comparing, in operative and in emotional way, with this reality. METHODS: Authors have investigated mind attitude and fear emotion evoked by death, through DAP-R and COLLETT-LEASTER FEAR OF DEATH questionnaires, respectively, elaborated by American experts and modified for Italian reality by Study Centre and Research on Death and Dying. Group investigated is composed by health operators operating in our hospital A.O.R.N. ‘A. Cardarelli’ ðN ¼ 104Þ: These data was reported several variables: age, sex, civil state, department of affiliation (Emergency Department, Onco-hemathologic Department, Surgery, Medicine), work qualification:

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(MD, Nurse) evaluated with descriptive analysis and statistical analysis performed with ANOVA tool. RESULTS DAP-R highlights neutral acceptance as prevalent attitude: Age factor: Young operators tend to avoid death in a statistically significant way in comparison to elderly; Work qualification factor: avoiding death and approach acceptance has statistically higher mean scores in nurses than in M.D. COLLETT does not show significant differences in four fear dimensions: Department factor: Death fear has significantly higher mean scores in medicine than in emergency; Work qualification factor: Fear death and about dying of others has significantly higher mean scores in nurses than in M.D. CONCLUSIONS: There are statistically significant differences in the several groups evaluated in comparison to death fear and mind attitude.

268 When Cancer Has Advanced}Education and Support Programs Coffin JM, Raco G, Hassard J, Akkerman D Cancer Information and Support Service, The Cancer Council Victoria Carlton, Victoria, Australia PURPOSE: The Cancer Council Victoria (TCCV) offers education/support programs for people whose cancer has advanced, their families and friends. Living Well Forums (LWF) commenced in 1997. In 2002, the first Living with Advanced Cancer Education Program (LWACEP) was piloted in the palliative care setting. Both programs will be profiled including the reactions and experiences that arise for participants. METHOD: LWF are free, facilitated, half-day programs held in metropolitan and regional Victoria. Topics include financial, legal, medical and psychosocial issues relevant to advanced illness. The LWACEP is a free 4-week program covering treatments, communication and relationships, looking ahead, self-care and wellbeing. RESULTS: To date 16 LWF and six LWACEP have been offered to over 250 participants. Over 60 facilitators have trained to offer the LWACEP and a manual has been developed for LWF facilitators. Both programs are evaluated by TCCV’s Centre for Behavioural Research in Cancer (CBRC). Participant evaluations reflect their emotional responses and the level to which their expectations were met. These themes have been conveyed via group discussion, written comments and artwork. Overall, it is evident the programs

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provide the opportunity to share concerns and experiences, but overwhelmingly, participants expressed comfort in the knowledge that they ‘are not alone’. CONCLUSION: The programs offered by TCCV for people whose cancer has advanced provide information and education within a strong, supportive mechanism. Evidence demonstrates that the support of health professionals, whilst invaluable, is most successful when augmented by shared experience and fellowship among peers.

269 End-Of-Life Preferences of Paediatric Patients with Cancer Drew Da, Hinds PSb, Oakes LLb a Centre for Children’s Cancer and Blood Disorders, Sydney Children’s Hospital, Randwick, Australia; b Division of Nursing Research and Patient Services, St Jude Children’s Research Hospital, Memphis, USA PURPOSE: The viewpoint of the terminally ill child at the time of an end-of-life decision has not been formally investigated. We identified the preferences of children and adolescents with advanced cancer about their end-of-life care and the factors that influenced their decisions. PATIENTS AND METHODS: Paediatric patients 10 or more ears of age were interviewed within 7 days of participating in one of the following three end-of-life decisions: enrollment onto a phase 1 trial ðn ¼ 7Þ; adoption of a do not resuscitate order ðn ¼ 5Þ; or initiation of terminal care ðn ¼ 8Þ: The patient, parent, and the primary oncologist were interviewed separately by using open-ended interview questions. RESULTS: Twenty patients, aged between 10 and 20 years participated. Eighteen patients (90%) accurately recalled all of their treatment options and identified their own death as a consequence of their decision. Influencing factors and themes from patients, parents and physicians varied} from caring about others, parental respect for child’s choice to prognosis. CONCLUSION: These children and adolescents with advanced cancer realised that they were involved in an endof-life decision, and were capable of participating in a complex decision process involving risks to themselves and others. The decision factors most frequently reported by patients were relationship based; this finding is contrary to existing developmental theories.

Copyright # 2006 John Wiley & Sons, Ltd.

270 A Meaning-centered Intervention to Enhance Job Satisfaction and Quality of Life in Palliative Care Nursing: A Randomized-controlled Trial Fillion La, Bairati Ib, Dumont Sc, Gagnon Pd, Tremblay Ie a Nursing Faculty Laval University Quebec, (Quebec), Canada; bMedicine Laval University Quebec, (Quebec), Canada; cSocial Work Laval University Quebec, (Quebec), Canada; dPharmacy & Psychiatry Laval University Quebec, (Quebec), Canada; eNursing Faculty Laval University Quebec, (Quebec), Canada INTRODUCTION: Nurses working in palliative care frequently encounter emotional challenges such as repeated bereavement and family distress. Strategies for improving work satisfaction and reducing caregivers’ stress are recommended. Despite these acknowledgements, ways to relieve existential distress and increase spiritual support of palliative caregivers are still largely undocumented. We designed an existentially-based psycho-educational group intervention, MeaningMaking in Palliative Care Practice, to support palliative care nurses. Its format and content are based on Frankl’s (1967) logotherapy and on an existential approach developed for terminally-ill cancer patients (Greenstein and Breitbart, 2000). PURPOSE: The study aims at verifying the efficacy of the 4-week intervention to enhance nurses’ job satisfaction and quality of life (QoL: emotional and spiritual). METHODS: A randomized-controlled trial, using a waiting-list design, was undertaken. A sample of 118 nurses providing palliative care for a significant part of their work time was enrolled in the trial. Measures of QoL (emotional: POMS-TMD; spiritual; FACIT-SP), and job satisfaction (JDS) were taken at pre- and post-intervention, and at three-month follow-up. RESULTS: Controlling for several potential confounding variables (demands/resources workstress-related, and socio-demographics), profile analyses were used to test the psycho-existential intervention capacity to enhance job satisfaction and QoL in nurses providing palliative care. CONCLUSIONS: Discussion on how meaningbased coping strategies can help nurses deal with emotional sources of stress encountered in their work with the dying, as well as the relevance of this meaning-centered intervention, is provided.

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ACNOWLEDGEMENTS: The study was financially supported by a CHRSF grant and a scientist FRSQ-FRESIQ salary-award to the first author.

271 Association of Delirium Symptoms with Medication in Terminal Cancer Gagnon Pa,b, Allard Pd, Gagnon Bc, Me´rette Ce, Tardif Fa,b a Palliative Care La Maison Michel-Sarrazin, Que´bec, Canada; bPsychiatry Centre Hospitalier Universitaire de Que´bec, l’Hoˆtel-Dieu de Que´bec, Que´bec, Canada; cPalliative Medicine Montreal General Hospital, Montre´al, Canada; dPalliative Meidicine Elisabeth Bruye`re Hospital, Ottawa, Canada; eBiostatistic Centre de Recherche Universite´ Laval Robert-Giffard, Que´bec, Canada BACKGROUND: Delirium is a severe and frequent complication in terminal cancer reported to be associated with opioids, benzodiazepines, corticosteroids, co-analgesics and anticholinergics. However, there is a lack of prospective data to confirm this hypothesis. OBJECTIVE: To describe the association between the use of medications with delirium symptoms in terminal cancer. METHODS: 1516 patients admitted for terminal cancer in 7 palliative care units in Canada, who survived longer than 48 h, were followed from admission until death (average survival: 21 days; average age: 68.4) between October 2001 and December 2004. All data were prospectively recorded and delirium symptoms, as rated with the Confusion Rating Scale (CRS), were correlated using mutlivariate analysis with doses of opioids, benzodiazepines, and corticosteroids, as well as with frequency of prescription of coanalgesics and anticholinergics. RESULTS: We compared the medication taken 48 h before the apparition of significant delirium symptoms to the overall delirium-free population. Delirium was associated with higher dosage of opioids (> 90 mg daily; OR ¼ 1:451; p ¼ 0:0045) and more frequent prescription of co-analgesics (OR ¼ 1:59; p ¼ 0:0022). A non significant relation was found with corticosteroids (OR ¼ 1:022; p ¼ 0:652). Surprisingly, delirium symptoms showed an inverse correlation with higher benzodiazepine dosage (4 2 mg daily; OR ¼ 0:679; p ¼ 0:0077) and more frequent intake of anticholinergics (OR ¼ 0:385; p50:0001). CONCLUSIONS: Analysis of risk factors in terminal cancer remains a complex and challenging task. Opioids and

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co-analgesics were associated with delirium as predicted by previous studies. The inverse correlation with benzodiazepines and anticholinergics remains surprising and may be related to confounding variables not unravelled so far by the analyses.

272 Certain Problems of Palliative Care and Euthanasia in Polish Physicians and Medical Students Views Leppert W, Luczak J Chair and Department of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland AIMS: To explore attitude toward breaking bad news and euthanasia and knowledge of palliative care of physicians during internal medicine specialty training and third year medical students. METHODS: Questionnaire survey of 217 physicians and 401 students after theoretical course comprising basic palliative medicine for physicians and after lectures for students concerning medical ethics. RESULTS: Outcome indicates difficulties in breaking bad news in physicians and students. In contrast to percentage of surveyed who want to be fully informed in case of incurable disease (80% physicians, 84% students) only 40 and 59%, respectively, stated that patient should be fully informed. Over 1/3 surveyed both physicians and students gave appropriate definition of euthanasia, 90% physicians and 82% students would not perform euthanasia, 75% physicians and 67% students were against legalization of euthanasia. For 49% physicians and 51% students palliative care is ‘care for the non-curable people improving their comfort’. Regarding morphine administration 70% doctors and 23% students indicated oral as most preferable route, 74% physicians and 43% students chose appropriate statement there is no maximal morphine dose, 64% doctors and 6% students indicated appropriate answer that constipation is most common side effect of morphine. CONCLUSIONS: Breaking bad news is significant difficulty for both physicians and students. There is lack of knowledge in bioethics and small percentage of respondents considering practice of euthanasia and larger group accepting its legalization. In contrast to students majority of physicians have knowledge concerning route of administration, dosing and side effects of morphine.

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273 Emotional Profile of Doctors Working in Oncology: A Swiss French Survey Arigoni Fa, Mermillod Ba, Sappino APa, Waltz Pb a Service of Oncology Geneva University Hospitals, Geneva, Switzerland; bService of Liaison Psychiatry, Geneva University Hospitals, Geneva, Switzerland PURPOSE: To explore mental health, job stress and satisfaction features among oncologists, paediatricians and primary care practitioners (Pcps). METHODS: We carried out a cross-sectional mailed survey on physicians working in oncology ðN ¼ 180Þ; paediatricians ðN ¼ 185Þ and Pcps ðN ¼ 197Þ from both private and institutional sectors from the French speaking part of Switzerland. General Health Questionnaire and the Maslach Burnout Inventory were used to assess mental health’s prevalence; job stress and satisfaction features were measured through a specifically developed questionnaire. Scores were compared across specialties. RESULTS: We obtained a 68% (380/562) participation. Approximately 30% of the respondents exhibited evidence for psychiatric morbidity and burnout. Oncologists and paediatricians were found to differ from Pcps: they had lower scores on burnout and higher rates of satisfaction mainly for interpersonal aspects (global differences on burnout’s depersonalisation dimension ðp ¼ 0:029Þ; satisfaction ðp ¼ 0:005Þ and satisfying interpersonal aspects ðp ¼ 0:01Þ). Descriptive data indicate that oncologists’ relations with their peers were determinants of their interpersonal satisfaction. Action through treatments, contact with patients and feelings of autonomy were also considered as important satisfiers. No clear contribution of demographics and job characteristics was yet identified. CONCLUSIONS: Scores for oncologists and paediatricians displayed higher degree of professional satisfaction than primary care practitioners. These observations though reassuring should provide a basis for further exploration particularly in the field of interpersonal interactions.

274 Psycho-oncologic File (cartella psiconcologica} CP): From Assessment to Work in Progress; A Report About an Effective Method in Balance between Free Talk and Structured Interview Armanni G, Catanzaro P, Nataloni G, Mauro A, Regni S

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Department of Oncology, Haematology and Biological Sciences, Perugia Regional Hospital, Perugia, Italy PURPOSE: We experienced use of Cartella Psiconcologica (CP), a particular kind of file, drawn up to supply a psychodynamic ‘fil rouge’ both to patient and psycho-oncologist. The author will comment on two years’ activity with CP on assessment time and results of a cases’ overview. METHODS: CP, compiled in different sanitary institutions by skilled psycho-oncologic team personnel, consists of six sections: personal information, oncologic situation eventual psychiatric diagnosis, eventual structural diagnosis (Kernberg, 1984), recommended interventions, follow up. Data analysis concerned: oncologic diagnosis, illness consciousness, psychiatric comorbidity, suggested intervention. RESULTS: CPs of 430 patients were filled in, 72% of these are women, breast cancer (38%) and leukaemia/ lymphomas (24%) are the most common pathologies. Illness communication is effective (80% illness consciousness); a large group of patients had a diagnosis related to depression (60%); anxiety affects 22%. Counselling in hospital is the most frequent form of intervention (42%), individual psychotherapy 32%, group psychotherapy 8%; pharmacotherapy concerns 46% of patients. At the beginning of interventions compliance is 74%. CONCLUSIONS: CP proved to be useful for patients as a symbolic connection toward a body/mind approach in a medicalised environment. It is an important instrument in a work in progress mode among equip members to share the method. After two years we are working on a new release of CP especially developed for a LAN. ACKNOWLEDGEMENTS: Umbrian regional psycho-oncology services are financed by Umbrian Association Against Cancer, Oncologic Radiotherapy Umbrian Association and Italian Association Against Leukaemia and Lympho.

275 Bridging the Gap by Transforming Nursing Knowledge into Action Courtney U ARC Cancer Support Centre ARC House, Dublin 7, Ireland OBJECTIVE: Oncology nursing offers a unique range of challenges in meeting client needs as

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many more patients are treated as Out-Patients in Day Wards. Feelings of vulnerability experienced by many patients may not be exhibited during the decreased time spent in hospital and many clients actively try to find a way to cope with feelings of loss of control by exploring the availability of community-based supportive services. METHOD: The ARC Model of Care offers holistic community based support in Ireland since 1996. Nurse led and client focused, a team of nurses, psychotherapists as well as other health care professionals and trained volunteers, with a range of skills meet the changing needs of the people affected with cancer and ensure appropriate holistic supportive research-based therapies are available as an adjunct to primary medical cancer care. Support within ARC falls under three main headings which are: counselling support, complementary therapies and psycho-educative programmes. Following a nursing assessment the client chooses to participate in partnership with their supportive care treatment plan. Nursing support empowers clients through their cancer experience and educational or informational deficits extend of this role using active listening as well as teaching skills. This responds to client need within the community and includes facilitation of psycho-educative support groups. RESULTS: Client choice is paramount to the success of support with over 7500 visits are made to ARC each year. The ARC Model clearly demonstrates ways of bridging the gap by transforming nursing knowledge into action!

276 (Using) Complementary and Alternative Medicine: A Discourse Analytic Study of Cancer Patients’ Talk Eliott JAa,b, Kealey CPc, Olver INa,b,d a Royal Adelaide Hospital Cancer Centre Royal Adelaide Hospital, Adelaide, Australia; bMedicine University of Adelaide, Adelaide, Australia; cRoy J. & Lucille A. Carver College of Medicine University of Iowa, Iowa, United States; dCancer Council Australia Cancer Council Australia, Sydney, Australia PURPOSE: Complementary and Alternative Medicine (CAM) is increasingly used within western nations, with a corresponding increased number of studies designed to identify the prevalence of various treatment modalities, and efficacies of these. This study examines patient perceptions of both CAM and CAM users about

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which little is known. METHOD: Twenty-eight adult cancer patients (a population identified as likely to use CAM) close to death were interviewed using open-ended questions to elicit speech on treatment (including CAM) decisions at endof-life. Transcribed interviews were analysed using discourse analytic techniques, identifying similarities and differences in language used. RESULTS: Consistent differences in talk around CAM were found between 13 users and 15 non-users of CAM, primarily related to the perceived value of these treatments. Often drawing upon a mind-body discourse that holds individuals responsible for their health, users valued CAM for the perceived benefit to quality of life, for ameliorating both the side-effects of conventional allopathic medicine and pain consequential upon their illness, and for a holistic approach to healthcare that complemented that of conventional medicine. Non-users devalued CAM as unable to cure their disease (but did not similarly devalue conventional medicine, and negatively construed CAM users as desperate, challenging medical wisdom, or as lesser ‘others’. Users and non-users cited the effect of the high cost of CAM as influencing uptake. CONCLUSION: Despite increased legitimization and medicalisation of CAM, patients assess them differently to allopathic medicine, with different (positive and negative) assessments attributable to users.

277 Computer based Evaluation of a Screening Procedure for Psycho-oncological Treatment during Radiotherapy Herschbach Pa, Geinitz Hb, Sehlen Sc, Pirker Ca, Erg Pa a Clinic and Policlinic for Psychosomatic Medicine Technical University of Munich, Munich, Germany; b Department of Radio-Oncology Technical University of Munich, Munich, Germany; cDepartment of Radio-Oncology Ludwig Maximilian University Munich, Munich, Germany PURPOSE: The objective of the study is to evaluate the acceptability and feasibility of a computer touchscreen technology as a method to screen cancer patients under radiotherapy for psychosocial support. METHOD: A questionnaire was computed, which is specific for accessing psychological distress in radiooncological patients (‘StressIndex Radioonkologie, SIRO’, Sehlen et al., 2003).

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The study contains the following steps: (1) program the questionnaire SIRO for the tabletPCs. (2) Validation of the computer version of the SIRO. (3) Defining a cut-off-score for indication for psychotherapy. (4) Evaluation of the procedure during daily routine. Overall the data of n ¼ 568 patients and n ¼ 40 physicians and nurses are accessed. RESULTS: First experiences show, that the implementation of the procedure into daily routine is very complex, but also an impressive influence of the procedure on the perceived importance of psychosocial aspects within treatment is obvious. Statistical results about acceptability and benefits of the procedure shall be presented. ACKNOWLEDGEMENTS: The project is funded by the Deutsche Krebshilfe e.

278 The Role of the Psychologist in the Health Care Team of a Bone Marrow Transplantation Centre Ferrandes Ga, Biffa Ga, Cai Pa, Riccardi Fa, Bacigalupo Ab a Clinical Psychology and Psychotherapy ‘San Martino’ Hospital, Genoa, Italy; bHematology, BMT Unit ‘San Martino’ Hospital, Genoa, Italy BACKGROUND: The psychological intervention for patients undergoing bone marrow transplantation involves: a series of weekly ward based sessions aimed at evaluating the patient at an early stage in the treatment and getting to know his experience in depth. The idea is to target team work to the patient as a person who carries complex emotions and expectations towards transplantation. The patient will in fact experience at the same time fear of death and hope of ‘rebirth’, as symbolically represented by the transplantation itself. OBJECTIVE: To highlight the most prominent psychological aspects of the process: motivation to treatment, feelings of being pervaded by the disease, identity crisis, fear of losing reproductive capacities, fear of death, feelings of isolation, both during hospitalization and after discharge. METHODS: Clinical/psychological interviews with patients and/or their relatives, meetings with the physicians in multidisciplinary teams for supportive therapy and individual psychotherapy. A cohort of 300 patients has been treated during the last six years. CONCLUSIONS: The complexity of the emerging themes underlines the need to increase the psychological intervention and improving the

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care-giving as a whole, in order to both help the patient to experience the transplantation in an adaptive way, and to support the care staff and medical personnel in coping with the unavoidable emotional load. To get to know the patient early in the treatment facilitates further meetings, helps to create a sense of trust in the psychologist, to elaborate emotions, to strengthen the rapport and to interiorize the complex experience of having a transplant.

279 A Research on Patients Needs and an Artistic Tool as Institutional Mediators for Relationship and Communication Ferro AMa, Sogno Gb, De Amicis Va, Porazzo Sa, Bracco Va a Mental Health, San Paolo Hospital, Savona, Italy; bMedical Oncology, San Paolo Hospital, Savona, Italy BACKGROUND: This study suggests a reflection about the five-years cooperation of our Mental Health Department with the Oncology Service of San Paolo Hospital. In this project a classic research method together with an artistic tool were defined as important institutional mediators in relationship development and communication facility inside the Oncology Service. In particular we considered the relationship of patients with the care staff, between patients and between the operators of oncology and psychooncology staffs. METHODS: The artistic tool was ‘The Listening Copybook’, a thick copybook with few written pages but many others empty, ready to be filled by patients, with poetry, accounts and tales. It could give to the reader the opportunity to think, but even to write, to draw or to notice something about the illness feeling. The classic tool was the NEQ questionnaire; it was submitted to 168 patients in a two-months period, between February and March 2006. RESULTS: Our preliminary results confirm other previous national reviews. In detail we evidenced some special items, such as a non conscious need for psychic support, the difficulty to communicate living experiences, and the desire of many patients to be heard. COMMENT: In this study we could verify consistency and inconsistency between the tools we used. Both of them have made the contact easier between the patient and the care staff, as was between members of the care staff itself. We could also reconsider some aspects of

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our patient management policy owing to a different approach to patients.

280 The Epistemological Groundings of Psychooncology Research: Is there Room for a ‘Love of Humanity’? Morley LK Oncology, Clinics Building, Tamworth Base Hospital, Tamworth, Australia The epistemological groundings of psycho-oncology research: Is there room for a ‘love of humanity’? The idea of examining the philosophical underpinnings of psycho-oncology literature is not one that has been discussed at length. Perhaps the reason for this is that oncology is the field of study which researches the physicality of cancer and so, naturally, its research base is grounded in the scientific paradigm. Psycho-oncology, however, in its endeavor to understand more about the psychological and emotional affects of cancer, lives more within the realm of social research. Social research allows different professions to contribute to the research base, so it has a much broader range of perspectives on the research process (Crotty, 1998). The social work profession, for example, can incorporate many different aspects of the social research ‘maze’ yet it is still a major player in contributing towards psychooncology literature. The intention of this paper is to discuss the valuable contributions different research methodologies can offer to psychooncology. It suggests that the different philosophical underpinnings and theories result in very different ways of looking at and solving a problem and this is valuable in understanding the complexity of the emotional wellbeing of people affected by cancer. It then goes on to look more specifically at the idea of a ‘love of humanity’ in social work, which is concerned primarily with human experience, not how it is theorized, but how it is lived (Morley, 2002). In the area of oncology social work, or psycho-oncology in general, this could have far reaching implications. Crotty M. 1998. The Foundations of Social Research. Allen and Unwin: Sydney, Australia. Morley L, Ife J. 2002. Social work and a love of humanity. Austral Soc Work 55(1): 69–77.

281 When Kohut Meets Sisyphus in Oncology Institute Ayzenberg A

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Oncology, Kaplan Medical Center, Rehovot, Israel The significant lengthening of life expectancy in metastatic patients and improvement in life quality, creates exciting new challenges for psychotherapy. Patients living for several years while experiencing threat of death on an unknown date, face a confusing, tricky mission: to continue ‘life in full’ on one hand, and to prepare for painful inevitable terminal separation on the other. This duality usually instigates distress and demands highly complex coping. In the same time, it carries a promise for accelerating intense mental processes and opportunity for deep, psychotherapeutic analytic work. In these stages of illness a patient can be metaphorically described as an image of Sisyphus: carrying a heavy rock up the hill, never succeeding in climbing the top. But Camus himself claimed that Sisyphus could be even happy, facing his own human authentic existence and fate. What would Heinz Kohut be saying about this matter of happiness in the institute of oncology? My guess is that Kohut will approve, adding that this happiness could take place only if some conditions are met: only if vulnerability of the self, rooted in early pathological object relations could be understood, interpreted and so to say, treated and healed. Psychotherapy should represent the encounter of two traditions: the existential stance which deals with issues of ‘being’ and ‘meaning’ in the here and now, and Self psychology therapy which tries to reveal and decipher childhood injuries and pain and their enactment through illness. A case study integrating elements of those two psychotherapeutic attitudes will be presented.

282 New Antidepressants in Oncological Clinical Practice: Data from a Single-blind ITT Comparative Study on 558 Patients Berra C, Amodeo L, Caldera P, Torta R Psychoncology Unit, University of Turin, Turin, Italy PURPOSE: Depression often develops in chronic pathologies, cancer especially, worsening prognosis. Few studies were conducted on antidepressants in organic comorbidities, and no guidelines exist. Therefore, we studied effectiveness, tolerability and safety of antidepressants in oncological population. METHODS: This ITT single blind trial included 558 consecutive cancer outpatients with depressive symptoms, treated with

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amisulpride (127pts), sertraline (102pts), citalopram (90pts), venlafaxine (75pts), mirtazapine (60pts), paroxetine (55pts), escitalopram (37), ad fluoxetine (12). Patients were evaluated baseline, after 4 and 16 weeks for depression and anxiety (MADRS, HADS, CGI), coping styles (MINIMAC), pain (VAS, QUID), quality of life (EORTC-QLQ-30) and side effects (DOTES). RESULTS: All drugs had a global positive effect on depressive symptoms (p50.001), but qualitatively different: amisulpride (50 mg) improved somatic MADRS items (p50.001), venlafaxine cognitive and affective ones (p50.001). Maladaptive coping style (Desperation; Anxiety) were reduced (p50.001), while Fighting and Negation improved (p50.001). Pain improved with venlafaxine (p50.001) and citalopram (p50.05). Dropout rates were lower with citalopram and amisulpride, while with mirtazapine (42%), sertraline (21%) and venlafaxine (19%) were higher. Preponderant side effects were: weight gain with amisulpride; nausea, anorexia with sertraline and citalopram; sedation or agitation with mirtazapine; headache, constipation with venlafaxine and paroxetine. No serious adverse events were reported. CONCLUSIONS. These represent the first comparative evaluation of new antidepressants in oncological clinical practice. The analysis of these data could suggest a tailored antidepressant approach in this population. Larger controlled studies are needed.

283 Suggestion of a New Clinical Intervention: The ‘Restructuring’ Psychotherapy Groups for Breast Cancer Patients with Psychological-relational Problems being Before Falling Ill Verrengia A, Bruno R, Ruggiero G, Gridelli C Division of Medical Oncology, ‘S. G. Moscati’ Hospital, Avellino, Italy; Institute of Systemic Medicine and Psychology, Naples, Italy PURPOSE of this paper is to propose a reflection about necessity to develop a specific psychotherapy group model with restructuring rather than supportive–expressive goals, for cancer patients. This reflection came out from the first experience of a psychotherapy group for early breast cancer patients. The group, including early breast cancer patients subjected to adjuvant chemotherapy, was closed and for limited time (once a week for twelve times). The group started following guidelines and techniques of a supportive–expressive psychother-

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apy and was marked by a high drop-out rate. It was clear that people who left therapy shared similar features, such as who kept attending showed other similar features. The main difference between these two groups of people was the lifestyle before cancer, defined as satisfactory for people who left group and unsatisfactory for people that completed therapy. For these last people, cancer and then taking part in therapy group were a chance to review their own aspects of personality and relationships. They realized that they had already suffered from psychological pain before falling ill and this sorrow turned into their physical sickness. So, while group meetings were going on, we noticed that the work was turning from bringing into focus the management of cancer related emotions and problems to a psychotherapy oriented forward understanding and restructuring patients personality and their own way to make them in relation with significant people. This turn was due to following patient’s feelings and needs with psychotherapists agreement. Requests and benefits obtained from women who finished therapy made us realize that people with unsatisfactory life before cancer need specific therapy and cannot be treated together with patients with a satisfactory pre-existing life where cancer and related-treatment was a sudden and sad interruption of their, even happy, life. We noticed that the patients at first getting ill in the soul and then in the body, meant a relation of cause–effect in this succession of events always with implication of hetero or auto feeling of guilt involved, need different help because they have different needs. In our relation we are going to give more details of these needs and how to manage the work to satisfy them.

284 ‘Getting Back on Track’: A Pilot Study of a SingleSession Psychoeducational Group Intervention for Women with Breast Cancer Completing Adjuvant Treatment Cheng Ta, Jackman Ma, Jones Ja, Esplen MJa, Haines Sb a Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, Toronto, Canada; b Nutrition Services Princess Margaret Hospital, Toronto, Canada BACKGROUND: As women with breast cancer are living longer due to early detection and improved treatments, more attention is directed

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to heir survivorship experiences and the late effects of their cancer treatments. The re-entry transition from patient to survivor can be a very difficult and stressful time. Consequently, a brief psychosocial group intervention delivered at this important transition time may address the challenges that women face at re-entry, facilitating greater adaptation and more optimal recovery. PURPOSE: This presentation will address the results of the pilot phase of research into a single-session group model for women of breast cancer delivered at ‘re-entry transition’ to facilitate an increase in selfefficacy, preparedness, knowledge and a decrease in health-related distress and mood disturbances. METHOD: 30 women completing adjuvant radiation treatment were recruited to participate in a single-session psychoeducation class. The class content was complemented by standard patient education print material and delivered by a multidisciplinary team. A questionnaire package was administered at pre-test (T0) and post-tests at 3months (T1) and 6-months (T2) clinic follow-ups. An open-ended patient satisfaction survey was also administered to solicit participants’ opinions and satisfaction with the class. RESULTS: Feedback was obtained on the acceptability and feasibility of the class. CONCLUSION: The results of this pilot study suggest that re-entry transition can be facilitated by a single-session psychoeducational group intervention.

285 Cognitive–Behavior Group Intervention for Relatives of Cancer Patients: A Controlled Study Cohen Ma,b, Abraham Kc a School of Social Work, Haifa University, Haifa, Israel; bSocial Work Department, Rambam Medical Center, Haifa, Israel; cOncology Department, Rambam Medical Center, Haifa, Israel AIMS: To assess the effect of cognitive–behavior (CB) group intervention on psychological distress and adjustment of relatives of cancer patients with primary disease. METHOD: Fifty-two relatives participated in CB group intervention, while another 52 served as a control group. All participants completed pre- and post-intervention, and a four-month follow-up questionnaire consisting of the Brief Symptom Inventory (BSI), Psychological Adjustment to Illness scale (PAIS), Mini Sleep Questionnaire (MSQ) and Multidimensional Scale of Perceived Social Support (MSPSS); participants in group intervention also

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reported compliance with home practice. RESULTS: Participants in the intervention group scored significantly lower than controls on the BSI and PAIS, recorded fewer sleep difficulties in the post-intervention and follow-up measures, and reported higher perceived support in the follow-up measure. By contrast, no significant change was observed in the control group during the study period. On the reliable change index (RCI), 30.8% of the intervention group but only 3.9% of the controls statistically improved on their psychological distress. Improvement in the intervention group was associated with higher compliance with home practice. CONCLUSION: The study provides evidence for the positive effect of CB group intervention for family members, which endured for four months after the intervention ended.

286 Psychosocial Problems: Interventions that Help Fobair P Supportive Care Program Cancer Center, Stanford, Stanford, CA, USA PURPOSE: To describe psychosocial problems following cancer treatment and three interventions that help return survivors to a sense of inner control. METHOD: Review of English language databases from 1980 to 2006. RESULTS: Problems include depression (20–40%) and distress (35–40%) a particular source of concern as negative mood may be a prognostic factor in cancer mortality. Energy loss and fatigue (35– 80%) affect survivors’ ability to work and enjoy leisure. A poor body image (31–70%) is associated with loss of self-esteem. Sexual satisfaction after treatment decline in 30–64% among male and female survivors. Cognitive changes (20–45%) affect work and personal life. Group support, journal writing and physical exercise have each demonstrated improvements in mood among survivors. Group support can lower emotional suppression allowing for greater adoption of ‘fighting spirit,’ and ‘less mood disturbance.’ Attending group members showed decreases in overall PTSD, less re-experiencing, arousal and avoidance. Psycho-educational care provided benefit to survivors in lowering anxiety, depression, nausea, vomiting, pain, and increasing knowledge. Journal writing was effective in decreasing the survivors’ physical symptoms and medical visits for cancer related morbidities. Written emotional disclosure buffered the effects of social constraints

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and distress among cancer patients. Physical exercise helped survivors improve their physical condition, sexual attractiveness, feel less confusion, fatigue, depression and mood disturbance compared with inactive women. CONCLUSION: The urgency for supportive interventions comes from data showing consistent patterns of loss among cancer survivors, losses that may contribute to premature mortality.

287 A Multi-modal Psychological Intervention for Women with Gynaecological Cancer Gedge RB, Clarke DM Psychological Medicine, Monash University, Melbourne, Australia PURPOSE: A substantial proportion of women experience mood disorders and impaired quality of life (QOL) during and after treatment for gynaecological cancers. This study examines the efficacy of a multi-modal psychological intervention designed to improve QOL for these women. METHOD: Women scheduled to receive adjuvant treatment for gynaecological cancer were offered a six-week group program conducted by a psychologist. The program included psycho-education to increase positive coping strategies, expressive writing to facilitate processing of traumatic material, and mindfulness meditation to enhance spiritual well being. Those who agreed to participate were randomized to either an intervention group or a wait-list control group. Outcome measures of QOL, anxiety, depression, demoralization, coping style, and spiritual well being were collected at baseline and following the intervention approximately two months later. Analysis was performed using a mixed-effects regression model. RESULTS: Of 116 women invited to participate, 54 consented. Twenty eight were randomized to treatment, of whom 27 attended at least one program session, and 26 provided outcome data. Twenty-six were randomized to wait list control, with 23 providing outcome data. Whilst time was a significant factor in reducing anxiety for both groups, the intervention group demonstrated significantly greater improvements in all measures including anxiety, depression, demoralization, spiritual well being, and positive coping styles. These improvements were generally of a clinically significant magnitude. CONCLUSIONS: The study indicates that a multi-modal intervention designed specifically to address issues

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faced by women with gynaecological cancers can provide clinically significant improvements in QOL.

288 Breast Cancer’s Effect on Family’s System Dynamics Watson M Psychological Medicine, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK PURPOSE: While the emotional impact of cancer and it’s treatment is well documented in patients, partners and adult family members, there is less evidence relating to school-age children of mothers treated for cancer. The impact of cancer, and what makes a vulnerable family, has recently been examined as part of a multi-national European Union funded study [COSIP Study]. The UK group of this collaborative has focussed on family and patient characteristics which may be associated with increased distress in school-age children of mothers with early stage breast cancer. METHODS: Mothers diagnosed with early stage breast cancer over the previous 36 months were approached during clinic visits and asked to participate in an assessment of distress levels and family characteristics. Almost half of the patients approached had children between the age of 6–17 and 125 families participated in the study. RESULTS: These indicated that rates of emotional and behavioural problems in the children were higher than reported in community samples. Factors associated with an increased problem level in the children included; maternal depression, low levels of family cohesion, and low emotional responsiveness. Whether a mother was on/off chemotherapy was not associated with child problems. CONCLUSIONS: Where mothers have early stage breast cancer, a substantial minority of their school-age children have emotional and behavioural problems which are linked to maternal depression and poor family communication. Present family services in oncology are poorly developed and psychological care programs need to take account of this largely unseen need. ACKNOWLEDGEMENTS: This Research was supported by the European Union.

289 An Open Naturalistic Study of Mirtazapine for Depression Treatment in Cancer Patients Elbi Mete H, Ersoy MA, Noyan A

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Psychiatry, Ege University School of Medicine, Zmir, Turkey Depression is quite common in cancer patients. Choice of antidepressant in the cancer patients with depression is still under scrutiny. Twenty one consecutive depressed oncology patients are recruited and 19 had been followed for 6 months. All patients were started mirtazapine at 15 mg daily dose and the dose was increased in the absence of significant treatment response and side effects. Depressive symptoms decreased at the end of the first month, which persisted for the remaining 23 weeks of the study. Mean Hamilton Depression Scale scores fell significantly from 21.4  4.9 at baseline to 6.5  3.2 at the first month. Four of the 19 patients reported at least 1 side effect during treatment; however the vast majority of these side effects were described as mild to moderate degree. This prospective analysis of open-label data set provides preliminary evidence regarding the efficacy, safety and tolerability of mirtazapine treatment in cancer patients with depression. Relatively low doses of mirtazapine appears to be effective and safe in treating in cancer patients who maintained radiotherapy and/ or chemotherapy and improvement maintains till the end of 24 weeks of treatment.

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groups received standard risk counseling) on standardized measures of (a) psychosocial functioning, (b) BC risk/knowledge and (c) screening behaviors. RESULTS: RCT follow-up measures continue to be collected. One hundred and sixty women recruited from preventive oncology clinics and newspaper ads were randomized (107 to the group/53 to the control). Participants had a mean age of 45  11 years (range 22–69), 67% were married and 67% reported a university education. Seventy-four percent overestimated their BC risk, the mean level of breast cancer anxiety (BCAS) was 26  11, (range 15–57), 50% scored >20 on the Impact of Event Scale and 35% scored >60 on the Brief Symptom Inventory, global measure of distress. Preliminary analyses on the whole sample demonstrate significant reductions in perceived BC risk and BC anxiety (p50.001) and improvement in BC risk/knowledge (p50.001). Final between group results will be presented. CONCLUSIONS: Women with a family history of BC demonstrated interest in a randomized group psychotherapy trial, significantly overestimated their BC risk and experienced high levels of BC anxiety. ACKNOWLEDGEMENTS: Funding from the Canadian Breast Cancer Research Alliance.

291 290 Results of a Randomized Controlled Trial of a Group Intervention for Women with a Family History of Breast Cancer Esplen MJa, Hunter Jb, Leszcz Mc, Glendon Gd, Hompson Ae a Behavioral Sciences and Health Toronto General Research Institute, Toronto, Canada; bDepartment of Psychiatry Mount Sinai Hospital, Toronto, Canada; cDepartment of Psychiatry Mount Sinai Hospital, Toronto, Canada; dOntario Cancer Genetics Network Cancer Care Ontario, Toronto, Canada; eOntario Cancer Genetics Network Cancer Care Ontario, Toronto, Canada Women with a family history of breast cancer (BC) often overestimate their BC risk, which has been associated with psychological distress that may interfere with screening adherence and comprehension of risk. PURPOSE/METHODS: The RCT aimed to compare the effects of a 12session (8 weekly; 4 monthly) supportive–expressive group intervention addressing emotional and existential issues to a standard care arm (both

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Positive Effects of Cognitive Behaviour Therapy (CBT) for Fatigue in Cancer Survivors, a Randomised Controlled Trial (RCT) Gielissen MFMa, Verhagen Sb, Witjes JAc, Bleijenberg Ga a Expert Centre Chronic Fatigue Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; bDepartment of Medical Oncology Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; cDepartment of Urology Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands Although there is enough evidence that fatigue in cancer survivors is a severe problem, no evidencebased treatment is available. Recently a pilot RCT of yoga for breast cancer survivors could not demonstrate positive effect on fatigue. The therapy in our study makes a distinction between precipitating factors and perpetuating factors of fatigue after cancer. At this moment there is no clear relationship between the persistence of fatigue and initial disease and cancer treatment variables. Therefore, the assumption is that the

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cancer itself and/or the cancer treatment may have triggered the fatigue (precipitating factors), but other factors are responsible for the persistence of the fatigue complaints (perpetuating factors). As perpetuating factors of post-cancer fatigue we consider; insufficient coping with the experience of cancer, fear of disease recurrence, dysfunctional cognitions related to fatigue, dysregulation of sleep and activity level, low social support and negative social interactions. Not all six perpetuating factor are present in each patient. Based on questionnaires it was determined which perpetuating factor should be included in the treatment protocol. Therefore, the CBT was adapted to each individual patient. In a RCT we randomised 50 patients to the intervention condition and 48 patients to a waiting list condition. The results showed a clinical relevant effect of CBT on fatigue and functional impairments in cancer survivors. These positive effects were maintained at followup. Funding for this study was provided by the Dutch Cancer Society (KUN 2001-2378).

292 Integration of Trauma Counseling and Health Education in Supportive/Expressive Group Therapy for People Diagnosed with Cancer: a Pilot Study Just Aa, Walls Mb, Beeden Ab, Barrett Lb, Boyes Sa a Mental Health Services, Townsville Hospital, Townsville, Australia; bCancer Centre, Townsville Hospital, Townsville, Australia INTRODUCTION: Supportive/expressive psychotherapy groups are frequently part of appropriate psycho-oncological care. Given that cancer has been recognised as a traumatic event capable of creating posttraumatic stress symptoms (PTSS) (e.g. Brennan, 2001) or posttraumatic stress disorder (e.g. Spiegel and Classen, 2000; Tjemsland, Soreide and Malt, 1998), the facilitators of the supportive/expressive groups at the Townsville Hospital Cancer Centre have integrated interventions in their therapy to target PTSS. This occurred following observations that many group participants exhibited trauma responses. PURPOSE: To reduce PTSS co-morbidity and promote quality of life. METHOD: Two supportive/ expressive psychotherapy groups were conducted over a 4 month period. They incorporated trauma interventions and psycho-education about cancer treatment and health promotion. One group was for women with breast cancer; the other for patients of both genders. The cancer status of

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participants ranged from early to advanced stages. RESULTS: Based on pre- and post-intervention administration of the Trauma Screening Questionnaire (Brewin et al., 2002) and qualitative reports, evaluation indicated that integration of trauma interventions and psycho-education reduced PTSS symptoms and increased resilience and quality of life in both groups. CONCLUSIONS: The findings impress as significant in terms of identifying the benefit of integrating PTSS techniques and psychoeducation regarding treatment and health in supportive/expressive groups. Further, this combination encourages participation of people who are reluctant to enter support groups as this is seen in many cultures as a sign of emotional weakness. This presentation will outline and discuss the group interventions and provide participants’ evaluation of this form of therapy.

293 Evaluation of a Psychoeducational Group Intervention for Patients with Cancer: A Randomized Controlled Trial Weis J, Brocai D, Heckl U, Seuthe-Witz S Psychooncology Tumor Biology Center at the University Freiburg, Freiburg, Germany Within the last two decades psychosocial group interventions have been developed to help cancer patients cope better with the psychosocial sequelae of cancer diagnosis and treatment. Many empirical studies have provided evidence-based knowledge that structured group interventions for cancer patients improve psychological wellbeing, reduce anxiety and depression, and improve coping and mental adjustment. For the first time in Germany a controlled clinical trial (RCT) has been conducted to evaluate the effects of a psychoeductional support group based on a multicenter study approach in terms of quality of life. The project was funded by German Cancer Aid. We evaluated a structured intervention program based on 12 sessions (one session per week) for patients with first diagnosed breast cancer and colorectal cancer. In RCT the intervention has been compared with a waiting group. Patients have been randomized after baseline assessment of the outcome criteria (T1). Points of measurement were at the end of the program after three months (T2) and at six (T3) resp. nine months (T4) after baseline. N ¼ 252 patients could be randomized, n ¼ 134 for the treatment

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and n ¼ 118 for the waiting control group. All patients were female, 92% with the diagnosis of breast cancer. The data have been evaluated based on intent to treat analyses. As main results the treatment group show significant improvements in global quality of life and anxiety in the short term, whereas all differences between treatment and control were reduced at the follow-up time nine months after baseline (T4).

294 Treating Insomnia Associated with Cancer: A Randomized, Multi-centre Trial of Cognitive Behaviour Therapy (CBT) Delivered by Cancer Nurse Specialists Espie Aa, Kelly HLa, Fleming La, White CAa,b, Taylor Lc a Section of Psychological Medicine, University of Glasgow, Glasgow, Scotland; bPsychosocial Oncology, NHS Ayrshire and Arran, Irvine, Scotland; cMedical Oncology, Aberdeen Royal Infirmary, Abederdeen, Scotland Sleep disturbance is commonly associated with the diagnosis and treatment of cancer. In 25% of cases insomnia is persistent and impacts significantly upon quality of life. The purpose of this study was to investigate the efficacy of a non-pharmacological intervention to reduce clinical complaints of severe insomnia and to improve quality of daytime functioning. The study conformed to a pragmatic randomised trial with participants allocated in a 2:1 ratio to CBT or treatment as usual (TAU) in two centres. All participants met clinical and research diagnostic criteria for insomnia associated with a medical condition. In all cases the insomnia had become a chronic problem, persisting after active anti-cancer therapy. CBT was delivered according to a treatment manual across five, small group sessions. Primary outcomes were subjectively assessed sleep (diary) and objectively estimated sleep (actigraphy) at post-treatment and 6 month follow up. Of 201 participants who consented 150 eligible participants were randomised to CBT (100) and TAU (50). The majority of participants had had breast, prostate or colorectal cancers. CBT was associated with an average reduction in sleep-onset latency plus wake time after sleep onset of approximately 60 minutes per night of sleep, relative to little change in TAU. Importantly, demographic and clinical factors did not contraindicate response to this form of insomnia treatment. Daytime improvements in

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health-related QoL were also obtained following CBT. Therapists and participants found the treatment programme both feasible and acceptable to work with in practical terms.

295 Transpersonal Mind–Body–Spirit Approach to Explore Different Levels of Suffering and Well-being in Persons Living with Cancer: An Experimental Study Aragona M Medical Oncology, University of Messina, Messina, Italy Suffering of persons living with cancer is very profound and subjective perception of quality of life (QOL) is frequently poor. However, according to WHO, health is not merely the absence of disease or infirmity, but a state of complete physical, emotional, mental, social, spiritual wellbeing. Transpersonal body–mind–spiritual psychotherapy (Grossman, Sica) was used for 55 early stage breast cancer patients, in 6 months, weekly, group setting. Binaural beat meta-music, with meditation, facilitate hemispheric brain synchronization at theta, delta waves frequency. Bioenergetics aspect of the Simonton psychoncologic and Maltz psychodynamic methods were also used. Clinical–pathological–immunological data were recorded and many instruments were used to evaluate improvement of disease and physical, emotional, mental, social, spiritual well being. All patients explored their suffering, frequently different from cancer, at different levels of consciousness to transform it in a healthier way. They felt more aware and congruent whit theirselves, their personal needs and their being in the world. They reported improvement of psychological and physical suffering, subjective well-being, enthusiasm, joy in every day life. Among others, SEIQoLDW showed an important switch of desiderata, initially focused on QOL physical– psychosocial aspects, towards self-recognition, self-realization and spiritual QOL aspects (p50.001), as expression of personal growth, well-being (Maslow). This transpersonal approach seems to be useful to alleviate suffering of persons living with cancer, to improve QOL, ell-being, sense of life and death, by expanding personal selfawareness at physical, emotional, mental, social, spiritual consciousness levels. ACKNOWLEDGEMENTS: I would like to appreciate Arturo Sica for teaching me the

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transpersonal body–mind–spiritual approach of Joules Grossman.

Clinical Epidemiology, National Cancer Institute, Genoa, Italy; bPsycho-Oncology National Cancer Institute, Genoa, Italy

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PURPOSE: This survey was aimed at estimating prevalence and determinants of severe depression among Italian non-professional caregivers after the cancer patient’s death. METHODS: ISDOC is a mortality follow-back survey of 2000 cancer deaths, identified with a 2-stage probability sample, representative of Italian adults cancer deaths. Non-professional caregivers were identified and, after consent, interviewed about the multidimensional problems encountered by the patient and the family during the last 3 months of life. After the interview, the non-professional caregivers were evaluated for depressive symptoms using the 20-item CES-D scale. RESULTS: From the 1843 identified non-professional caregivers, we obtained 1231 valid interviews. The median time between the patient’s death and the interview was 234 days (range 103–374). Most interviews were performed 4–8 months (58.9%) after the patient’s death. CES-d was filled in by 1181 caregivers (95.9%). Using the cut-off of 16 in the CES-D score, 63.7% of the caregivers were classified as depressed (39.0% with a conservative cut-off of 23). After adjusting for a number of characteristics of the patient, the disease and the caregiver, the highest depression scores were observed when the caregiver was a female, aged 65 years or more and when he/she was the spouse-partner of the patient. CONCLUSIONS: This large, representative survey confirmed a high rate of depression among surviving caregivers of cancer patients. Intervention and support re needed before and after the patient’s death.

Relationship Between Social Service Input and Psychiatric Diagnoses in Cancer Patients Athanasiadis La, Tsiara Nb, Stravoravdi Pb, Karamitrou Vb, Drakopoulu Fb a 1st University Psychiatric Department Greece Aristotle University of Thessaloniki, Thessaloniki, Greece; bPsychosocial Service, Research Department ‘Theagenion’ Cancer Hospital of Thessaloniki, Thessaloniki, Greece PURPOSE: To explore the relationship between the psychiatric diagnoses of cancer patients referred to the Psychiatric Service and the social service input they might have received following a request by the referring ward oncologist. METHOD: One hundred inpatients at the Thessaloniki NHS Cancer hospital in N. Greece were randomly selected for this study. The authors looked at the medical files of the patients and examined the relationship between the DSM IV TR current psychiatric diagnosis (coded as depression/ anxiety, organic/agitation, adjustment disorder) or lack of a positive diagnosis, and the input (accommodation, financial, other) offered by the Social Service as required. A number of study limitations were identified. The analysis of the data was performed by the SPSS 11 statistical package. RESULTS: The Social Service input was offered to 9/45 of patients with depression/anxiety, 0/10 with organic/agitation, 3/11 with adjustment disorder and 4/15 without a positive psychiatric diagnosis. The analysis (crosstabs) showed that 5 cells had expected count less than 5, so an exact significance test was selected for Pearson’s chisquare. A relationship between social service input and psychiatric diagnosis was not proved (x2 ¼ 3:035; df ¼ 4; exact p ¼ 0:522). CONCLUSIONS: The results of this preliminary study do not support the view that there is a relationship between the psychiatric diagnoses in cancer patients and the social service input they may receive.

297 High Prevalence of Depressive Symptoms Among Italian Surviving Caregivers. Results from the Italian Survey of the Dying of Cancer (ISDOC) Costantini Ma, Morasso Gb, Beccaro Ma

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298 Assessing the Role of Spirituality in the Adjustment to Cancer De Jager Meezenbroek EC, Van den Berg M, Tuytel G, Visser A, Garssen B Helen Dowling Institute, Utrecht, The Netherlands PURPOSE: The development and psychometric testing of a new spirituality questionnaire the Spiritual Attitude and Involvement List (SAIL). This instrument should overcome the problems of many spirituality scales, such as restriction to religion, too limited number of subscales and a weak psychometric basis. METHODS: This project includes three successive studies: study 1

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among students, study 2 among a healthy adult population sample and study 3 among cancer patients. The first version of the SAIL consisted of 14 subscales and 106 items. In all studies item analyses, factor analyses, and internal consistency tests are performed and convergent and divergent validity is determined. RESULTS: Study 1 and 2 (N ¼ 950 and N ¼ 466; respectively) resulted in a revised version of the SAIL (SAIL 2) that consists of 8 subscales and 41 items. The internal consistency and test-retest reliability appeared to be adequate (a ¼ 0:75–0.88 and r ¼ 0:77–0.92, respectively). Convergent validity was demonstrated by the association of 7 of the subscales with a short spirituality questionnaire the FACITSp-12 ðr > 0:30Þ: Divergent validity was partly demonstrated as 6 subscales were not associated with Internal Locus of Control ðr50:15Þ. Currently, we are gathering the data of at least 250 cancer patients for the last study. This study will yield information about the relationship of the subscales with variables such as well-being, fatigue and pain. CONCLUSION: The psychometric characteristics of the SAIL 2 appeared adequate in two large samples. This instrument will be valuable for assessing the role of spirituality in the adjustment to cancer.

299 Psychological Morbidity in Cancer Patients Gil Fa, Costa Ga, Perez Xc, Salamero Mb, Sanchez Nb, Sirgo Ac a Psychooncology Service, Institut Catala d’oncologia l’hospitalet, Barcelona Spain; bPsychology Service, Psychiatric Institute Hospital Clinic, Barcelona, Spain; cOncology Service Hospital Sant Joan Reus, Spain; Medical Oncology Department, Hospital Duran i Reynals, Institut Catala d’oncologia, Barcelona, Spain A few data are available on psychological morbidity among cancer patients in Spain. As a part of a more general investigation (CatalanoBalear Psycho-Oncology Group}PSOCAB), the prevalence of psychological morbidity were examined in cancer patients in north-east of Spain (Catalonia). From June 200 through April 2006, a total of a 250 ambulatory cancer patients with good performance status and no cognitive impairment were enrolled. The Structured Clinical Interview for DSM-IV (SCID) and The Hospital Anxiety-Depression Scale (HAD-S) were used to assess psychological morbidity. Of 250 patients,

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24% (60 patients) had a psychiatric disorder, main of them were adaptative disorders (51 patients). Total psychiatric ‘caseness’ was 24% according to HAD-S cut-off (14). This study show that around 25% of cancer patients report psychiatric disorders. The final results of our study will determine the number of cancer patients needed of psychological care, indicating the psychooncological resources needed in our population.

300 Prevalence and Predictors of Mood Disorders in Early Breast Cancer: Results from 2181 Women in the START (Standardisation of Breast Radiotherapy) trial Hopwood Pa, Mills Jb, Sumo Gb, Bliss JMb a Psycho-Oncology Service Christie Hospital, Manchester, UK; bClinical Trials & Statistics Unit The Institute of Cancer Research, Sutton, UK PURPOSE: To measure prevalence and clinical predictors of anxiety (A) and depression (D) over 5 years follow-up in women with early breast cancer and determine the association of mood with body image (BI) and sexual functioning (SEF). METHODS: Women participating in the quality of life (QL) sub-study completed the HADS, Body Image Sale (BIS), and standardised QL measures, at baseline (after surgery and adjuvant chemotherapy (CT) but before radiotherapy) and at 6, 12, 24 and 60 months follow-up. At baseline, the independent effects of age, time from surgery, type of surgery, chemotherapy and endocrine therapy were identified using multiple regression analysis. Change over time and associations with body image and sexual function were tested using the Generalised Estimating Equations model. RESULTS: 2181 (99%) women provided baseline QL, (mean age 56.5 years, range 26–87). 17.1% women had mastectomy (Mx), and 82.9% underwent conservative surgery; median time from surgery was 8.0 weeks (IQR 5.6–19.6). 33% received CT. At baseline 32% reported borderline or case A; 12% borderline or case D; there was no significant change over time. Mx and better SEF were associated with lower A and D at baseline and over time; anxiety was consistently reduced in older women but CT did not predict mood over time. There were persistent independent negative associations between A/D and BI. CONCLUSIONS: Anxiety rates were 3 times greater than depression and this persisted over time; older age and Mx were protective but a

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significant interaction exists between D/A and BIS/SEF. Cause and effect cannot be distinguished.

301 Effects of Chemotherapy on the Cognitive Function in Breast Cancer Patients Rubio Ba, Sirgo Aa, Torres Ab, A´vila Cc a Psycho-oncology Unit, Oncology Department, University Hospital Sant Joan, Reus, Spain; b Oncology Department, University Hospital Sant Joan, Reus, Spain; cPsychology Department, University Jaume I, Castello´n, Spain INTRODUCTION: In recent years has been investigated the effect of chemotherapy treatment on the cognitive function of the cancer patients, taking into account that many patients complain of cognitive problems that interfere in their everyday functioning during and after the treatment. Literature shows contradictory results due to different methodological issues. PURPOSE: To review the available literature on the topic: 1. To provide a summary of the results obtained in the diverse studies carried out to date. 2. To analyze possible methodological problems of the studies to improve future investigations on the topic. METHOD: A review of the available literature on the relationship between adjuvant chemotherapy and cognitive function in women affected of breast cancer through the database MedLine, gathering all the available papers since 1990– 2006. The keywords used for the search have been: cognition, brain, cognitive function, cognitive deterioration, cognitive deficits, chemotherapy, adjuvant therapy, oncology, cancer, oncological patient, breast, tests of neuroimage, chemobrain and chemofog, neuorocognitive examination, systemic therapy and hormonal treatment. RESULTS: (1) A presentation of the results obtained in the revised studies; (2) A critical analysis of the possible causes of methodological weakness among the studies. CONCLUSION: The revision shows the need to carry out prospective and longitudinal studies, using greater samples size, using greater homogeneity among the cognitive tests and including a evaluation of diverse cognitive domains. The revision also shows the need to evaluate other variables that may be modulating the relationship between chemotherapy treatment and cognition, and to include tests of neuroimaging to clarify results.

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302 Fatigue, Sleep, Mood and Performance Status in Patients with Multiple Myeloma Coon SK, Richards K, Kennedy R, Stewart CB, McNatt P College of Nursing, University of Arkansas for Medical Sciences, Little Rock, USA PURPOSE: To describe fatigue, sleep, mood and performance status and the relationships among these variables in patients newly diagnosed with multiple myeloma. METHODS: Data were obtained from 178 patients (77 females, 101 males) before they started an intensive treatment protocol. Assessments included haemoglobin, fatigue with the Profile of Mood States (POMS) and Functional Assessment of Cancer Therapy–Fatigue (FACT–F), sleep with the Actigraph, mood with the POMS, and performance status with the six-minute walk test measuring aerobic capacity and the dynamometer measuring muscle strength. Data analysis consisted of descriptive statistics and Pearson correlations. RESULTS: 71% of females and 53% of males had haemoglobin below 12g/dl. Haemoglobin was negatively correlated with fatigue and mood disturbance. Average sleep efficiency was 84% for females and 77% for males. Sleep efficiency was positively correlated with aerobic capacity and negatively correlated with fatigue. Aerobic capacity was positively correlated with muscle strength and negatively correlated with fatigue. Correlations were significant at the 0.05 level. CONCLUSIONS: Over half the patients were anaemic before starting chemotherapy and this affects their quality of life. Sleep disturbance probably also increases fatigue and may impair functional performance. Increased muscle strength may improve aerobic capacity. Interventions are needed to decrease fatigue, improve sleep and functional performance. ACKNOWLEDGEMENTS: NIH/NINR and OrthoBiotech, Inc.

303 Phenomenological Features in Affective Disorders During Cancer Fei L Neuro-Psychiatric Sciences University of Florence, Florence, Italy PURPOSE: The author investigates the features of three psychopathological conditions in psychooncologic clinical area: Adjustment Disorder with

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Depressed Mood as reaction to cancer and two different types of Major Depression during the course of cancer, respectively, in absence and in presence of previous Mood Disorders. METHODS: Three brief case-reports are described: after an evaluation by SCID I and a careful clinical description, each case is studied by a phenomenological analysis. RESULTS: Despite relevant psychopathological and clinical differences, the phenomenological core seems to be common: important modifications in the experience of time in own status and role and in the experience of own space are present in the three conditions. CONCLUSIONS: During the course of cancer, different affective disorders seem to show similar features, related likely to the hard and painful perception of the risk of death.

304 Depression and Fatigue in Cancer Patient: Is There a Relationship with Exercise? Humpel Na, Iverson DCb a Centre for Health Behaviour & Communication Research, University of Wollongong, Wollongong, Australia; bFaculty of Health & Behavioural Sciences University of Wollongong, Wollongong, Australia PURPOSE: Depression and fatigue are common effects of a cancer diagnosis and its treatment. A natural reaction is to reduce or cease exercise. Exercise during and following treatment has the potential to reduce fatigue, improve mood and overall quality of life. This study aimed to explore the relationship between depression, fatigue and level of exercise in breast and prostate cancer survivors. METHOD: Posters and study flyers were placed in cancer related medical waiting rooms. Patients could complete the survey during an interview or by mail. RESULTS: Ninety one participants (65% men) with a mean age of 61 years completed the questionnaire and 35% were less than 4 months since diagnosis. Body Mass Index score demonstrated that 42% were overweight and 25% were obese. Taking part in sufficient exercise for health benefits (150 minutes each week) was reported by 27%. Depression was indicated in 30.8% (CES-D) and was significantly lower ðM ¼ 8:5Þ in those sufficiently active compared to those not sufficiently active ðM ¼ 12:8Þ; Fð1; 88Þ ¼ 4:86; p50.03. Significantly less fatigue was reported (M ¼ 44:2; higher score is less fatigue) in those sufficiently active compared to

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those not sufficiently active ðM ¼ 36:5Þ Fð1; 88Þ ¼ 10:21; p50.002. CONCLUSION: This study demonstrated that those who exercise following a cancer diagnosis report improved mood and less fatigue. This has implications for recuperation and ongoing well being. Interventions are needed that examine how much exercise is required to gain these benefits.

305 Depression, Disease-, and Treatment-related Predictors of Complementary and Alternative Medicine (CAM) Use in a Nationwide Cohort of 3400 Danish Women Treated for Breast Cancer Pedersen CGa, Christensen Sa, Zachariae Rta, Jensen Anders Bb a Psychooncology Research Unit, Institute of Psychology, Aarhus University, Aarhus, Denmark; b Department of Oncology, Aarhus University Hospital, Aarhus, Denmark AIM: Use of CAM has been related to depression as well as disease- and treatment-related variables, but previous findings are inconsistent. Our aim was to explore predictors of CAM use in a large population-based sample of women treated for breast cancer. METHODS: In an ongoing nationwide prospective study of the prognostic influence of psychosocial factors in breast cancer, baseline data were analyzed for 3400 women (response rate: 68%). Depression (BDI-II) and CAM use since time of diagnosis were measured 12–16 weeks post-surgery. RESULTS: 1355 (40.2%) participants had used one or more than one type of CAM since the time of diagnosis. CAM users were younger (M ¼ 52:3 yr; SD ¼ 8:94) than nonusers (M ¼ 56:3 yr; SD ¼ 8:56) (p50.001), and users of CAM had higher total BDI-II scores than non-users Z ¼ 7:82; p50.0005. In a backward stepwise logistic regression analysis, CAM use was associated with: having received chemotherapy (OR:1.38; p50.0005); no medical comorbidity (OR:1.56; p ¼ 0:001), having standard weight BMI (OR:1.35; p ¼ 0:029), and depression (OR:1.03; p50.0005). Type of surgery, tumor size, axillary lymph node status, and marital status were not associated with CAM use. CONCLUSION: Our results support previous findings that women with breast cancer using CAM exhibit more depressive symptoms than non-users, and that attempts to alleviate treatment-related symptoms might play a role.

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306 The Contribution of Attachment Security and Social Support to Depressive Symptoms in Patients with Metastatic Cancer Rodin Ga,b,c, Walsh Ab, Zimmermann Ca,c, Gagliese Lb,c,d, Jones Ja,b,c a Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, Canada; bBehavioural Sciences and Health Research Division, Toronto General Research Institute, University Health Network, Toronto, Canada; cFaculty of Medicine, University of Toronto, Toronto, Canada; dDepartment of Kinesiology and Health Science, York University, Toronto, Canada PURPOSE: The present study examined the extent to which social support and attachment security buffer the relationship between physical distress and depressive symptoms in a sample of ambulatory patients with metastatic cancer. METHODS: Patients with stage IV gastrointestinal cancer or stage III or IV lung cancer were recruited from outpatient clinics at Princess Margaret Hospital, Toronto, Canada. Subjects completed the Memorial Symptom Assessment Scale, the Medical Outcomes Study Social Support Survey, the Experiences in Close Relationships Questionnaire, and the Beck Depression Inventory-II. RESULTS: Results from 326 consecutive patients indicate that physical symptom frequency, severity, and distress are directly associated with the severity of depressive symptoms, and inversely related to the degree of attachment anxiety and avoidance, and perceived social support. Attachment security (on the dimension of anxious attachment) was found to significantly buffer the effect of disease-related factors on depressive symptoms, such that high attachment anxiety was associated with a steeper increase in depressive symptoms across disease burden. Perceived social support was found to mediate the relationship between attachment security and depressive symptoms. CONCLUSIONS: Findings from this study demonstrate a significant relationship between physical and psychological distress in patients with metastatic cancer. They indicate that attachment security has a significant buffering effect on the relationship between depression and physical distress and that this effect is partially mediated through social support. These findings suggest that the

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interaction of individual, social, and diseaserelated factors contribute to the emergence of depressive symptoms in patients with metastatic cancer. ACKNOWLEDGEMENTS: Funded by the Canadian Institutes of Health Research Grant #62861 (GR) and York University (LG).

307 International Development of an EORTC Wellbeing Module Young Ta, Vivat Bb, Efficace Fc, Sigurjardo´ttir Vd a Lynda Jackson Macmillan Centre, Mount Vernon Cancer Centre, Northwood, UK; bDepartment of Health and Social Care, Brunel University, Osterley Campus, Isleworth, UK; cQuality of Life Unit, EORTC Data Center, Brussels, Belgium; d Palliative Care, Landspitali University Hospital, Kopavogur, Iceland AIMS: To develop a spiritual well-being questionnaire, focusing on the ‘function’ rather than the ‘substance’ of patients’ beliefs and practices. METHODS: EORTC Guidelines for module development were used with modifications. A literature search identified 84 potential issues in 3 areas: relationships with self and others, existential concerns and religious or spiritual beliefs and practices. These were translated from English into Croatian, Dutch, Flemish, German, Italian and Icelandic and were shown to 22 patients and 22 health professionals from 7 European countries for comments on content and relevance. Highest ranked issues were rewritten as items (i.e. in statement form), and shown to 17 patients from 3 countries. Items from this phase were retained on the basis of patient rankings, translatability, and correlations between items. RESULTS: Simple questions for assessing importance of issues were inadequate for complex issues, so were rephrased. Translation was difficult for items relating to ‘spirituality,’ which has culturallyspecific meanings. EORTC Guidelines were modified for earlier deletion of items. 84 issues were reduced to 38 items for pilot-testing. For some patients, responding to the items became a spiritual intervention as they considered previously unaddressed issues. CONCLUSIONS: The EORTC Guidelines were a useful framework for development but required modification for this complex project. Pilot testing is underway aiming to recruit 150+ patients and using the additional languages of French, Norwegian and Spanish.

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Debriefing interviews are being used to investigate the implications of self-completing the questionnaire and check the questions are not distressing or difficult to understand.

308 Psycho-Neuro-Immunology: Influence of Psychosocial Intervention on T and NK Cell Subsets in Patients with Breast Cancer Andritsch E, Ladinek V, Zloklikovits S, Stanzer S, Buernhofer T Internal Medicine Division of Oncology, Graz, Austria PURPOSE: The aim of our study is to examine the influence of psychosocial intervention on the wellbeing and immune defence system in patients with operated primary breast cancer. PATIENTS AND METHODS: Sixty women between the age of 45 and 70 years were randomized into either a group with psychosocial intervention ðn ¼ 30Þ or in a control group (n ¼ 30; intervention after a control period of 6 months). In addition, healthy volunteers ðn ¼ 30Þ were evaluated. Standardized questionnaires as well as a semi-structured interview were used for all three study groups. For the patients the IES, MAC, BDI, EORTC QLQ-C30, STAI, and Sense of Coherence Scale (SOC) were employed. The healthy volunteers were examined with BDI, QLQ-C30, STAI, and SOC. All participants were evaluated for psychosocial and immune parameters (measured by multicolour flow cytometry) at three different time points during a six months study period. RESULTS: As of now, 21 patients participating in the first intervention group and patient control group compared to 15 healthy volunteers were evaluated. We found significant differences in the number of NK cells (20  7% vs 12  5%, p50.0001) and T cells (55  10% vs 63  8%, p ¼ 0:02) of patient compared to normal controls. Additionally, we observed a significant change in the mean of the trait anxiety (35  11 vs 32  7) in the intervention group compared to the control group (39  8 vs 35  8). Further results of the ongoing study will be presented and discussed.

309 Stressful Life Events and Risk for Cancer}A Prospective Study Bergelt Ca,b, Prescott Ec,d, Grnbæk Md,e, Koch Ua, Johansen Cb

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a

Institute of Medical Psychology, University Clinic Hamburg, Hamburg, Germany; bInstitute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark; cDepartment of Cardiology, Rigshospitalet, Copenhagen, Denmark; dThe Copenhagen City Heart Study, Bispebjerg Hospital, Copenhagen, Denmark; eNational Institute of Public Health, Copenhagen, Denmark PURPOSE: The hypothesis that severe stress can increase cancer risk is popular in the public and among cancer patients. We investigated the association between self-reported stressful life events and the risk for cancer. METHODS: The study sample consisted of 8736 Danes aged 21–94 who had been examined in 1991–1994 within the Copenhagen City Heart Study. Experience of stressful life events was measured from a questionnaire-based self-report. For the analyses, the sample was divided into four groups (no, one, two and three or more events). Cancer cases were ascertained by linkage to the Danish Cancer Registry, which ensured unbiased outcome assessment. Information on confounding variables was obtained by self-report of the participants. The sample was followed for up to 11.2 years (1991– 2002), during which time cancer was diagnosed in 1011 persons (12%). Regression analyses for etiologically based cancer groups were conducted with the Cox proportional hazards model, adjusting for a number of well-known risk factors for cancer. RESULTS: No association was found between the number of stressful events and the risk for all cancers, for cancers related to smoking or alcohol consumption or to the immune system. The risk for hormone-related cancers was slightly increased among people with several stressful life events. CONCLUSIONS: The results of this prospective study with unbiased outcome assessment and adjustment for a number of confounders do not support the hypothesis that experience of stressful life events is associated with an increased risk for cancer.

310 Survival After a Psychoeducational Intervention Among Patients with Malignant Melanoma}A Replication Study Boesen EH, Boesen S, Frederiksen K, Ross L, Johansen C Department of Psychosocial Cancer Research, Institute of Cancer Epidemiology, Copenhagen, Denmark

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PURPOSE: Results of a randomised intervention study from 1993 of psycho-education to patients with malignant melanoma in the early stages showed a beneficial effect on recurrence and survival six years after the intervention. The present study is a replication of this study where we applied a similar intervention in a randomised design among Danish patients with malignant melanoma. We evaluated the effect on recurrence and survival for the 259 participants in the study and the 137 patients who declined participation. METHOD: A total of 259 patients with primary cutaneous malignant melanoma were randomly assigned to the control or intervention group. Patients in the intervention group were offered six weekly sessions of 2 hours of psycho-education. Participants and non-participants were followed up for vital status and recurrence 4–6 years post surgical treatment. Prognostic factors (thickness of the tumour and lymph node status), sex and age were adjusted using Cox regression (proportional hazards regression) providing an adjusted survival rate ratio as well as an adjusted relapse-free survival rate ratio along with 95% confidence intervals. RESULTS: For the control group compared to the intervention group the hazard ratio for survival was 1.30 (0.5–3.5) and for recurrence 0.73 (0.3–1.9). Being non-participant increased the risk of death by more than 2 fold (RR ¼ 2:26; CI ¼ 1:0–5.2). CONCLUSION: Psycho-education did not extend survival or recurrence free interval. The result adds to the number of studies with negative findings on survival after participation in psychosocial interventions that have emerged in the recent years.

311 Personality Type and the Risk of Cancer in a French Electrical Utility Company (GAZEL cohort) Geoffroy-Perez Ba, Cordier Sa, Zins Mb, Ducimetie`re Pc, Consoli Sd a U 625 National Institute of Health and Medical Research (INSERM), Universite´ Rennes I, Rennes France; bU 687 National Institute of Health and Medical Research (INSERM) Saint-Maurice France; cU 258 National Institute of Health and Medical Research (INSERM) Villejuif France; d Department of C-L Psychiatry European Georges Pompidou Hospital Paris, France PURPOSE: The objective of this study was to assess the role of psychological factors such as

Copyright # 2006 John Wiley & Sons, Ltd.

personality types in modulating the classic risk factors for cancer. METHODS: In 1993, 74 percent of the 15 010 male volunteers from the GAZEL cohort of employees of the French national utility company responded to self-administered psychological questionnaires: Buss & Durkee Hostility Inventory and Grossarth-Maticek & Eysenck Personality-Stress Inventory. In the 8 years of follow-up (60 391 person-years), 169 new cases of cancer have been recorded in the registry kept by the medical departments of the company. RESULTS: Hostility and especially neurotic hostility were associated with the risk of cancer (RR respectively ¼ 1:42; 95% confidence interval (CI) 0.96–2.09, and 1.45 (1.00–2.09) in the highest tertile). The so-called ‘cancer-prone’ personality at PSI was more specifically associated with the risk of cancers related to smoking and we observed a multiplicative risk between smoking and score above the first tertile. No other personality type was consistently associated with the risk of cancer in this study. CONCLUSIONS: Our results suggest an association between psychological factors and the risk of cancer and show that these relations are most likely of low intensity and, if real, are probably interacting with established risk factors. ACKNOWLEDGMENTS: We thank the team of Inserm Unit 687 and the Caisse Nationale d’Assurance Maladie des Travailleurs Salarie´s and the Association pour la Recherche contre le Cancer for supporting this project.

312 The Relation between Coping, Meaning in Life, Recurrence and Survival and in a Sample of Austrian Breast Cancer Patients Dietmaier G, Ladinek V, Samonigg H, Andritsch E Department of Internal Medicine, Division of Clinical Oncology Medical University Graz, Graz, Austria PURPOSE: Possible relations between coping with cancer and the survival in cancer patients were investigated in a couple of studies. Even though they were limited by small sample sizes or a retrospective design, there is some evidence that distress predicts shortened survival and active coping ameliorates the chances. METHODS: 3, 4, and 5 years after the initial diagnoses 212 breast cancer patients (stage I or II, in an adjuvant situation) were interviewed to identify predictors of the subjective fulfilment of meaning in life and to investigate if the coping style implicates

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survival. RESULTS: Hopelessness/Helplessness (MAC), Paranoia (BSI), fatalistic acceptance (MAC), the Karnofsky Index, Aggression (BSI) and Anxious preoccupation (MAC) were significant predictors of the subjective fulfilment of meaning in life (ESK, R2 ¼ 0:589; p ¼ 0:042). At present 3.8% ðN ¼ 8Þ of the patients have died because of their cancer and 10.8% ðN ¼ 23Þ are suffering from a relapse. With MANOVAs significant relations between recurrence and avoidance (IES) five years ago ðp ¼ 0:048Þ and between recurrence and avoidance ðp ¼ 0:010Þ and aggression (BSI) four years ago ðp ¼ 0:038Þ could be identified. Patients being free of disease tended to be older ðp ¼ 0:070Þ than patients with relapses. Regarding the 8-year survival patients, who had died, stated a higher level of anxious preoccupation (MAC) 3 years after the initial diagnoses ðp ¼ 0:480Þ: CONCLUSIONS: This study underlines the necessity for further research to learn more about cancer patients’ needs relating to psychosocial support during the course of disease.

313 Development of Psycho-Social Oncology}King Hussein Cancer Center-Jordan Khatib J Psychosocial Oncology, King Hussein Cancer Center, Amman, Jordan The Psycho-Social Oncology program at King Hussein Cancer Center KHCC started at 2003, it is the first of its kind in Jordan and the Arab world. It began with a psychiatrist then social worker. It is now more than 20 professionals structured as follow: 1}Mental health division divided into three parts (a}Psychiatric unit; b}Psychology unit; c}Pediatric unit); 2}Social work division (a}Clinical social work; b}Support social work). A strategy of work was done based on the NCCN Guidelines. Clinically, we receive patients from two sources: Screening}we screen all patients using the Arabic version of distress thermometer, our social workers who are part of the comprehensive care teams do the basic evaluation then they refer patients to the relevant service. CONSULTS: We respond to consults from the medical teams. Our social support division provides different services to patients and families including: Volunteer work; Support groups; Accommodations, transportations, and occasional financial support in cooperation with King Hussein Cancer Foundation. We conduct monthly

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meeting for patients each month and discuss an issue, organize trips, and parties. Our pediatric team is composed of social workers, psychologist, play specialists, child development and education specialists, the team provides the following services: Responds to consults; Social work services including home visits; Play services; Back to school program; Summer camp program. RESEARCH: We conducted two pilot works: Distress in KHCC Cancer inpatients; Psychosocial effects of children cancer on patients and families.

314 Psychosocial Factors and Survival among Breast and Prostate Cancer Patients: A Population-Based Study of African-Americans and Whites in the USA Soler-Vila Ha,b, Kasl SVb, Jones BAa a Epidemiology & Public Health, Miller School of Medicine, University of Miami, Miami, FL, USA; b Epidemiology & Public Health, School of Medicine, Yale University, New Haven, CT, USA PURPOSE: Breast (BC) and prostate cancer (PC) represent 31 and 33% of all estimated new cancer cases, respectively. We investigated the association between selected psychosocial factors and survival in a population-based cohort of 322 women and 251 men newly diagnosed with BC and PC and monitored for up to 15 years. Psychosocial factors have been associated with cancer outcomes but research on USA ethnically diverse populations is limited. METHODS: About half the sample was African-American. We explored the role of coping, emotional support, cancer-related fatalism, and patients’ beliefs regarding treatment-related risks, curability of cancer, and regular checkups as effective detection tool. Cox proportional-hazards models were adjusted for socio-demographic and biomedical variables (race, marital status, education, income, access to care, stage at diagnosis, co morbidity, obesity, smoking, ER/PR, histological grade, genetic alterations, and treatment). RESULTS: Lower emotional support was associated with a higher risk of death from any cause among BC (Hazards Ratio (HR ¼ 1:39; 95% confidence interval ðCIÞ ¼ 1:09–1.79) but not PC cases. Further, not believing in the curability of cancer was related to higher mortality for BC (HR ¼ 1:67; 95% CI ¼ 1:11–2.51) and PC cases (HR ¼ 1:70; 95% CI ¼ 1:16–2.50). Significant interactions were identified. CONCLUSIONS: Future research should focus on identifying the mechanisms underlying these associations

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(e.g. treatment decision-making, adherence to treatment and post-treatment protocols, psychoneuroimmunological links) as such findings have potential translation into intervention strategies. ACKNOWLEDGEMENTS: Research supported by U.S. Department of Defence, National Institutes of Health (NCI and NIMH), and the American Cancer Society (National and Connecticut Division).

a positive impact on both immunological (salivary Ig A) and psychosocial scores, which suggest further investigation with larger study groups would show more pronounced effects. S-Interferon-g results were less clear and require further investigation. The paper will be accompanied by images and narratives which arose from the intervention.

316 315 Looking at the Connection Between the Immune System and Psychosocial Function: A PhD Research Project Virago MCEa, Dunkley Mb, Hzelton Mc, Collins SMd a Health/Biomedicine University of Newcastle, Newcastle, Australia; bHealth/Biomedicine University of Newcastle, Newcastle, Australia; cHealth/ Nursing and Midwifery University of Newcastle, Newcastle, Australia; dThe Newcastle Melanoma Unit Mater Misercordiae Hospital, Newcastle, Australia PURPOSE: The objective was to assess the degree of correlation between immunological function and an art psychotherapy intervention, to address distress and psychosocial function surrounding a diagnosis of non-metastatic melanoma. There is a known immunological component to melanoma. The proposition was based on the understanding of whole/integral systems dynamics and the concept of the whole body hologram in dealing with memory; the capacity of both psychosocial and immune functions, as irreducible parts of the whole organism, to be negatively perturbed by apparently unremitting distress and positively changed through active learning in a supportive and interactive environment. That there is an obvious inter-relational dynamic between human psychosocial factors and their immunological status has been known anecdotally since antiquity and actively researched over the past 50 years, but not so in relation to art psychotherapy; an activity engaging kinaesthetic, sensory, imaginative and cognitive functions. METHOD: Weekly art psychotherapy sessions were held over six months in a small, mixed gender, closed group setting. Pre-and post-session saliva samples were collected, DTH tests administered at 3 monthly intervals and psychosocial questionnaires delivered before, after and at 12 month intervention follow-up. RESULTS: A comparison of mean scores suggests

Copyright # 2006 John Wiley & Sons, Ltd.

Measurement of Health Related Quality-of-Life in Terminal Cancer Patients Bacci Sa, Miccinesi Gb, Tamburini Mc a Statistics University of Florence, Florence, Italy; b Epidemiology CSPO Florence Italy; cPsychology National Cancer, Institute, Milan, Italy PURPOSE: To measure the quality-of-life of terminal cancer patients in palliative care through Rasch models. Specially, as the health related quality-of-life (HrQoL) is a multidimensional variable, a method to detect the dimensions that analyses the responses to a questionnaire is proposed. METHODS: 485 Therapy Impact Questionnaires (TIQ) were collected at the beginning of therapy during an Italian multi-center study on stadiation of case-mix in palliative care, which took place in 1995–1996. The TIQ was developed for cancer patients in 1991 at the National Cancer Institute in Milan. Because of the good properties of Rasch models, the proposed method used different tools from the Rasch framework: step by step Cronbach’s alpha, infit and outfit statistics, and the explorative factorial analysis. RESULTS: First of all, dimensions defined by means of a classical method such as confirmative factorial analysis are not consistent with the Rasch model’s hypothesis. Second, the proposed method detected two new dimensions: the first one (13 items) about physical symptoms and the other one (8 items) about the impact of therapy on the patient. CONCLUSIONS: The correct detection of latent dimensions in a questionnaire is a special requirement to objectively measure the HrQoL. The physical and mental status for each patient to whom the TIQ was administered could be estimated and it was possible to evaluate probabilistically the presence and the intensity of the items. ACKNOWLEDGEMENTS: Authors are pleased to thank the Co-operative Research Group on Palliative Medicine and the coordinator Dr F Toscani for having made available the data, and

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Prof. Mesbah for the methodological aspects of the contribution.

317 The Illusion of Returning to Normal: Comparing Quality of Life Scores during the First Two Years after Allogenic Haematopoietic Stem Cell Transplantation to Population Norms Bailer Ha, Larbig Wb, Ka¨chele Ha, Grulke Na a Psychosomatic Medicine and Psychotherapy, University Hospital of Ulm, Ulm, Germany; bMedical Psychology, University of Tu¨bingen, Tu¨bingen, Germany PURPOSE: For long-term survivors, it is reported that their quality of life (QoL) returns to normal. We study the course of QoL during the first two years post HSCT using the EORTC QLQ-C30 and compare scores to norms representative for the German population. METHODS: From 9/ 1999 to 12/2001, 140 patients were recruited from the transplant units at the university hospitals Ulm and Tu¨bingen, Germany, and followed-up on for at least two years. Patients were administered the QLQ-C30 before HSCT and several times thereafter. A half standard deviation (SD) is considered as clinically significant. For all 15 scales of the QLQ-C30, mean scores of our sample for all eight measure points were compared to the respective normative scores. RESULTS: Number of cases decreases from 140 at admission over 108 at discharge to 47 at about 26 months post HSCT, primarily due to deaths. Except for the scales global health, pain, and constipation the mean scores for all other scales point towards a clinically significant worse QoL at most of the measure points. Most restrictions are seen for the scales role functioning, social functioning, fatigue, and financial difficulties (difference to the mean 4 1 SD for all eight measure points). CONCLUSIONS: Returning to normal QoL seems to be an illusion at least for the first two years after HSCT. ACKNOWLEDGEMENTS: Supported by German Jose´ Carreras Leukaemia-Foundation.

318 Quality of Life in Patients Undergoing Transplant of Haematopoyetic Stem Cells (THSC): A Proposal for Psychological Intervention Barbero J, Coca C, Arranz P, del Rinco´n C, Herna´ndez Navarro F

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Hematology Hospital Universitrio La Paz, Madrid, Spain Transplant of haematopoietic parent cells (THSC) becomes a treatment more and more used for different diseases. The following study presents three successive phases: (a) a descriptive study assessing relevant psychosocial variables related to THSC in a 170 patient sample that undergo this treatment. This evaluation took place previous to THSC and at follow up after 2, 8, 15 and 24 months. This results allowed an empirical approach to the subject in order to develop a psychoeducational program for this kind of scene; (b) The same psychoeducational program was applied to a sample of 134 patients who undergo THSC. The follow up began before the THSC, and then conducted 100 days after (first medical revision), 1 year and 2 years from the beginning of the treatment; (c) The quality of life and other psychosocial variables were compared between 2 groups of patients made equal in age, sex, diagnosis and type of transplant: one group received the program mentioned before and a second group, belonged to a different hospital where a similar bio-medical protocol was applied, but assisted with another psychosocial intervention designed for general cancer patients. Finally, conclusions related to the psychosocial variables considered and to the protocol used along the whole THSC process are presented as well as different suggestions for future research.

319 Which is the Most Frequently used Health-Related Quality of Life (HRQOL) Measure in Cancer Clinical Trials? Efficace F, Bottomley A, Coens C Quality of Life Unit European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium Whilst a huge number of HRQOL measures are available to assess patient’s burden of the disease, little evidence exists regarding the most frequently used questionnaire in randomized controlled trials (RCTs) in oncology. A systematic literature search was undertaken on a number of databases including Medline, Cancerlit, and the Cochrane Controlled Trials Register. RCTs published from 1990 to 2004 including a HRQOL evaluation were searched. RCTs using proxy-based questionnaires were excluded. Only HRQOL multidimensional

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self-reported patient measures were taken into account. The search focused on the top four major cancer disease sites, in terms of incidence, in North America and in Northern and Western Europe, that is: breast, colorectal, non-small cell lung cancer (NSCLC) and prostate cancer. According to the eligibility criteria, 159 RCTs enrolling 58 635 patients were identified. Fifty were conducted with breast cancer, 29 in colorectal cancer, 48 in NSCLC and 32 in Prostate cancer. Overall, 94% of the studies used a previously validated HRQOL measure. The most frequently used HRQOL measures were the EORTC questionnaires being used in 76 studies (48%). Other questionnaires frequently used were the Rotterdam Symptom Checklist and the Functional Assessment of Cancer Therapy being used in 17 studies (11%) and 15 studies (9%), respectively. Other questionnaires used included the Visual Analogue Scale and the Functional Living Index for Cancer. This evidence could be useful when designing HRQOL evaluation in future cancer clinical trials as the EORTC modular approach to HRQOL evaluation is particularly valuable for clinical trials.

320 Health-Related Quality of Life for Adolescents and Young Adults with Cancer or a Blood Disorder: Validation of the PedsQLTM Generic Core and Cancer Module After Age-Appropriate Modification Ewing JEa, King MTb, Smith Aa, Goodenough Bc, Lindeman Rd,e a Faculty of Science, University of Technology, Sydney (UTS), Sydney, Australia; bCentre for Health Economics Research & Evaluation (CHERE), University of Technology, Sydney (UTS), Sydney, Australia; cCentre for Children’s Cancer & Blood Disorders (CCCBD), Sydney Children’s Hospital, Sydney, Australia; dSouth Eastern Area Laboratory Service (SEALS), Prince of Wales Hospital, Sydney, Australia; eSydney Children’s Hospital, Sydney, Australia PURPOSE: To validate the PedsQL 4.0 Generic Core and PedsQL 3.0 Cancer Module after modification for the 16–25 year old patient group. METHODS: Patient self- and proxy-report versions of the questionnaires originally designed for 13–18 year olds with cancer, were modified for appropriateness to our target group and administered in clinics and wards at three Sydney

Copyright # 2006 John Wiley & Sons, Ltd.

Hospitals (Sydney Children’s Hospital, Prince of Wales Hospital, and the Royal Hospital for Women), or via telephone. The Memorial Symptom Assessment Scale (MSAS) was used to categorise participants into known-groups according to symptom severity (slight, moderate and severe). RESULTS: 88 young adult patients aged 16–25 and 79 nominated proxies completed questionnaires. 54% of the patients were 16–19 years old, 74% had cancer and 26% had a blood disorder. The modified versions demonstrated good internal consistency reliability for the Generic Core Total Score (a ¼ 0:95 self-report, 0.96 proxy-report), and the Cancer Module Scales (average a ¼ 0:81 self-report, 0.91 proxy-report). Clinical validity, construct validity and discriminant validity were demonstrated through knowngroups analysis, confirmatory factor analysis and correlations, respectively. The degree of self-proxy concordance for internal domains highlighted the need to ask the patient about their HRQOL whenever possible. CONCLUSIONS: These new versions of the PedsQL Generic Core and Cancer Module are reliable, valid and sensitive. Their use as outcome measures in clinical trials and clinical practice will enhance future research into adolescents and young adults in the Australasian context. ACKNOWLEDGEMENTS: Anne Senner, Prof Glen Marshall, Prof Michael Friedlander, Prof Neville Hacker, Dr Richard Cohn, Dr Susan Russell, Dr Peter Petocz, Dr Scott Dunksley, Dr David Goldstein, Dr Sue Vachalec, Dr Craig Lewis, Dr Marcus Vowels, Dr Scott Dunksley, Dr James Varni, Pam Woodhouse, Theresa Malone, Sally Francis, Tali Foreman, Sally Watts and Mary Ryan.

321 Psychosocial Impact of Indwelling Urethral Catheter on Quality of Life: Experience of Men with Obstructive Prostate Enlargement in a Nigerian Hospital Ilesanmi REa, Adejumo POb a Nursing University of Ibadan, Ibadan, Nigeria; b Nursing University of Ibadan, Ibadan, Nigeria PURPOSE: To assess the psychosocial impact of indwelling urethral catheters on the quality of life of men with obstructive prostate enlargement. METHODS: A descriptive study that utilized triangulation approach for data collection. A total of one hundred and twenty (120) subjects were

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recruited randomly using a one third sample frame of clinic attendance. Respondents were then divided into two groups based on the duration on indwelling catheter. Twenty respondents who had not less than two months experience were invited as key informants to assess their lived experiences, while one hundred subjects responded to questionnaires. Two separate data were derived. The quantitative data were analysed using the SPSS, while the qualitative data were analysed by content analysis. Three hypotheses were drawn and tested using non-parametric test, the Mann–Whitney -U and Kruskal Wallis. All test of statistical significance were at a probability level of 5%. RESULTS: Result showed that 32% of the respondents had psychological morbidity as patients struggled with feelings of depression, isolation and embarrassment which affected their self concept. There was inadequate attention and information on issues of sex, suggesting dissatisfaction with care. However, there was variability in the rating of quality of life in which 30.5% had a modal score of 70–74, on WHOQOL-Brief. The lowest score was between 50 and 54, representing 3.2% of the study sample. CONCLUSION: Study concludes that patients on long term catheterization require attention to personal issues like sex and adequate information that will foster psychosocial adjustment.

322 Does Reflexology Improve Quality of Life in Women Who Have Undergone Surgery for Early Breast Carcinoma? Walker LGa,c, Sharp DMa, Walker MBb, Greenman Ja a Institute of Rehabilitation, University of Hull, Kingston upon Hull, UK; bOncology Health Centres Hull and East Yorkshire Hospitals, NHS Trust Kingston upon Hull, UK; cPostgraduate Medical Institute, University of Hull, Kingston upon Hull, UK PURPOSE: A pragmatic randomised controlled trial was carried out to evaluate the effects of reflexology on QofL in women with early breast cancer. METHODS: 183 women with early breast cancer were randomised six weeks post-surgery to self-initiated support (SIS) (comparator intervention), SIS plus reflexology, or SIS plus scalp massage (control for physical and social contact). Patients randomised to reflexology and massage had eight sessions at weekly intervals. The primary endpoint was 18 weeks post surgery, and the

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primary outcome was the Trial Outcome Index (TOI) of the Functional Assessment of Cancer Therapy}breast cancer version. The secondary endpoint was 24 weeks post surgery, and secondary outcomes included the Hospital Anxiety and Depression Scale (HADS) and the Mood Rating Scale (MRS). RESULTS: After adjusting for age and baseline scores, at the primary endpoint (week 18), massage, but not reflexology, was significantly better than SIS in terms of the Trial Outcome Index (TOI). Reflexology and massage were both better than SIS for MRS relaxation, and massage was better than reflexology and SIS for MRS easygoingness. At the secondary endpoint (week 24), reflexology, but not massage, was better than SIS in terms of the TOI and MRS relaxation. The difference between reflexology and massage was not significant. The three groups were similar in terms of HADS anxiety and depression at both endpoints. CONCLUSIONS: When compared to SIS, reflexology and massage have statistically significant, but modest, effects on QofL following surgery for early breast carcinoma. ACKNOWLEDGEMENT: Funding from the NHS R&D.

323 Quality of Life and Styles of Coping in a Population of Cancer Patients Undergoing Oncologic Treatment: Comparison Between CAM Non Employing Versus Employing Subjects Sguazzotti Ea, Ostacoli La, Pacchiana Parravicini MVa, Picci RLa, Saini Ab a Mental Health, A.S.O. S. Luigi, Orbassano, Torino, Italy; bMedical Oncology, A.S.O. S. Luigi, Orbassano, Torino, Italy PURPOSE: To investigate psychometric differences between cancer patients non-employing complementary and alternative therapies (CAM) and those employing. METHODS: An anonymous interview collecting demographic data, use of CAM and administration of FACT-G, HADS, Mini-MAC tests was performed to patients undergoing oncologic treatments in four different institutions. Statistical analysis was performed with the not parametric Mann–Whitney U test for continuous variables. RESULTS: 194 subjects are included, 101 females and 93 males. The most represented group of age is 56–65. Forty-two patients declared use of one or more CAM (21.7%) in association with oncologic treatment; in this subgroup women were 25

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(58.1%) and males 18 (41.9%). Significant differences the two groups were found in the FACT-G test as concerns physical wellbeing ðp ¼ 0:001Þ and emotional wellbeing ðp ¼ 0:01Þ both in favour of CAM non employing patients (3.15  0.78 vs 2.56  1.01 and 2.73  0.80 vs 2.35  0.78, respectively). A borderline significance was found in social wellbeing ðp ¼ 0:08Þ in favour of CAM employing patients (2.45  0.65 vs 2.65  0.58). None of the HADS nor Mini-MAC items showed any significant difference. CONCLUSIONS: Data point out a difference in the quality of life between CAM-non employing and CAM-employing patients with a worse perception of both physical and emotional wellbeing in the second group; level of anxiety and depression and styles of coping are not different between the two groups. This suggest more subjective uneasiness as a possible major trigger for recourse to CAM.

324 A Controlled Study of Job Strain in PrimaryTreated Cancer Patients Gudbergsson SBa, Berg Fossa SDa, Dahl AAa, Sanne Bb a The Cancer Clinic Rikshospitalet-Radiumhospitalet Trust, University of Oslo, Oslo, Norway; b Center for Child and Adolescent Mental Health, University of Bergen, Bergen, Norway BACKGROUND: As more cancer patients survive their return and re-adaptation to work life has become an important theme. Little research has been done on re-adaptation for example measured as job strain. AIM: To explore job strain of the work situation in Norwegian cancer survivors compared to matched controls from the general population. METHODS: Our sample consisted of 417 survivors who had finished primary treatment, and they were compared to 570 matched controls from the general population. Job strain was self-rated with the Demands–Control–Support Questionnaire (DCSQ). RESULTS: No differences in job strain of relevance for the daily work situation were observed between cancer survivors and controls, or between male and female survivors. The DCSQ category of low support and the combination low support/high demands were significantly more common among survivors. Both these DSCQ categories were significantly associated with changes of work career due to cancer. CONCLUSION: Being a cancer survivor after successful primary treatment was associated with

Copyright # 2006 John Wiley & Sons, Ltd.

significantly more job strain compared to matched controls. Awareness of job strain seems relevant in the follow-up of working cancer survivors.

325 Perceived Unjust or Discriminatory Treatment in the Workplace After Breast Cancer: Results From a Population-based Comparative Study Drolet Ma, Brisson Ca, Brisson Ja, Maˆsse Bb, Maunsell Ea a Unite´ de recherche en sante´ des populations, Universite´ Laval, Que´bec, Canada; bFred Hutchinson Cancer Research Centre, Seattle, USA PURPOSE: Despite reports of unfair treatment at work because of cancer history, we have little quantitative data about perceived discrimination or unjust treatment at work because of breast cancer diagnosis and treatments. We assessed this among breast cancer survivors and similar women never diagnosed with cancer. METHODS: A population-based retrospective cohort study was conducted in Quebec, Canada, based on all working women aged 560 when first treated for breast cancer in Quebec, and on randomly selected, similarly-aged Quebec women without cancer but also working when survivors were diagnosed. Data were obtained by telephone interviews conducted 3 years after diagnosis among 646 survivors (73% of those eligible) and 890 comparison women (51%). RESULTS: Overall, similar proportions}20% of survivors and 22% of controls}reported having been treated unfairly or discriminated against at their job during the 3-year period (relative risk ¼ 0:81; 95% confidence interval 0.61–1.08, adjusted adjustment for number and duration of work absences during the 3 years of follow-up). However, compared to controls, survivors more often attributed unjust or discriminatory treatment to their state of health (controls: 8%; survivors, 60%). CONCLUSIONS: Despite survivors being more likely to attribute perceived negative treatment at work to their health, it is reassuring to see no excess of survivors reporting unjust or discriminatory treatment at work during the 3 years after breast cancer diagnosis and treatments compared to healthy women. ACKNOWLEDGEMENTS: Funding: Canadian Breast Cancer Research Alliance, Quebec Cancer Foundation, Canadian Institutes for Health Research.

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326 The Role of Illness Perceptions in Cancer Patients Undergoing Psychosocial Rehabilitation Larsen Ia, Solander KGa, Boesen Ea, Johansn Ca, Elsass Pb a Department of Psychosocial Cancer Research Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark; bCenter for Humanistic Health Research, Department of Psychology Faculty of Social Sciences, University of Copenhagen, Copenhagen, Denmark

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Mehnert Aa, Koch Ua, Kegel Db, Leibbrand Bc, Barth Jd a Institute of Medical Psychology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany; bParacelsus Klinik am See, Bad Gandersheim, Germany; cSalzetalklinik Bad Salzuflen, Germany; dRehabilitationsklinik Nordfriesland, St. Peter-Ording, Germany

PURPOSE: To examine whether illness perceptions predict the level of distress, quality of life (QoL), and return to work among cancer patients who attend rehabilitation. Previous studies of cancer patients have found an association between illness perceptions and distress during and in the immediate time-period after treatment. Yet, none of these studies have looked at the influence of illness perceptions in the context of psychosocial rehabilitation of cancer patients. METHOD: From July 2005 to April 2006 more than 500 cancer patients with different cancer types are expected to attend a week-long psychosocial rehabilitation course. The assessment of illness perceptions, distress, QoL, and the degree of work affiliation is based on questionnaires mailed to the patients two weeks prior to and one month after the rehabilitation. Mediation analyses will be performed to examine whether a change in any of the outcome variables (distress, QoL, and return to work) one month after attending the rehabilitation course may be attributed to a change in illness perceptions. RESULTS AND CONCLUSIONS: Preliminary results from the baseline and one month follow-up data will be presented outlining the effect of illness perceptions on cancer patients’ level of distress, QoL, and return to work. This study extends previous findings on cancer rehabilitation by examining whether illness perceptions may be one of the mechanisms underlying the effects of rehabilitation. ACKNOWLEDGEMENTS: The study is supported by a scholarship from The Psychosocial Research Fond, The Danish Cancer Society.

PURPOSE: The identification of psychosocial and medical factors associated with patients’ ability to return to work is becoming an important research field with regard to social reintegration of patients. The objective of this study is to examine the process of returning to work and to analyse predictors for occupational reintegration. METHOD: 1290 patients (81.3% female) principally capable of work were asked to complete pre- and postrehabilitation as well as one year follow-up validated measures of distress, mental and physical health, psychological, medical as well as socioeconomical and occupational variables (77.2% participation rate). Frequent cancer types were breast, gynecological cancer, head and neck cancer. RESULTS: Sixty-nine percent of participants returned to work within the first year following cancer rehabilitation. Those patients were younger (P50.001), had a higher educational level ðP ¼ 0:006Þ and a higher net income ðP ¼ 0:004Þ: Differences in gender, cancer type and stage were not found (P>0.27). Patients who did not manage to return to work had more medical complications and hospital stays (P50.01), had higher levels of pain ðP ¼ 0:03Þ; anxiety and depression (P50.05), took more analgesics, barbiturates and psychotropic drugs (P50.001) and used more often psychosocial counseling ðP ¼ 0:004Þ: However, strong predictors for occupational reintegration were a positive appraisal of the resumption of work and one’s subjective ability to work. CONCLUSION: The results help to understand the different reasons why patients do not return to work and to provide suggestions for occupational and psychosocial interventions. ACKNOWLEDGMENTS: The study was funded by the Arbeitsgemeinschaft fu¨r Krebsbeka¨mpfung NW, Bochum, and the Paracelsus Kliniken Deutschland GmbH.

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Hair Loss Induced by Chemotherapy: An Anthropological Study of Women, Cancer and Rehabilitation

Copyright # 2006 John Wiley & Sons, Ltd.

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Hansen HP Institute of Public Health, University of Southern Denmark, Odense, Denmark This presentation is based on a research project about Danish women, cancer and rehabilitation. PURPOSE: The overall purpose of the study was to examine how women treated for cancer experienced courses of cancer rehabilitation in a Danish context. The purpose of the part of the study presented here was to gain an insight into the impact of hair loss on women undergoing chemotherapy. Female cancer patients who undergo chemotherapy treatment often experience hair loss and throughout history, hair has been a powerful symbol of the relationship between the individual and society. METHODS: It draws on an ethnographic fieldwork study comprising participant observation at three residential cancer rehabilitation week-long courses in Denmark, informal interviews, subsequent in-depth interviews with 24 of the women, and examination of written sources. RESULTS: The women equated hair loss with the loss of womanhood, with sickness and with death and used wigs and make-up to minimise these effects. The data point up an interpretation of the woman’s bald head as a very powerful sign associated with gender, the body and death. CONCLUSIONS: The analysis demonstrates how the women’s embodied experiences are pervaded by culturally embedded signs, and how cancer rehabilitation is less concerned with total recovery in the sense of ‘being cured’ than with normalising and integrating the individual in personal and social contexts. Hair loss has a considerable impact on the women, on their social relations and their everyday lives.

329 Neuropsychological Dysfunction Following Chemotherapy and Its Impact for Oncological Rehabilitation Poppelreuter M, Weis JB, Mumm A, Bartsch HH Institut for Rehabilitation Research and Prevention Tumor Biology Center, University of Freiburg, Freiburg, Germany PURPOSE: Neuropsychological dysfunction in oncological patients is a topic of increasing empirical interest. While the possibility of such deficits, especially in memory and attention processes, is repeatedly confirmed, little is known about specific risk factors, pathogenetic causes,

Copyright # 2006 John Wiley & Sons, Ltd.

the long term course of these sequelae, their correlation with factors such as psychological distress and fatigue, and the possible effects of cognitive rehabilitation. METHODS: We conducted a controlled-randomised study to evaluate the effects of specific neuropsychological interventions in patients with systemic malignancies after hematopoetic stem cell therapy (HSCT) and breast cancer patients after adjuvant chemotherapy ðN ¼ 191Þ in an inpatient oncological rehabilitation unit. RESULTS: The application of a short neuropsychological screening procedure with 452 patients revealed high prevalence rates of cognitive deficits in both target groups (HSCT: 61.1%; breast: 47.1%), specific risk factors in patients after HSCT being allogenic transplantation and female sex, CMF-chemotherapy and current antihormonal therapy in breast cancer patients. We saw significant improvements in neuropsychological status during inpatient rehabilitation, independent from specific training. The third assessment six months later revealed further minor improvements. We identified an estimated percentage of about 10% of the breast cancer patients and 16% of the HSCT-patients displaying long term cognitive sequelae. CONCLUSIONS: Our data confirm the possibility of cognitive deficits as long term sequelae following chemotherapy. This necessitates further investigation of this topic, especially the identification of risk factors and the development of strategies for neuropsychological assessment and cognitive remediation for this subgroup of patients after potentially curative treatment.

330 Perceived Cognitive Difficulties in Breast Cancer Patients Prior to Adjuvant Treatment Compared to Age-Matched Healthy Controls Sherman MLa,b, Sheridan MAa, Peterson SLa, Roth JLa, Foshe KAa a Department of Psychology, University of Missouri– Kansas City, Kansas City, USA; bThe Cancer Institute, St. Luke’s Hospital, Kansas City, USA PURPOSE: Cross-sectional data suggest some women experience cognitive difficulties following systemic breast cancer treatment. It is unknown, however, whether cognitive difficulties might also be perceived earlier in the cancer experience, even prior to adjuvant treatments. This study compares cognitive symptoms reported by women recently diagnosed with breast cancer (BrCA), prior to

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adjuvant treatment, and age-matched healthy women (Control). Additionally, relationships of perceived cognitive difficulties with fatigue, depression, and anxiety are examined. METHODS: Thirty-five participants completed Cognitive Symptom Checklists assessing attention/concentration, memory, language, visual processes, and executive functions, and self-reports of fatigue, depression, and anxiety. Independent t-tests explored group differences on symptoms in each cognitive domain, as well as fatigue, depression, and anxiety. Correlations of fatigue, depression, and anxiety with cognitive symptoms were also examined. RESULTS: BrCA and Control group means were not significantly different for symptoms in any cognitive domain. Surprisingly, the Control group reported slightly more cognitive symptoms, with a trend for statistically greater memory symptoms (p50.09). The groups did not differ on fatigue, depression, or anxiety. With little exception, these latter variables were significantly related to symptoms in each cognitive domain (rs ¼ 0:27–0.68), but with different subgroup patterns. CONCLUSIONS: Before adjuvant treatment, women with breast cancer perceived cognitive difficulties comparable to age-matched healthy controls. Consistent with prior studies, reported cognitive symptoms were associated with fatigue, depression, and anxiety. Longitudinal study is indicated to examine changes in perceived cognitive function and associations with fatigue, depression, and anxiety over time.

331 Reasons for the Lack of Cervical Cancer Screening among Second-Generation Chinese-American Women Bair AH Cancer Center University of Pennsylvania, Philadelphia, PA, USA PURPOSE: Cervical cancer is highly preventable. Despite the availability of cervical cancer screening technologies, Chinese women have the lowest screening rates among women of the major ethnic groups. Younger, college-aged Chinese women also have lower rates of screening, yet they are engaging in high-risk activities for developing precancerous cervical lesions. This study elucidated and described the reasons reported by second-generation Chinese-American college-aged women for never obtaining cervical cancer screening. METHODS: Purposeful sampling was used

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until data saturation was reached. Twenty-two women were interviewed. Data analysis occurred simultaneously with data collection. Latent and manifest content analysis was used to form codes. Theses codes were then organized into descriptive categories, and then themes, that best fit and described the data. RESULTS: Five groups of themes emerged: (1) My mom never stressed it; (2) I don’t have any problems; (3) I don’t know much about it; (4) I don’t want to bring it up; and (5) It’s a lot of effort. The findings reflected the cultural models that young women have of the world around them and of the Pap smear. The connections they made between obtaining a Pap smear and parental disapproval, taboo, asserting autonomy all impacted their behavior. CONCLUSIONS: The empirical findings provide a scientific basis for developing culturally-sensitive strategies to promote cervical cancer screening and for guiding policy in eliminating health disparities among Chinese-American women. This study begins to address some of these disparities.

332 Diagnosed with Breast Cancer: The Impact of Women’s Experiences on Their Views of Participating in an Early Mammographic Screening Programme Clements AMa, Henderson BJb, Tyndel Sa, Evans Gc, Watson Ea a Cancer Research-UK, Primary Care Education Research Group, University of Oxford, Oxford, UK; bInstitute of Medical & Social Care, University of Bangor, Bangor, UK; cInstitute of Medical Genetics, St Mary’s Hospital, Manchester, UK PURPOSE: Early mammographic screening is offered to many women in the UK who are at moderate/high risk of breast cancer because of their family history. Relatively little is understood about the impact of early and regular surveillance on the psychological wellbeing of women, and even less about the impact of being diagnosed with breast cancer while undergoing early screening. This qualitative study explores the impact that their diagnosis of breast cancer has on the value that women place on being on such a programme. METHODS: In-depth interviews are being undertaken with women diagnosed with breast cancer while on an early screening programme. Women with both interval and screen detected cancers are included in the study. Interviews include explorations of women’s motivations for joining the early

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screening programme, their views about the value of mammography and their reactions to cancer diagnosis. FINDINGS: Women interviewed so far describe an extensive range of feelings at the point of diagnosis, from relief to total devastation, from feeling saved to being betrayed by the system. We will consider possible links between these feelings and the following themes: women’s experiences of breast cancer within their family; a sense of inevitability that one day they too would develop breast cancer; the anticipation that they would receive a diagnosis of breast cancer while on the screening programme; their understanding of the likelihood of mammography detecting a cancer. The relationship between the women’s feelings about having their breast cancer detected while on an early screening programme and their engagement with subsequent clinical care will be explored.

analysed by multivariate logistic regression. RESULTS: The analyses were based on 28 765 women with 22 956 (80%) classified as high-risk patients at diagnosis. The adjusted risk for being diagnosed with a high-risk breast cancer was reduced with longer education and with increasing disposable income. Further, there was an urban– rural gradient, with a higher risk of high-risk breast cancer among women in the rural areas of Denmark. The social inequality seemed to be manifest mostly among postmenopausal women, although similar patterns of higher stage at diagnosis with shorter education or lower income were observed among the premenopausal women as well. CONCLUSION: Certain socio-economic factors seem to represent independent risk factors for being diagnosed with a high risk breast cancer in Denmark.

334 333 Relation between Socioeconomic Status and Tumour Stage in Women Diagnosed with Breast Cancer in Denmark, 1983–1999 Dalton SOa, Du¨ring Mb, Mortensen PBc, Lync JWd, Johansen Ca a Department of Psychosocial Cancer Research, Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark; bDanish Breast Cancer Group, Copenhagen, Denmark; cNational Center for Registerbased Research Aarhus University, Aarhus, Denmark; dDepartment of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada BACKGROUND: More socially disadvantaged patients with breast cancer have consistently poorer survival than those who are better off and this may be related to differences in the timing of diagnosis. This study aims to investigate the association between socioeconomic position and stage of breast cancer at the time of diagnosis. METHODS: Using a nationwide clinical database we identified a nationwide population-based cohort women with a primary invasive breast cancer diagnosed between 1983 through 1999. High-risk breast cancers were defined as tumour size >20 mm, 1+ tumour-positive axillary lymph node, ductal histology, tumours with malignancy grade>II and negative receptor status. Information on socioeconomic variables was obtained from Statistics Denmark. The risk of being diagnosed with a high-risk breast cancer was

Copyright # 2006 John Wiley & Sons, Ltd.

Psychological Factor and Breast Cancer Delay in Southern Italy Montella Ma,b, Crispo Aa, Serravezza Gb,c, D’Aiuto Gd, Schittulli Fb,e a Epidemiologia Istituto Nazionale Tumori, Fondazione ‘G. Pascale’, Napoli, Italy; bLILT Lega Italiana per la Lotta contro i Tumori, Italy; c Oncologia Medica ASL LE2}Ospedale ‘F. Ferrari’, Casarano (LE), Italy; dChirurgia ‘A’ Istituto Nazionale Tumori, Fondazione ‘G. Pascale’, Napoli, Italy; eChirurgia Istituto Oncologico, Bari, Italy PURPOSE: Early detection has been identified as a key factor in long-term survival of patients with breast cancer. Among women with breast cancer, both socioeconomic and psychological factors may be associated with delay in seeking medical attention. The aim of this study was to assess if breast cancer delays is influenced to psychological aspect in Southern Italian. METHODS: The study was carried out on 728 consecutive patients with breast cancers recruited in the centers of Naples, Bari and Lecce; the interviews were conducted on the basis of a semi-structured questionnaire developed for the study. The variables examined were age, education, symptom status at first presentation: symptomatic, asymptomatic (by chance) and through diagnostic test, date of first symptom presentation; objective motivation (severe anxiety, psychosis, fear), psychological motivation, date of first consultation, consulted provider, tumor size and nodal status. RESULTS:

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The 13% of patients report to have had a psychological motivation. Patient delay was associated with psychological motivation: a significant higher risk of >3 months delay was found among women who reported to have had psychological motivations (OR 8.4, 95% CI 4.8–14.5). Also the medical delay was seen to be associated with this psychological variable (OR 3.8, 95% CI 2.1–6.). CONCLUSION: In conclusion our study suggests that diagnostic delay is associated with psychological factor, therefore it would be useful to consider this kind of relationship for intervention program such as screening campaigns that generally have a lower compliance in Southern Italy.

335 Predictors of Survival Benefits Needed by Premenopausal Early Breast Cancer Patients to Make Endocrine Therapy Worthwhile Thewes Ba, Meiser Ba, Duric Vlatka Mb, Stockler Mb, Stuart-Harris Rc a Medical Oncology, Prince of Wales, Sydney, Australia; bNHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia; cMedical Oncology, The Canberra Hospital, Canberra, Australia Endocrine therapies provide modest survival benefits for pre-menopausal women diagnosed with early breast cancer. However, these treatments may result in menopausal symptoms, sexual dysfunction, permanent infertility or the need to delay pregnancy. PURPOSE: This study aimed to quantify the survival gains that pre-menopausal women with early breast cancer require to justify adjuvant endocrine therapies, and to identify clinical, demographic and psychological correlates of the amount of benefit required. METHODS: 102 early-stage (Stage I or II) breast cancer patients, who were treated for a minimum of 3 months with endocrine therapy (tamoxifen, goserelin and/or oophorectomy) and who were between 6 and 60 months post-diagnosis at interview. Participants were asked to complete a face-to-face patient preferences interview that presented patients with four hypothetical clinical scenarios. The scenarios aimed to quantify (a) survival rate benefit and (b) time benefit required to justify endocrine therapies. RESULTS: Final results suggest the majority of participants considered adjuvant endocrine therapy worthwhile for a 2% absolute gain in survival rates and for a 6-month gain in life expectancy. Women who experience

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more severe endocrine side effects required larger gains to make endocrine therapy worthwhile (univariate p ¼ 0:02; multivariate p ¼ 0:04). Age, marital status, parity and plans for future pregnancy at diagnosis were not significantly correlated with benefits required. CONCLUSIONS: Pre-menopausal breast cancer patients consider adjuvant endocrine therapies worthwhile for modest survival gains. Heterogeneity of circumstances, attitudes, and preferences make it dangerous to guess what others might consider to be ‘in their best interests’.

336 Multicentre Prospective Study of Psychosocial Adjustment and Fertility Status Among Young Men Undergoing Combination Chemotherapy for Testicular Cancer and Lymphoma Achille MAa, Rosberger Zb,c, Robitaille Ra, Bultz BDd, Chan Pe a Department of Psychology, University of Montreal, Montreal, Canada; bDepartment of Psychiatry, SMBD Jewish General Hospital, Montreal, Canada; cDepartment of Oncology, McGill University, Montreal, Canada; dDepartment of Psychosocial Resources, Tom Baker Cancer Centre, Calgary, Canada; eDepartment of Urology, McGill University Health Centre, Montreal, Canada Epidemiological studies have clearly indicated an increase in the incidence of testis cancer and lymphoma in young men worldwide, with a significant negative impact of cancer and treatment on patients’ fertility. In the present study, we assessed psychosocial adjustment and andrological profiles longitudinally in 54 newly diagnosed patients treated with chemotherapy and recruited between August 2003 and May 2006. Patients filled out measures of quality of life (QOL; FACT}G), impact of events (IES), infertility distress (IDS), perceived stress (PSS), and information seeking style (MBSS), at diagnosis, and 6 months, 1 year and 2 years post-diagnosis. Healthy age-matched volunteers ðN ¼ 62Þ and men presenting with idiopathic infertility ðN ¼ 20Þ acted as controls. Standardized semen analyses and motile sperm index were obtained at each time point. Preliminary results at diagnosis and 6 months will be presented. At diagnosis, 63% of patients with testis cancer, 27% with lymphoma, 75% with idiopathic infertility and 6% of healthy controls had semen profiles below WHO reference values. All patients showed a significant decrease

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in motile sperm index at 6 months. Analyses of variance showed higher depression ðp ¼ 0:019Þ; anxiety ðp ¼ 0:009Þ and perceived stress ðp ¼ 0:00 2Þ and lower QOL ðp ¼ 0:001Þ in patients compared to community, but not infertile, controls at baseline, and higher anxiety ðp ¼ 0:006Þ; general stress ðp ¼ 0:007Þ and lower QOL ðp ¼ 0:001Þ at 6 months. Further analyses will examine relationships between andrological and psychosocial profiles. This innovative research will help better counsel patients regarding survivorship and fertility issues. ACKNOWLEDGEMENTS: This study was funded by the Canada Institutes for Health Research (CIHR-HGG#62294).

337 Changes in Sexual Function Along the First Year After Breast Cancer Diagnosis Estape´ Ta, Estape´ Jb, Grau JJc a Psychoncology FEFOC, Barcelona, Spain; b Medical Director FEFOC, Barcelona, Spain; c Medical Oncology Hospital Clinic, Barcelona, Spain PURPOSE: Intimate physical contact is one of the areas of quality of life which could be impaired due to breast cancer. The aim of this study is to follow sexuality along the first year after breast cancer diagnosis to find out its changes, and also relate them to psychological parameters. METHODS: Breast cancer patients undergoing chemotherapy were interviewed about their sexual life and asked to compare it to sexual activity before cancer. Patients completed 4 times validated instrument (FACT-B) and interview on sexual dysfunction. RESULTS: 115 BCP were approached. 46 (40.15%) stated they do not have an active sexual life before cancer. Among the remaining 69 (59.85%), maintain an active sexual activity. 41.90% continue sexual activity, being the comparison between this two percentages significant. Changes in this variable along the other times measured were not significant. Sexual satisfaction (rated 0–10) diminished also significantly ðp ¼ 0:045Þ: Changes in sexual satisfaction were not related to type of treatment received nor to surgery option, but yes with FACT-B whole punctuation in every evaluation time (p50.019, p50.0001, p50.0001, p50.0001). CONCLUSIONS: Relevant to be aware of changes and to tailor interventions on this sensitive area, in order to restore better quality of life.

Copyright # 2006 John Wiley & Sons, Ltd.

338 Body Image and Sexuality After Leg Amputation and Rotationplasty in Bone Tumour Patients Fraberger GJa, Seliger Eb, Kotz Ra a Department of Orthopaedics, Medical University Vienna, General Hospital Vienna, Vienna, Austria; b Empirical Research, Statistical Consulting & Statistics, General Hospital Vienna, Vienna, Austria PURPOSE: Limb amputation and rotationplasty due to a bone tumour creates physical and emotional difficulties. Regarding these two surgery methods previous studies discuss the decision between function and aesthetics; in other words what kind of mutilating surgery causes more emotional burden. As one’s sexual life is important in reflecting the re-integration consequently its evaluation is important. This paper aims to find out how the perceived body image and sexuality changes after amputation, and rotationplasty to find out what kind of surgery-method causes more psychological stress. METHODS: Participants rated their perceived attractiveness before and after surgery and with and without their artificial limb on a VAS. A self-reported questionnaire assessed the quality of sexuality issues and how sexuality changed after surgery. Three groups were formed with 21 patients after transfemoral, 44 transtibial amputation and 16 after rotationplasty. RESULTS: Participants rated their attractiveness after surgery lower then before, no differences between amputation and rotationplasty occurred. Attractiveness was not rated differently for both surgery-groups and for men and women wearing a prosthesis compared to being without it. Results revealed a high level of interaction and communication and a low level of anxiety regarding sexuality. Sores showed no significant differences between amputation and rotationplasty and between men and women. CONCLUSIONS: Results did not mirror the often-discussed psychological distress regarding the dramatic challenge of the body’s image after rotationplasty. Both treatment methods, rotationplasty and amputation seem to have similar effects on participant’s body perception as well as on changes in the quality of sexuality.

339 Female Oncology Patients Referred to Psychiatry with Co-morbid Sexual Dysfunction Hughes MK

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Neuro-oncology, Psychiatry Section, The University of Texas, M.D. Anderson Cancer Center, Houston, USA INTRODUCTION: Sexuality is an important quality of life issue that was not routinely addressed elsewhere in a large metropolitan community cancer hospital. A Clinical Nurse Specialist (CNS) in the Psychiatry Section evaluated patients’ sexual function during each consultative assessment. The Psychiatry Section is a Consult-Liaison Service heavily utilized by the oncology services in this institution assessing both inpatients and outpatients. METHOD: Over a 5-year period, 558 oncology patients were referred to this CNS for psychiatric reasons and a sexual function evaluation was performed with each assessment. This was by interview and was subjective. A retrospective chart review was done with the institution’s Internal Review Board approval. RESULTS: Co-morbid sexual dysfunction was found in 77% of all patients and in 78% of female patients. 78% of all patients were female and most had breast cancer. A description of the specific types of sexual dysfunction will be discussed. In all cases, the cancer diagnosis or the cancer treatment was thought to contribute to the sexual dysfunction. CONCLUSION: When a woman has several co-morbid conditions, especially cancer, it is easy to overlook sexual issues. Patients do not readily bring up sexual concerns, so it is important that the clinician do a cursory sexual assessment on all patients. Annon’s PLISSIT model for sexual assessment is a valuable tool for the clinician. Specific interventions will be described and need to be customized for the patient, taking into consideration the patient’s other co-morbid conditions.

340 Sexuality Assessment in Patients with OncoPathology: ‘Need to Break Psychological Barriers’ Pramod DSa, Salgokar RNb, Nirmalkumar ARc, Vaishali PSd a Community Health alert Organisation of India, Dhule, India; bCommunity Health Health alert Organisation of India, Dhule, India; cMedical Health alert Organisation of India, Dhule, India; d Counselling Health alert Organisation of India, Dhule, India ISSUES: Onco-patients suffer from anxiety/ depression. Sexuality/sexual dysfunction here is

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not well-documented. AIMS: [1] gain insight in marital/sexual behavior and Potency [2] study impact of Genital-Ca on couples quality of life. [3] Suggest counselling patterns for affected patients. STUDY PROTOCOL: 127 couples breast-Ca [46%], Cervical-Ca [23%], Prostate-Ca [255], Testicular-Ca [6%] who returned to villages after Onco-therapy in Cities. Response noted by evaluation questionnaire. It included sexuality assessment and quality of life before Diagnosis/ treatment of Genital cancer. Second Evaluation to determine impact of Genital-Ca therapy on sexual relations and marital happiness. RESULTS: Sexuality decides quality-of-life and survivalperiod in martial relationship. 65% couples suffer depression/anxiety/fear. 11% couples described impotency/frigidity in sexual relations after Diagnosis. 84% claimed behavioral change to anatomical distortion of sex organs in therapy while 16% attributed this to fear of death. 82% couples acknowledged that discussion on this hitherto forbidden issue of sex helped them in overcoming guilt/stigma with qualitative improvement in sexual attitude. In prostatic cancer patients 86% with sexual dysfunctions undergone surgical therapy while 14% on Chemo/Radio-therapy. In Ca-breast patients 58% women undergone surgery, while 42% on Chemo-radio therapy. CONCLUSION: Sexual dysfunction is common with surgery than Chemo/Radio therapy. Effect of cultural/education-status needs assessment. With counsellors, physiotherapists/family back-up we can solve this sensitive issue. With our limited NGO set-up and strong cultural-barriers against sexuality we made cancer affected couples to express their trauma.

341 Sexual Life and Quality of Relationship After Laryngectomy Singer Sa, Wollbrueck Da, Danker Ha, Schwarz Ra, Heim Mb a Social Medicine, University of Leipzig, Leipzig, Germany; bSonnenbergklinik Rehabilitation Clinic Bad Sooden-Allendorf, Germany PURPOSE: Patients with advanced laryngeal cancer often have to be treated with laryngectomy altogether with a permanent tracheostoma. Questionable is, whether that has an effect on sexuality and to whom patients want to talk about it. METHODS: All patients who underwent laryngectomy within the last two decades in six

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big hospitals in Germany were asked to participate in the study. A total of 218 patients were interviewed face-to-face in their houses. Standardized multi-scale questionnaires was used}the Dyadic Adjustment Scale (DAS), the EORTCQLQ-C30 and H&N35, the German Questionnaire for Coping after Laryngectomy (FPAL), and some additional single items. RESULTS: Laryngectomees are willing to answer questions about sexuality, either in questionnaires or in interviews, only 10–20% missing values occurred. Quality of relationship is mostly as good as in the general population. Sexuality is an important topic for patients, even when they do not have a partner. 23% state, that their sexual relationship is impaired due to the tracheostoma. 57% do not enjoy sexuality as much as before the operation. 76% of the patients want to talk about sexual problems with their partner, 28% with a friend, 16% with a doctor, 6% with a speech therapist, and 10% with self help group. CONCLUSIONS: Sexuality seems to be an important issue for laryngectomized patients. It is often affected and people are willing to talk about it. ACKNOWLEDGEMENTS: Supported by the German Federal Ministry of Education and Research.

experts throughout North America. The web education includes vignettes (real Native survivors talking about how they dealt with a particular issue), storytellers (stories based on real experiences of more than one survivor to allow patients to share their experiences, but remain anonymous), sample questions for patients to ask of their providers, and many choices for the type of content the patient wishes to review. By October 2006, ten modules will be online. This presentation will include information about how to access the web site; innovative features; the tailoring software and the patient privacy protections. RESULTS: Through Native Partners working one-on-one with patients, the website averages 300 hits a day without any marketing. Marketing to Native communities, healthcare providers and cancer centers will begin May 2006. Online evaluation shows the information is well-accepted. CONCLUSIONS: Patients of breast and other cancers and both genders are currently using the website. This project shows the benefits of tailored, interactive Internet-based cancer information for survivors. ACKNOWLEDGEMENTS: This study is supported by the Susan Komen Foundation [#POP0503920] and the National Cancer Institute [R25 CA 101938].

342 Supporting Native Americans’ Psychosocial Needs through Tailored Online Education Burhansstipanov La, Krebs LUb, Gamito Ec, Douma Md, Bradley Ae a Native American Cancer Research Pine, CO, USA; bSchool of Nursing University of Colorado at Denver, Health Sciences Center Denver, CO, USA; cCancer Center University of Colorado at Denver Health, Sciences Center Denver, CO, USA; d Institute for Dynamic Educational Advancement, Washington, DC, USA; eRocky Mountain Division Cancer Information Service Colorado Springs, USA The purpose of the ‘Native American Cancer Education for Survivors’ (NACES) project is to improve the quality of life of cancer patients by increasing knowledge and informed choice using innovative web-based technology (http:// www.NatAmCancer.org). METHODS: NACES is a community-driven project (of Native survivors) and the content is developed in partnership with an all-Native Survivors’ Advisory Committee, Native Partners, and cultural and scientific

Copyright # 2006 John Wiley & Sons, Ltd.

343 Self-managing Problems Associated with Cancer Diagnosis and Treatment Foster C, Hopkinson J, Hill H, Wright D, Roffe L Macmillan Research Unit, School of Nursing and Midwifery, University of Southampton, Southampton, UK PURPOSE: Patients have indicated the importance of support in day to day living with cancer. Self management refers to management of medical regimens, maintenance of life roles and management of emotional consequences of long term medical conditions by patients, in part, to enhance their sense of control and self-efficacy in relation to their condition. We conducted a systematic literature review to explore self initiated strategies used by people living with problems associated with cancer and treatment. METHODS: Searches were conducted using BIDS, BNI, Cancer.gov, CINAHL, Medline, Psychinfo, and Web of Science. Papers were selected on the basis of predefined eligibility criteria and rated by three independent coders. FINDINGS: There is little

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research evidence detailing strategies people use when living with problems associated with cancer or how this might be supported. 37 studies met the eligibility criteria. Most studies included heterogeneous groups of patients. CONCLUSION: There is insufficient evidence to determine how to support self management by people living with cancer. We are developing our research programme to conceptualise self management in this context. We are exploring ways to support self management by people living with advanced cancer in relation to their weight loss and eating difficulties and how people who have recently completed their treatment find ways to help themselves when living with changes experienced following a cancer diagnosis. Findings from these studies will be important for practice and inform the development of resources for people living with cancer who wish to help themselves. ACKNOWLEDGEMENTS: This research is funded by Macmillan Cancer Support.

344 Supportive Effects of Client-Centered Information on Psychosocial and Informational Needs of Cancer Patients and Relatives}User Survey of the German Cancer Information Service (KID) Gaisser AE, Wilcke S, Edler L, Gebest HJ Cancer Information Service German Cancer Research Center, Heidelberg, Germany BACKGROUND: Cancer patients, as well as their families, need information and psychosocial support. Client-centered information as provided by KID has been examined for its potential. METHODS: From March through July 2005, 2500 patients and relatives when contacting KID consented to participate in a user survey with selfadministered questionnaires (2 waves 2 weeks apart) on the service and impact provided by KID. Needs of patients and relatives as well as perceived benefit from the contact were assessed in terms of assurance, relief of anxiety, relationship within the family and general coping using standard statistical survey methods. RESULTS: In wave 1 and 2, 2056 and 1425 persons responded, 60% patients and 40% family members with median age of 56 and 51 years, respectively. Main reasons for contacting KID were need of individual information (patients/ relatives: 74/66%), explanations (37/45%) and individual counselling (38/39%). Prior sources of information were mainly internet (14%/22),

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brochures/books (14/14%) and specialised physicians (16/13%). 37% of patients and 57% of relatives felt rather anxious about the disease situation. Most appreciated about KID was time to talk, counsellor’s responsiveness to personal needs and their expertise. In the follow-up survey, relatives stated they could better cope (50%) and patients felt more assured about medical care (52%). Anxiety was reduced considerably in both groups. CONCLUSION: Client-centered and relevant telephone information is an easily accessible supportive service for patients and relatives that can reduce anxiety, enhance coping and provide reassurance.

345 The CANSURVIVOR Project: A Multidisciplinary Approach to Survivorship Ivers MEa, Dooley BAa, Bates Ub, Malone Kc a School of Psychology UCD Dublin, Dublin, Ireland; bPsycho-oncology Service St. Vincent’s University Hospital, Dublin, Ireland; cDepartment of Psychiatry St. Vincent’s University Hospital, Dublin, Ireland PURPOSE: To assess the bio-psycho-social needs of post-treatment breast, colorectal, prostate and lung cancer survivors in the Irish East Coast area and develop a multidisciplinary pilot rehabilitation programme to address service deficits, maximize quality of life and support long-term health-enhancing lifestyle behaviour change. METHODS: Interviews and focus groups with health professionals, carers and survivors ðn ¼ 18Þ informed the development of a comprehensive survey of medical, socio-economic, behavioural and psychological variables. 220 survivors (6 months–13 yr post-treatment) completed the survey (age range 37–75 yr; 65 males, 155 females). Quality of life, health-related behaviours and variables related to behaviour change, i.e. selfefficacy, control beliefs, hope, anxiety, depression, coping and social support provide the main profile data. RESULTS: A sample of the findings from qualitative and quantitative analysis show 10% continue to smoke, 45% gained weight and 28% reduced regular physical activity since pre- diagnosis. Also, 20% are in the clinical range for anxiety and high anxiety is significantly related to lower quality of life and lower internal locus of control, self-efficacy and hope. CONCLUSIONS: Results to-date provide evidence to support the need for a comprehensive cancer rehabilitation

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programme. A multidisciplinary pilot programme is in development running in autumn 2006, overseen by the Psycho-oncology unit with input from the Departments of Physiotherapy and Nutrition. ACKNOWLEDGEMENTS: This research was funded by the Health Service Executive-East Coast Area. Conference attendance courtesy of an Oncology Scholars Travel Award from Cancer Research Ireland.

346 Interprofessional Education for Social and Healthcare Professionals in Cancer Care Jussila AL, Jokinen T, Jokinen J School of Health and Social Care Oulu University of Applied Sciences, Oulu, Finland PURPOSE: The purpose of this research was to study educational needs, contents and organising of the interprofessional cancer care education for health and social care professionals in the Northern Finland. METHODS: The questionnaire was developed based on two European curricula, one for nurses by EONS, and the other for radiation therapists by ESTRO. Data was collected among health and social care professional ðn ¼ 221Þ in basic and specialised care in the Northern Finland. Data was analysed by SPSS. RESULTS: The education was highly needed among 86.4% of all participants. Most important contents were pain killing, nutrition care, psychological aspects of cancer and hospice care. Interactive and communicative learning methods were much suggested instead of hearning. Only 29% of participants wanted to include clinical practice into the course, which was classified as a further education. CONCLUSIONS: The study explained the educational needs among health and social professional in the Northern Finland and gave a basis for planning the course together with the Northern Cancer Society and Oulu University Hospital. Now the course has been carried out once and the participants´ feed back was very good. The course will be repeated in the near future.

PORT}Psychosocial Oncology Research Training}is an innovative transdisciplinary research training program that links Canada’s top psychosocial oncology researchers with promising national and international doctoral and postdoctoral students across a variety of disciplines. Its mission is to train a new generation of scientists in the development, implementation, evaluation, and transfer of theoretically-based and cuttingedge psychosocial approaches to comprehensive oncology care. PORT Trainees have available to them financial support, internship opportunities and mentorship from 21 PORT faculty. While pursuing graduate work within their field of study (e.g. nursing, psychology, philosophy, management/marketing, nutrition, and dentistry), PORT Trainees participate fully in the various aspects of the PORT program. This includes a graduate level 13-week, 3-hour weekly seminar taking place simultaneously in real-time via videoconferencing at the 4 university sites across Canada. In addition, Trainees attend the annual PORT workshop, collaborate on joint research projects, attend conferences, and disseminate their research findings in scientific and clinical settings. The quality, depth, and ease of interactions enabled by PORT means that researchers and clinicians with strong and complementary backgrounds come together to discuss research and bring innovative solutions to pressing psychosocial oncology issues. PORT serves as an exemplar in promoting psychosocial oncology best practice and knowledge uptake among all stakeholders involved}hospitals, community centres, volunteer organizations and government. This 6-year program (2003–2009) is funded primarily by the Canadian Institutes of Health Research and the National Cancer Institute of Canada.

348

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History of a Lung Cancer Support Group: 1996– 2006 Peabody E, Holland JC Department of Psychiatry, Memorial SloanKettering Cancer Center, New York City, USA

PORT}A Canadian Exemplar of High Quality, Cutting-edge Transdisciplinary Research Training in Psychosocial Oncology Loiselle CG School of Nursing, Faculty of Medicine, McGill University, Montreal, Canada

This support group for patients with lung cancer was begun 10 years ago because a patient asked, ‘Why is there no support for people with lung cancer like there is for breast cancer?’ A support group has met every other week for ten years with 240 patients; 174 women, 66 men. Changes over

Copyright # 2006 John Wiley & Sons, Ltd.

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the ten years: (1) Early stage patients dropped out; patients with advanced disease continued, and the group is now open to stage 4 patients who find solace in talking ‘with others in the same leaky boat’. (2) The themes now center on their issues: illness, treatments, doctors, side effects, fears of progression, death, concerns for family. (3) Patients now live longer with advanced disease due to the newer lung cancer therapies and they must cope over long periods with severe symptoms and side effects. (4) Education about lung cancer and advocacy for lung cancer research is growing rapidly. Stigma is diminishing as people recognize that it occurs increasingly among non and former smokers. There is a great need, given to frequency of significant psychosocial problems associated with this disease, to develop more support groups for these patients.

349 ‘I can’t get help for the person with cancer, let alone the family’: Building counselling capacity in South Australia Abell EJ, Strassnick K, Ryan MF Cancer Control Programs, The Cancer Council, South Australia, Adelaide, Australia PURPOSE: People with cancer who are provided with an opportunity to explore feelings with a member of their treatment team or a counsellor experience less psychosocial distress than people not provided with this opportunity. This is also important for partners, carers and family (1). The shortage of professional positions to provide psychosocial support is well documented and the need for greater investment in broadly based support services that are readily accessible and low cost is cited as a potential way forward in Optimising Cancer Care in Australia 2003. METHODS: This paper will describe a workforce capacity building model involving a partnership between the Centre for Counselling, Education and Research Inc., an accredited provider of counsellor education, and The Cancer Council South Australia. RESULTS: As a result, 16 trainee and qualified counsellors working in the community accessed a one day elective module to develop a basic understanding of cancer, its treatment and side effects, and psychosocial issues. In the three months following the delivery of the module, 36 people were provided with counselling via the partnership. Due to the level of interest the module will be offered again in

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2006. CONCLUSIONS: Through this model, specialist mental health services that may be best applied to those with significant and ongoing distress can be complemented and supplemented. ACKNOWLEDGEMENTS: Dr Pauline Morgan Clinical Psychologist College of Counselling, Education and Research (Note 1) ‘Clinical practice guidelines for the psychosocial care of adults with cancer’, National Breast Cancer Centre and the National Cancer Control Initiative, 2003.

350 Psychological and Psychiatric Side Effects Produced by Chemotherapy Abian La, Garcia Valverde Aa, Cortes-Funes Fa, Narvaez Aa, Gongola Bb a Psycho-Oncology Unit, Hospital 12 De Octubre, Madrid, Spain; bHospital Torreca´rdenas Almeria, Spain Most of the clinical investigations reviewed evaluate the physical side effects produced by antineoplasic drugs with no mention to psychological or psychiatric disturbances. On the other hand, the psycho-oncological trials evaluate the psychosocial and emotional responses produced by the various changes in the patient’s life}which are often derived from the illness and the treatment}while leaving aside the psychological effect produced by the chemotherapy. Herein, we analyze the most frequent drugs used in oncology paying special attention to the psychological and psychiatric side effects. Reviewing and highlighting these side effects will help clinicians to recognize the etiology of the psychological or psychiatric symptoms and will help them to guide the patient to a better therapeutic approach. To achieve this goal we need to work with an interdisciplinary team.

351 Quality of Life and Cancer: A Comprehensive Study Nucci NAGa, Valle EREb a Oncology Center, Hospital Municipal Dr. Mario Gatti, Campinas/SP, Brasil; bEscola de Enfermagem Universidade de Sa˜o Paulo, Ribeira˜o Preto/ SP, Brasil PURPOSE: It is well accepted that the experience of a life-threatening illness such as cancer causes various and significant damages that interfere with one’s Quality of Life (QoL). The patient’s way to deal with the illness, as his own perception of

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well-being, seems to contribute to the biological evolution of the disease, therefore becoming therapeutic co-factors. Attempting to approach the QoL concept and understanding the phenomenon ‘having cancer’, this study had the purpose to evaluate the QoL in patients with cancer. METHODOLOGY: Based on a phenomenological qualitative methodology, it was started with guided questions such as: ‘What QoL means to you?’ and ‘How are you feeling your life now?’ Fifteen patients in treatment were interviewed. RESULTS: Five themes came up from the first question}QoL meaning: Health; Financial autonomy; Living well in affective aspects; Care; An extensive concept. As for the second question, eleven themes were found, which were sorted out into three categories: PAST (healthy body, work, autonomy), PRESENT (incapacity, pain, anxiety, fear) and FUTURE (uncontrollable, hopeful, faith-fullness, ‘in God’s hands’). CONCLUSION: The studied aspects showed limited and lost lives, but also optimist and positive perspectives facing the future. The role of Psychology aiming a better attendance in Oncology was discussed and presented as very important. This may be useful to subsequent studies that seek for the promotion of more focused intervention strategies in order to improve the QoL in patients with cancer.

352 Positive Attitudes Towards Maximum Physical Capacity Tests on Cancer Patients During Chemotherapy Adamsen La, Knutsen La, Quist Ma, Midtgaard Ja, Rorth Mb a UCSF, Department 7331, Copenhagen University Hospital, Copenhagen, Denmark; bDepartment 5073 Copenhagen University Hospital, Copenhagen, Denmark BACKGROUND: A number of authors have emphasized the possible detrimental effects of vigorous exercise, including maximum physical capacity tests, on cancer patients during chemotherapy because of risk of adverse reactions. This concern represents a general uncertainty about exposing cancer patients who are undergoing chemotherapy to additional stressful burdens. PURPOSE: To explore the patients’ experiences of maximum physical capacity testing while concurrently undergoing chemotherapy and participating in a 6-week, 9 h weekly combined high and low intensity exercise intervention. DESIGN

Copyright # 2006 John Wiley & Sons, Ltd.

AND METHOD: Prospective, exploratory study using semi-structured qualitative interviews conducted prior to and at termination of the programme. The study included 100 patients (18–65 years, median 42 years) with or without residual disease with mixed diagnoses. RESULTS: Following the intervention, 66% of the cancer patients stated that they felt significantly safer in performing maximum physical capacity tests as these motivated them through self-perceived competitiveness and set a standard that served to encourage peak performance. Seven percent, primarily female patients, indicated a negative attitude towards the tests, 27% indicated an uncertain attitude towards the tests. CONCLUSION: The findings of this study show that the majority of patients experienced the maximum physical capacity testing as an autonomous motivating element for physical exercise. The maximum capacity tests were carried out without adverse reactions. It is important to underscore that the patients sample is not representative of all cancer patients in chemotherapy}being younger and more motivated than the majority of cancer patients.

353 The Psychological Effects of Diagnosis Communication on Child Brain Tumor Survivors Adduci Aa, Poggi Ga, Liscio Ma, Bolis Tb, Clerici CAc a Acquired Brain Injury Unit, IRCCS Eugenio Medea Bosisio Parini, (LC), Italy; bAIAMC Associazione Italiana Analisi e Modificazione del Comportamento e Terapia Comportamentale e Cognitiva, Milan, Italy; cPediatric Oncology Unit, National Cancer Institute, Milan, Italy PURPOSE: Psychological problems in brain tumor survivors in developmental age are due to many factors, including the way diagnosis is communicated and the patient’s awareness of their disease which are believed to play an important role in their emergence and persistence. METHODS: A group of 64 brain tumor survivors (age range: 4–18 years) was studied to verify the presence of psychological problems (through CBCL, VABS and TAD) and their relationship with the past communication of diagnosis (history of avoidance or ‘inadequacy’ of diagnosis communication to the patients}the latter being classified into inconsistent, incomplete or unclear). RESULTS: A significant correlation was found

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between mood disorder and Internalizing problems and a history of avoidance or inadequacy. CONCLUSIONS: Proper communication of diagnosis includes complete and consistent information about the disease, its evolution, its outcomes, cancer treatment, drug treatment and remediation which must be provided in a clear language according to the patient’s age and cognitive skills. Proper communication is associated to a lower number of psychological problems and favors the development of functional strategies to cope with the disease and related daily impairments.

354 Dynamic and Evolutionary Case History (DECH): Lucia’s History Aggero I, Duglio E, Musso M, Spiota E, Bottero G Polo Oncologico Azienda Ospedaliera Santi Antonio e Biagio, Alessandria, Italy INTRODUCTION: DECH is a build ‘ad hoc’ instrument used to follow any relationship changes between patients and therapist and to satisfy the need of measuring emotive and cognitive aspects during the course of psychotherapy. Lucia’s history was used to show DECH characteristics. Lucia is a female, 43 years old, operated for breast cancer. This patient was submitted to a psychotherapeutic run of 5 months. Her DECH fully shows all that was done together with her. OBJECTIVE: Our purpose is to underline the most important characteristics of DECH and by Lucia’s History, to show the right way to use it. METHODS: Lucia’s clinical interviews have been used to fulfil all DECH’s categories: the real innovation is the possibility to grade the intensity of both emotion and kind of topics in order to facilitate the discovery of conflict’s components. 27 topics are monitored about their positive, neutral or negative presence. 34 emotive aspect are graduated from 0 (no level) to 3 (high level). RESULTS AND CONCLUSION: DECH helps to follow patients’ needs during treatments. Until the fifth encounter no words were used to describe the fear of death. Psychologist understands that they can tolerate also that topics and for the first time speaks openly about death. Patient’s response was characterized by a more conscious awareness about her disease, appropriate emotive reactions, and the need of changing her sex habit with the husband. DECH is the basic

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instrument of the psychoncology team of the ‘Alessandria Polo Oncologico’.

355 Organisation of Early Rehabilitation for Head and Neck Cancer Patients at Karolinska University Hospital Ahlberg Aa, Laurell Ga, Engstrom Tb, Nikolaidis Pc, Sharp Lc a ENT, Karolinska University Hospital, Stockholm, Sweden; bSpeech Pathology, Karolinska University Hospital, Stockholm, Sweden; cOncology Sodersjukhuset, Stockholm, Sweden PURPOSE: To describe a clinical pathway for early rehabilitation of patients at a head and neck cancer center. METHODS: Head and neck cancer accounts for about 2–3% of all malignancies in Sweden. The cancer itself and the treatment affect the physical and the psychological well-being and have social and existential consequences. We have developed a program to provide early rehabilitation for these patients. Emphasis is put on giving patients information about treatment side-effects, improving patient involvement and self-care. It is combined with a physical training program including exercises for tongue motility, law opening, swallowing and head and shoulder function. In our region approximately 300 new cases of patients with head and neck cancer are diagnosed every year. Half of these patients will receive early rehabilitation while the remaining patients do not get any early rehabilitation and serve as a control group. A broad follow-up of the effects of the rehabilitation program is conducted. A computer database has been created with data from patientbased questionnaires as well as specific physical measures. RESULTS: We will present the organisation of the clinical pathway and the methods for follow-up. CONCLUSIONS: Development and implementation of early rehabilitation must be based on a multidisciplinary approach. In order to gain scientific knowledge of the outcomes large patient material is required. Our program is a health care development project extended over four years. This enables us to perform a longitudinal follow-up. ACKNOWLEDGEMENTS: The Swedish Cancer Society.

356 Cancer Patient’s Families: What Quality of Life? Aitini E, Sempreboni A, Aleotti P, Zamagni D, Cavazzini G

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Medical Oncology and Hematology, Carlo Poma Hospital, Mantova, Italy INTRODUCTION: The family plays an important role in the process of the patient adapting to the illness. The patient’s influence on family members determines a continual exchange characterised by interdependence and reciprocation. METHOD: The study was carried out on families of patients in support treatment. A self-evaluation questionnaire with multiple choice answers was used giving a score from 0 (‘not at all’) to 100 (‘a lot’). RESULTS: Twenty (20) family members were involved in the study, eight (8) males and twelve (12) females ranging in age from 30 to 75. The questions asked to the patients and the average score (AS) for each of them were the following: 1. How tired do you feel? AS: 50; 2. How has the illness of your family member affected the possibility of carrying out normal activities? AS: 51; 3. Have you experienced difficulty concentrating, e.g. reading a newspaper or watching TV? AS: 25; 4. Do you feel tense or worried? AS: 55; 5. Has the physical condition of your family member had an effect on your family and social life? AS: 45; 6. How would you describe your quality of life today? AS: 56. CONCLUSIONS: The average scores show that the decline in the quality of life and feeling tense and worried are the main problems for the family members of cancer patients. The results demonstrate the need to treat not only the cancer patient but also the family members offering them a network of support.

357 Fatigue and the Quality of Life in Cancer Patients Cengarle R, Sempreboni A, Aleotti P, Barbieri R, Aitini E Medical Oncology and Hematology, Carlo Poma Hospital, Mantova, Italy INTRODUCTION: An evaluation of the quality of life in cancer patients is essential as it represents an instrument to determine the physical, functional, psychological and social characteristics and changes that are a consequence of the illness and of the therapies prescribed for the treatment. METHOD: This study was carried out on cancer patients undergoing chemotherapy or support therapy at the Oncological department of the Carlo Poma Hospital in Mantova. A self-evaluation questionnaire with multiple choice answers

Copyright # 2006 John Wiley & Sons, Ltd.

was used giving a score ranging from 0 (‘no at all’) to 100 (‘a lot’). RESULTS: Fifty-one (51) patients were involved in the study, 36 males and 15 females, ranging in age from 51 to 70. The questions asked to the patients and the average score (AS) for each of them were the following: 1. How is your appetite today? AS: 28; 2. How tired do you feel? AS: 49; 3. How much pain do you feel? AS: 25; 4. How bad are the symptoms caused by your illness? AS: 35; 5. How has your illness affected your ability to carry out your normal activities? AS: 47; 6. How would you describe your quality of life today? AS: 47. CONCLUSIONS: The results demonstrate that fatigue is the principal problem for cancer patients. Physical and psychological fatigue, apart from being a frightening symptom since it is closely connected to the idea of life and death, is also linked to cancer with various degrees of frequency and intensity depending on the stage of the illness.

358 Cancer Patients Perception of Illness: A Single Institution Experience Aleotti P, Sempreboni A, Vivorio B, Aitini E Medical Oncology and Hematology, Carlo Poma Hospital, Mantova, Italy PURPOSE: The concept of perception/awareness of illness is difficult to define from a psychological point of view since it depends on internal and external variables of the person. METHOD: The study was carried out on 300 adult patients with cancer undergoing chemotherapy. A self-evaluation questionnaire was used. The first part asked for general information while the second part asked the patient to name the illness for which he/ she was being treated. The answers were then grouped as follows: correct diagnosis even using different terms (1 point), ambiguous diagnosis (2 points), incorrect diagnosis (3 points). RESULTS: Through an analysis with T Student applied to the different types, we found a significant statistical difference (p50.01): the female patients were more aware of their illness (average points 1.67) than the male patients (average points 1.97). Through an analysis with T Student applied to age and education level there was a significant statistical difference in the following age groups: 40–50 and 60–70, 50–60 and 60–70, 540 and 50–60, 540 and 60–70, 540 and >70, 40–50 and >70; and education levels: Middle School and University Degree, Elementary and High School, Elementary

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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and University Degree. CONCLUSIONS: The results demonstrate the influence of age and education level on the perception/awareness of illness. Just over half of the patients (54%) had a clear perception of the illness which confirms the need for reflection on the following arguments.

359 Protected Discharge: An Integrated Intervention NETWORK Between the Hospital and Local Health and Volunteer Associations Sempreboni A, Aleotti P, Mode` A, Voltolini S, Perrone A Medical Oncology and Hematology, Carlo Poma Hospital, Mantova, Italy PURPOSE: People affected by advanced cancer and their families often feel abandoned and alone after being discharged from the hospital or after symptoms worsen. The project aims to create: an intervention network coordinated between the hospital and local health authorities and associations to provide support for patients and their families, a multidisciplinary team and to identify and accompany these patients for treatment after being discharged from hospital; home assistance, community support centre and hospice. The patients involved are adult critical cancer patients who require palliative care. METHOD: The operative phases are: discharge from hospital after the completion of an evaluation form by the attending physician and nurses; identification of the type of treatment necessary after being discharged from hospital and transfer of the patient and the family in agreement with the project staff; implementation of personalised intervention; accompany and monitor intervention. RESULTS: The experiment, from July 2005 to March 2006, involved 107 adult cancer patients, 55 males and 52 females with 70% age between 60 and 80 years old. The frequency by destination is: Home 39, Community 15, Hospice 15, Evaluated 15, Outside District 3, Rehabilitation 3, Home/ Hospice 3, Home/Community 7, Under Evaluation 7. The frequency by type of cancer is: Breast 24, Lung 21, Colon 17, Pancreas 9, Kidney 6, Gastric 3, Biliary 3, Rectal 3, Cerebral 3, Peritonem 3. CONCLUSIONS: The request for home assistance, 36.4%, underlines the wish of the families to take care of the patient at home as long as there is adequate, organised intervention on the part of the health authorities which is able to provide them with protection and security.

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360 Contributing Factors and Physical–Psychosocial Characteristics of Desire for Early Death Among Patients Near the End of Life in Japan Akazawa Ta,c, Morita Tb, Akechi Tc, Furukawa Tc a Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan; bPalliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan; cPsychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan PURPOSE: How should we understand and support terminally ill cancer patients with desire for early death? The aim of this study was to examine prevalence, contributing factors, and related physical–psychosocial factors of patients’ desire for early death receiving inpatients palliative care in Japan. METHODS: Patients who were newly hospitalized in two palliative care units in Japan were recruited. Structured interviews were conducted to assess the patients’ desire for early death. Physical–psychosocial factors which might influence emergence of patients’ desire for early death were also examined. RESULTS: Among 315 newly hospitalized patients in the palliative care units, 137 patients (43.5%) with the mean age of 65.0 and the average length of survival time from time of the interview to time of death was 32 days were evaluated. Nine point five percent of the patients had desire for early death, and the prevalence rate increased to 18.3% when mild cases were included. The contributing factors of desire for early death were classified into 7 categories which were burden to others, physical distress, hopelessness, loss of self control, concerns about future sufferings, meaninglessness, and control the time of death. Fatigue, dyspnoea, and depression were also related to desire for early death. CONCLUSION: Terminally ill cancer patients receiving inpatient palliative care in Japan showed similar prevalence of desire for early death as patients in western countries. It is important to consider desire for early death as patients’ help sign of wishing to be released from intolerable distresses.

361 Multifaceted Psychosocial Intervention Program for Breast Cancer Patients after First Recurrence: Feasibility Study

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Akechi Ta,b, Taniguchi Kb, Suzuki Sb, Okamura Mc, Minami Hd a Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan; bPsychoOncology Division, National Cancer Center Hospital, East Kashiwa, Japan; cPsycho-Oncology Division, National Cancer Center Hospital, Tokyo, Japan; dOncology-Hematology Division, National Cancer Center Hospital, East Kashiwa, Japan PURPOSE: We developed a novel multifaceted psychosocial intervention program which involves screening for psychological distress and comprehensive support including individually tailored psychotherapy and pharmacotherapy provided by mental health professionals. The purpose of the present study was to investigate the feasibility of the intervention program and its preliminary usefulness for reducing clinical psychological distress experienced by patients with recurrent breast cancer. METHODS: The subjects who participated in the 3 months intervention program completed psychiatric diagnostic interview and several self-reported measures regarding psychological distress, traumatic stress, and quality of life. The assessments were conducted before the intervention (T1), after the intervention (T2), and 3 months after the intervention (T3). This study was approved by the Institutional Review Board and the Ethics Committee of the National Cancer Center of Japan. Written informed consent was obtained from each subject before enrollment into this study. RESULTS: A total of 50 patients participated in the study. The rates of participation in and adherence to the intervention program were 85 and 86%, respectively. While the proportion of psychiatric disorders at T2 (11.6%) was not significantly different from that at T1 (22.0%) ðp ¼ 0:15Þ; the proportion of that at T3 (7.7%) had significantly decreased compared with that at T1 ðp ¼ 0:005Þ: CONCLUSIONS: The novel intervention program is feasible, is a promising strategy for reducing clinically manifested psychological distress and further controlled studies are warranted.

362 Psychopathology and Screening in Palliative Care Serra Ja, Borges Sb, Albuquerque Ec, Vila˜o O´c a Sobral Cid’s Hospital, Coimbra, Portugal; b St Teoto´nio’s Hospital, Viseu, Portugal; cRegional Cancer Centre, Coimbra, Portugal

Copyright # 2006 John Wiley & Sons, Ltd.

PURPOSES: Several studies demonstrated a high prevalence of psychiatric and psychological problems in palliative care. The detection and referral of those patients are extremely important for their care but remain problematic depending on several problems including the issue of screening methods. This study aims to evaluate the prevalence of psychiatric morbidity of patients in cancer palliative care and the validity of Hospital Anxiety and Depression Scale (HADS), Distress Thermometer and EORTC quality of life questionnaire (EORTC QLQ-C30-version 3) as screening methods in this population. METHODS: Prospective analyses of 40 outpatients of the Palliative Care Service of Cancer Regional Centre of Coimbra, between January and March, 2006. Patients were interviewed by a psychiatry resident and given a diagnosis according to DSM-IV criteria. They also were given the questionnaires to be completed. Data on age, gender and medical diagnosis was compiled from the medical records. Data was analysed using SPSS 11.5 (Statistical Package for Social Sciences). Descriptive statistics was obtained to characterise the respondents. Comparisons between the groups were made based on hypothesis testing. A 5% significance level was considered. RESULTS: The prevalence of psychiatric morbidity was 60%; we found statistical positive correlations between HADS, Distress Thermometer and EORTC QLQ-C30- version 3 showing that those questionnaires are suitable for screening purposes.

363 Use of Psychotropic Drugs in Palliative Cancer Care: A Retrospective Study Gil Nuno Pa, Albuquerque Eb, Vila˜o O´c a Psychiatry and Mental Health, St Teoto´nio’s Hospital, Viseu, Portugal; bUnit of Psychiatry, Regional Cancer Centre, Coimbra, Portugal; cPalliative Care and Internal Medicine, Regional Cancer Centre, Coimbra, Portugal INTRODUCTION: Psychotropic drugs are commonly used in palliative cancer care as adjuvant pharmacotherapy for physical complaints. It is our purpose to study the use of these drugs in cancer patients in palliative care, as well as the psychopathology in that population. MATERIAL AND METHODS: Retrospective analysis of 120 in-patients admitted in the Palliative Care Ward of the Regional Oncology Centre of Coimbra (Portugal) during a 5-month period. RESULTS:

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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Psychotropic drugs were prescribed to as much as 90% of all patients, according to the following therapeutic classes: anxiolytic-hypnotics (72%), antidepressants (29%), antipsychotics (28%) and anticonvulsants-mood stabilizers (27%). Their use was usually directed to manage medical symptoms and, less often, psychological ones. In 82% of the patients, at least one psychological symptom was detected. DISCUSSION AND CONCLUSIONS: The use of psychotropic drugs in palliative care exceeds the use of this medication in other cancer patients and the major goal of their use is the management of medical symptoms. Considering that reason for using these drugs was rarely psychological distress and in view of the high prevalence of psychiatric morbidity, it is admissible that psychopathology is being under-diagnosed and under-treated. Cancer patients with advanced disease develop multiple physical and psychological symptoms and psychotropic drugs have a major role in their management.

364 Depressive Disorders in a Patients’ Sample with Cancer Mirapeix Ia, Dieguez Mb, Castelo Bc, Bayon Cd, Rodrı´ guez Vega Be a Psychiatry Principe de Asturias, Madrid, Spain; b Psychiatry Principe de Asturias, Madrid, Spain; c Oncology La Paz, Madrid, Spain; dPsychiatry Principe de Asturias, Madrid, Spain; ePsychiatry La Paz, Madrid, Spain In previous studies in general oncology population a high prevalence of depression disorders has been found. There are few studies that have registered the prevalence of depressive symptoms in cancer of colon and breast. PURPOSE: This study is included on a more wide one about the efficiency of psychotherapy interventions in oncology. The aim of the present study is to determine both the prevalence of depressive symptoms in a sample of patients diagnosed of colon and breast cancer and the percentage of possible cases in which depression diagnosis were confirmed through a clinical interview. METHODS: We selected a sample of 176 patients diagnosed of colon cancer and 162 patients diagnosed of breast cancer with A or B stages on ambulatory treatment. In order to detect depressive symptoms we’ve employed Hospital Anxiety and Depression Scale (HADS) and to confirm diagnosis of depression, a clinical inter-

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view. RESULTS: We obtained a 7.39% ðn ¼ 25Þ of patients with a HADS depression rate over 11 and a 13.60% ðn ¼ 46Þ of the sample with a HADS depression rate over 8. In those possible cases with a HADS rate equal or over 8 diagnosis were confirmed thought clinical interview in 86.96% ðn ¼ 40Þ: CONCLUSIONS: Our information supports a high degree of depressive disorders in a sample of patients with colon and breast cancer and that HADS appeared as a good scale for the screening of depressive disorders in our sample (almost rate over 11).

365 Prevalence of Anxious Symptoms in a Patients’ Sample Diagnosed of Breast and Colon Cancer Alcan˜iz Ma, Hospital Ab, Sereno Mc, Bayo´n Cd, Rodrı´ guez Vega Be a Psychiatry La Paz, Madrid, Spain; bPsychiatry La Paz, Madrid, Spain; cOncology La Paz, Madrid, Spain; dPsychiatry Prı´ncipe de Asturias, Madrid, Spain; ePsychiatry La Paz, Madrid, Spain INTRODUCTION: In previous studies in general oncologic population a high prevalence of anxiety and depression disorders has been found. PURPOSE: This study is included on a more wide one (FIS PI n: 050737) about the efficiency of psychotherapy interventions in oncology. The aim of the present study is to determine both the prevalence of anxious and depressive symptoms in a sample of people with breast and colon cancer using HADS test as screening instrument. METHODS: We elected a sample of 338 patients diagnosed of breast ðn ¼ 162Þ and colon cancer ðn ¼ 176Þ on ambulatory treatment during February–May 2006. RESULTS: We found a 14.79% ðn ¼ 50Þ of patients for a HADS rate over 11 on the anxiety subscale. For a rate equal or over 8 we found a 31.65% ðn ¼ 107Þ at the same subscale. CONCLUSIONS: We conclude that our information supports a high degree of anxiety symptoms in a sample of patients with breast and colon cancer. Osbornea RH, Elsworthc GR, Hoppera JL. 2003. Age-specific norms and determinants of anxiety and depression in 731 women with breast cancer recruited through a population-based cancer registry. Eur J Cancer 39: 755–762. Holtom N, Barraclough J. 2000. Is the Hospital Anxiety and Depression Scale (HADS) useful in assessing depression in palliative care? Palliative Med 14: 219–220.

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366 Evaluation of Psychosocial Needs of Dying Patients in Hospice Serpentini Sa, Alducci Eb, Dal Sasso La, Ballestrin Ga, Beltramello Ca a Hospice Casa Gerosa Distretto N.1, Azienda ULSS N.3, Bassano del Grappa, Italy; bFacolta` di Psicologia Universita` degli Studi di Padova, Padova, Italy PURPOSE: The objective of this study is to examine the importance and satisfaction level of psychosocial needs of dying cancer patients in Hospice context. METHODS: The instrument is a recording schedule, built to inquire into the needs belonging to four quality of life’s dimensions: physical–functional, psycho–emotional, relational and cultural. For each one of these needs the patient’s point of view about importance and satisfaction levels is specified. The schedule is administered during the first psychological interview and weekly. RESULTS: It was possible to assess six patients. Most important needs from patients’ point of view are those concerning physical–functional dimension, receiving respect, having a satisfying communication with relatives, facing fear. The most satisfied needs are: being respected, communicating with health team, receiving support and help by the family and living in a comfortable place. CONCLUSIONS: Limits result from the administering of the schedule and the scarce number of recordings; this suggests the unsuitability of standardization and generalization in palliative care. In fact, uniqueness and complexity of patient pain indicate to us the opportunity to focus on the single patient experience, in order to organize personalized interventions and to improve quality of life.

367 Introversion and Guilt in Patients with Cancer Michelidakis Ka, Alexandraki Kb,c, Myriokefalitakis Ia, Giannakakis Tb, Vlisides Da a Department of Psychiatry, Asklipieion General Hospital, Athens, Greece; bFirst Department of Medical Oncology ‘Agii Anargiri’ Cancer Hospital, Athens, Greece; cLaboratory of Biological Chemistry School of Medicine, National & Kapodistrian University of Athens, Athens, Greece PURPOSE: Since medical treatment for cancer has become more effective, cancer is not considered a terminal ill-condition but a chronic disease.

Copyright # 2006 John Wiley & Sons, Ltd.

Half of patients affected from cancer will not die from the neoplastic disease or its sequelae. On the other hand, diagnostic and therapeutic tools used in oncology carry a series of stressors, like chemotherapeutic agents with severe side effects, the fear for death, and alterations in social, professional, and family functioning. Depressive and anxiety disorders, commonly encountered in these patients, are frequently under-diagnosed and under-treated, and sometimes are complicated by neurovegetative symptoms secondary to cancer therapy. Purpose of the study was to examine personality factors and specifically the level of introversion and guilt in patients with cancer. METHODS: 69 patients affected from neoplastic diseases have been studied and have been compared with 69 healthy subjects. All patients with cancer were under treatment. Psychometric tools measuring structure and expression of hostility, anxiety and depression used were: [a] HDHQ: for non-physical aggressiveness assessment; [b] SCL-90R and DSSI/SAD: for somatization and psychiatric symptomatology assessment; [c] DSSI-SAD: anxiety and depression assessment. RESULTS: Patients with cancer presented higher scores of introversion and guilt when confronted to healthy subjects. CONCLUSION: The finding of altered psychological profile of patients with cancer implies that apart from the physical symptoms, these patients constitute a high risk group for psychiatric diseases. Oncologists have to take under consideration the psychiatric symptoms of their patients for succeeding a global assessment and an effective treatment.

368 Ifosfamide Neuropsychiatric Toxicity in Cancer Patients Alici-Evcimen Y, Breitbart W Psychiatry, Memorial Sloan-Kettering Cancer Center, NY, USA PURPOSE: Ifosfamide (IFOS) neuropsychiatric toxicity occurs in 5–30% of cancer patients. Clinical symptoms may range from mild confusion to stupor (Kerdudo et al., 2005). We report here an unusual manifestation of IFOS toxicity, a psychotic disorder with delusions, successfully treated with methylene blue. CASE: A 44 year old female with Burkitt’s lymphoma, was found screaming that she was healed by God, 48 hours after IFOS infusion. A psychiatric consultation was requested for agitation and refusal of further

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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treatment. On psychiatric assessment the patient was noted to have grandiose and religious delusions. Her cognitive functioning was intact, with no impairment in her level of arousal, attention, or concentration. An extensive work-up did not reveal an explanation for the acute onset of psychotic symptoms other than an IFOS-induced psychotic disorder with delusions. On day 7, the persistence of psychotic symptoms led us to consider using methylene blue. Two doses of 50 mg intravenous methylene blue were administered 4 hours apart with complete resolution of psychotic symptoms. DISCUSSION: Methylene blue is widely used for treatment and prevention of IFOS neurotoxicity in clinical practice. Controlled studies are needed to help determine the efficacy of methylene blue prophylaxis. Assessment of risk factors may help in determination of who should receive prophylaxis. CONCLUSIONS: We conclude that psycho-oncologists should be familiar with the diagnosis, treatment and prophylaxis of IFOS neuropsychiatric toxicity due to the availability of methylene blue for the treatment and prevention of this condition.

369 Anxiety in Children with Cancer and Their Parents Alvarado MC Instituto del Ca´ncer (SOLCA-Cuenca-Ecuador), Cuenca, Ecuador OBJECTIVE: The purpose of this research was to describe symptoms of anxiety in children with cancer who receive treatment at SOLCA-Cuenca and their parents, and, to study the correlation between their anxiety. METHODS: Participants included 32 children with cancer and their parents who responded to the Spanish versions of the State-Trait Anxiety Scales (STAIC and STAI, respectively), during hospitalization. RESULTS: Proper credibility for the global STAIC and STAI scales was obtained (alpha ¼ 0:84 and 0.87, respectively). Similar results were found for State and Trait scales. Parents showed more stateanxiety symptoms than children. Most of the children gave responses related to calm, safety, happiness. Parents expressed themselves as: being worried for future disgraces, not trusting in themselves, and not feeling rested, comfortable, relaxed or happy. Children and parents presented some trait-anxiety behaviours. Children expressed: wanting to cry, having difficulty making decisions and confronting problems, find hard to decide

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what to do, take things very seriously, being worried about making mistakes, school matters, things that could happen and what others think about them. Parents indicated: don’t feel good, want to cry, don’t feel rested, are unhappy, see things very seriously, don’t feel safety, and don’t feel satisfied. Meaningful correlations were found between parents and children Trait-Anxiety (r ¼ 0:60; p50.05). CONCLUSION: We find that parents present more state-anxiety symptoms than their children during hospitalization. Whereas some children and parents, in general, seem to present some trait-anxious behaviours.

370 Return to Work in Cancer Survivors}North West England Amir Za, Walsh Lb, Neary Da a Macmillan Research Unit, School of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK; bCentre for Occupational & Environmental Health, University of Manchester, Manchester, UK BACKGROUND: Over recent decades survival rates have improved significantly for most of the common types of cancer, resulting in an increasing number of cancer survivors, many of those are of working age. AIMS: (1) To estimate the percentage of cancer patients who returned to regular employment during the 18 month period following diagnosis and primary treatment. (2) To explore barriers to this process. METHODS: (1) A cohort of cancer patients registered in the North West of England was surveyed by post. Participants had to be between the ages of 18 and 55, have a primary diagnosis of cancer and be in paid employment at the time of their diagnosis. Also they were perceived to have a reasonable chance of return to work by their general practitioner. (2) A further sample of 30 cancer patients was interviewed indepth. RESULTS: Majority of cancer survivors (83%) have been successful in their attempt to return to the workplace. A disease related factor (kind of treatment) appeared to have a greater impact on predicting the return to work than personal or work related factors. Lack of financial arrangements explains the higher rate of survivors who returned to work after six months of sickleave. Lack of involvement of the medical profession resulted in a lack of preparation prior to the return to the workplace. CONCLUSIONS: The study provides baseline information for the

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development of an intervention to help people affected by cancer to achieve a successful process of return to work.

371 A Quantitative and Qualitative Comparison of Fears of Parents of Paediatric Brain Tumour, and Leukaemia Patients Boman KK, Anclair M Department of Woman and Child Health, Karolinska Institutet, Childhood Cancer Research Unit, Stockholm, Sweden PURPOSE: To investigate the disease-related fears of parents of patients after the diagnosis of central nervous system (CNS) tumour of their child. The occurrence of various kinds of diseaserelated fears was also examined as a function of (a) time elapsed since disclosure of the child’s diagnosis, and (b) treatment situation. METHODS: Parents of CNS tumour patients ðn ¼ 82Þ; and comparison parents of standard risk acute lymphoblastic leukaemia patients ðn ¼ 183Þ were studied. Disease-related fears were assessed using a classification of the Parental Psychosocial Distress in Cancer scale. Comparisons of entire subscale means, and qualitative evaluations were made based on item analyses to identify the kinds of fears that characterise parents of brain tumour patients. RESULTS: Parents of brain tumour patients exposed stronger disease-related fear compared to those of leukaemia patients in 5 out of 11 categories: Fear concerning child’s ‘physical growth’ ðt ¼ 1:89; p ¼ 0:008Þ; ‘future chances of finding a job’ ðt ¼ 5:69; p ¼ 0:000Þ; ‘emotional development’ ðt ¼ 2:83; p ¼ 0:036Þ; ‘chances to find a partner in the future’ ðt ¼ 1:87; p ¼ 0:025Þ; and about a ‘complete decline’ ðt ¼ 3:94; p ¼ 0:001Þ: CONCLUSIONS: Findings demonstrate the relatively increased vulnerability to parental disease-related fear caused by a child’s brain tumour. Qualitative findings reveal the most prominent fears of these parents. This knowledge offers guidance concerning particular worries to be focused on in information and support to parents of children with brain tumours.

372 A New Theoretical Model to Explain How Expressive Writing May Lead to Improved Physical Health and Psychological Outcomes in Cancer Patients

Copyright # 2006 John Wiley & Sons, Ltd.

Anderson JOa, Schofield PEb, Pattison PEa, Jefford Mb a Department of Psychology, University of Melbourne, Melbourne, Australia; bSupportive Care Research Group, Peter MacCallum Cancer Centre, Melbourne, Australia BACKGROUND: Expressive writing is the writing of deep thoughts and feelings connected to a traumatic event. Expressive writing has been found to significantly increase physical functioning and lessen psychological co-morbidities. To date, no study has both proposed a theory for why such benefits may arise and tested it using cancer patients. PURPOSE: To present a potential mechanism that may underpin the success of expressive writing, an intervention which may benefit cancer patients in adjusting to their cancer experience. RESULTS: The new model is based on the social constraint theory of Lapore (2001) and the meaning-making model of Park and Folkman (1997). The meaning-making model proposes that distress is alleviated when two levels of meaning-making are congruent. Expressive writing might assist with meaning congruency. However this model cannot fully explain the mixed results of one study in which breast cancer patients with high avoidance levels did not experience the expected psychological benefits of expressive writing. Social constraint theory proposes that the social context (high or low social constraint) impacts on avoidance, which in turn impacts on cognitive processing and distress. The new model proposes that social constraint leads to avoidance which mediates cognitive processing (defined as bringing the two levels of meaningmaking into congruence via expressive writing) which leads to health and psychological outcomes. CONCLUSIONS: The model is currently being tested using a randomised controlled trial with colorectal cancer patients. Both positive (posttraumatic growth) and negative (distress, anxiety and depression) psychological outcomes will be measured.

373 Identifying Symptom Burden and Distress of Cancer Patients with Chemotherapy: A Pilot Study for an Austrian Sample Andritsch E, Ladinek V, Zloklikovits S, Stanzer S, Buernhofer T Internal Medicine Division of Oncology, Graz, Austria

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PURPOSE: A large part of distressed cancer patients remain undetected in the clinical setting and consequently fail to receive adequate support to improve their well-being and quality of life. The purpose of the present pilot study was to identify distressed patients with an adapted instrument for an Austrian sample and to examine which somatic, psychological and social aspects are associated with the subjective level of distress. METHODS: A total of 148 cancer patients of an out-patient centre (Department for Internal Medicine, Medical University Graz, Austria) were surveyed during chemotherapy. The patients completed two times in the course of their treatment a 33-item symptom list with different aspects (somatic, psychological and social), the Distress Thermometer (DT) and the Hospital Anxiety and Depression Scale (HADS-D). RESULTS: Clinically significant distress (cut-off score 4) were shown in 43.4% of patients. No significant differences were found in association of gender, age and disease stage (curative vs palliative) in the present sample. HADS-anxiety (4.70  3.51) and HADS-depression (4.52  3.49) were significantly correlated to the overall distress (3.40  2.60). Preliminary results of the multiple regression analyses showed that pain, nausea, fatigue, nervousness, feeling down and the burden of daily housework were significantly predictive for the overall distress level of patients. CONCLUSION: The preliminary findings support further research activities concerning the development of a short and efficient screening instrument to detect highly distressed patients in the daily clinical routine.

374 Breaking Bad News: A Training Program for Nononcology Physicians Using the Spikes Protocol Anfossi Ma, Numico Gb, Dardanelli La, Cento Ga a Ufficio Qualita` Ospedale S. Croce e Carle, Cuneo, Italy; bOncologia Medica Ospedale S. Croce e Carle, Cuneo, Italy PURPOSE: To assess and answer to non-oncology physicians formative needs in breaking bad news to cancer patients. METHODS: We administered the ASCO questionnaire (Baile, Oncologist 2000) to 113 physicians working in our hospital. We first asked about the frequency and major problems in breaking bad news and whether they had any specific training or skills in communication. After data analysis two psychology-

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guided meetings were conducted, aimed at teaching the SPIKES protocol. At the end of the sessions attendees answered the following questions (1) Do you find that SPIKES is helpful in breaking bad news? (2) Which element of SPIKES is most easy? (3) and which most difficult? RESULTS: Five percent of the physicians give bad news more than 20 times per month, 45% between 5 and 20 and 50% more than 5 times; only 9% had a formal training, 34% learned from colleagues while 57% neither. In giving bad news 34% of the attendees has a plan, 37% some techniques and 29% neither. After the training course 86% answered that SPIKES could represent a useful tool. The majority reported that the easiest element is ‘Setting’ and the most difficult empathize with patients’ emotions and recognize patients’ perception of their own illness. CONCLUSION: Also non-oncology physicians are frequently involved in breaking bad news and need support to improve their empathic attitudes. SPIKES could be a simple and useful technique. These results prompted a 2-year training project oriented to teach a person-centered model of communication.

375 Telehealth Videoconferencing Applications in Psychosocial Oncology: Trials and Triumphs from the Trenches Angen MMJa, Carlson La, Currie Sb, Hoeber Mc, Houshmand Sd a Psychosocial Resources Tom Baker Cancer Centre, Calgary, Canada; bMedical Affairs and Community Oncology Alberta Cancer Board, Alberta, Canada; cTechnical Support Alberta Cancer Board, Edmonton, Canada; dBone Marrow Transplant Program Alberta Cancer Board, Calgary, Canada OBJECTIVES: To describe two different Telehealth videoconferencing psychosocial oncology applications recently funded by Alberta Health and Wellness. METHODS: One small and one large group psychosocial intervention were delivered via Telehealth for: (1) post allogenic BMT/ SCT patient support, and; (2) smoking cessation. Two six-session programs were offered for the BMT/SCT population over the course of six months with participants from six remote sites in the province of Alberta. Ten remote sites participated over the course of 1.5 years in the 8-session smoking cessation program. RESULTS: Presenters will discuss issues around program development,

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recruitment, delivery logistics and challenges. Clinical outcomes of the smoking cessation program in terms of quit rates compared to faceto-face groups will also be presented. CONCLUSIONS: Trials and triumphs will be highlighted for others interested in technological applications for psychosocial oncology interventions.

376 Anxiety, Depression and Quality of Life of Oncology Staff Anton SMa, Kurbel Sb, Enovi Sa, Tomanovi Ka, Perkovic Mc a Psychiatric Clinic, Clinical Hospital Osijek 31000, Osijek, Croatia; bDepartment for Oncology, Clinical Hospital Osijek, 31000 Osijek, Croatia; c Center for Preschool Education Osijek, 31000 Osijek, Croatia INTRODUCTION: Working on oncology represents prolonged traumatic stress which provokes specific process of adjustment. AIM: To analyze anxiety, depression and quality of life of medical oncology staff. To determine are there differences before and after holidays and between different categories of medical staff in those variables. SUBJECTS: Sample consisted of 21 medical staff persons, working on Department for Oncology on Clinical Hospital Osijek (7 oncologist, 6 graduate nurses, 8 nurses). METHODS: WHOQOL-BREF was used for estimation of quality of life, Beck Depression Inventory and Beck Anxiety Inventory for estimation of anxiety and depression symptoms. Examination was done before and after holidays. The significant statistical difference in data evaluation was at the level of 0.05. RESULTS: Increased values on BAI and BDI are in category of normal and mild increased values and do not represent pathological anxiety and depression in any of groups. Symptoms of anxiety and depression are statistically different among the groups, with statistically significant decline after holidays. There were statistically significant differences in all domains of WHOQOL-BREF between groups before and after holidays. CONCLUSIONS: Oncologist’s quality of life is better than quality of life of graduate nurses and nurses in all domains (physical health, social relationships, psychological and environmental influences). Psychological stress, for which was presumed that oncology staff gets through on working place, have no influence on quality of life of oncology staff because examined variables were

Copyright # 2006 John Wiley & Sons, Ltd.

in category from middle to excellent, before and after holidays.

377 Prognosis in Advanced Cancer Patients: A Time to Utilize the Available Tools Aprile Ga,b, Saman Mc, Iaiza Ea, De Pauli Fa, Fasola Ga a Department of Medical Oncology, University of Udine, Udine, Italy; bDepartment of Oral Medicine, Brigham and Women’s Hospital, Boston, MA, USA; cSchool of Medicine, University of Texas HSC, San Antonio, TX, USA BACKGROUND: Accurate prognostication in advanced cancer patients is crucial for clinical decision-making. With such a prediction, inappropriate therapies would be avoided, and patients would be selected for suitable strategies. When asked, physicians are seldom able to provide an accurate prognosis. Medical oncologists are rarely trained to accurately prognosticate, often tending to be overoptimistic. It is noteworthy that the accuracy of delivered prognosis has not significantly increased with the shift from a paternalistic approach to a more realistic one. METHODS/ RESULTS: A systematic search of the PubMed database from January 1996 to December 2005 was performed to review literature examining physicians’ prognostic skills. Oncologists prognosticate using a subjective judgement only, using an objective analysis, or with a combination of the two. Neither these methodologies has been extensively validated for clinical use. Relying solely on personal skills and intuition in prediction has been demonstrated as an imprecise tool. Objective judgement has obtained statistical significance in multivariate analyses, which led to the development of validated prognostic indices. However, none of these indices take into account QoL parameters or patients’ psychological profiles. Moreover, recent clinical recommendations (J Clin Oncol 2005; 23: 6240–6248) suggested that using survival models in prognosticating is rarely helpful if exclusively adopted. CONCLUSION: Useful clinical markers have been identified to help medical oncologists to better prognosticate. Evidence-based models should be combined with personal skills to provide us with a more accurate prognostic ability. Efforts are needed to validate the usefulness of personal expertise combined with literature research in accurately predicting prognosis in people with advanced cancer.

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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378 Physical Activity and Psychological Adjustment in Japanese Advanced Lung Cancer Patients During Chemotherapy Arai Ha, Hirai Ka,b, Harada Kc, Tokoro Ad a Center for the Study of Communication Design, Osaka University, Osaka, Japan; bGraduate School of Medicine, Osaka University, Osaka, Japan; c Graduate School of Sports Sciences, Waseda University, Saitama, Japan; dDepartment of Psychosomatic Medicine, National Hospital Organization, Kinki-chuo Chest Medical Center, Osaka, Japan PURPOSE: The purpose of this study was to examine relationship between physical activity and psychological adjustment in Japanese advanced lung cancer patients in chemotherapy. METHODS: The study design was prospective study. The sample was six advanced lung cancer patients in chemotherapy with written informed consent for the enrolment of a 4-week study. Physical activity was recorded by uniaxial accelerometry (Lifecoder1, Suzuken, Co. Ltd.), and psychological adjustment was measured by the Hospital Anxiety and Depression Scale (HADS). RESULTS: The average steps of the first week (T1) were 8813 ðS:D: ¼ 3770Þ steps, and that of the forth week (T4) were 9838 ðS:D: ¼ 6989Þ steps. The average score of HADS anxiety of T1 was 7.3 ðS:D: ¼ 5:0Þ; and that of T4 was 7.50 ðS:D: ¼ 6:8Þ: The average score of HADS depression of T1 was 6.2 ðS:D: ¼ 4:1Þ; and that of T4 was 6.0 ðS:D: ¼ 6:3Þ: Spearman’s correlational analysis revealed that higher steps were correlated with lower depression ðr ¼ 0:90; p50:05Þ at T1. At T4, however, higher steps were not correlated with HADS scores. Similarly, the change of steps had no significant relationships with neither of the change of HADS scores. CONCLUSIONS: The present study partly suggested that high physical activity was related to psychological adjustment in Japanese advance lung cancer patients in chemotherapy. ACKNOWLEDGEMENTS: This work is supported by Grant-in-Aid for Scientific Research (No. 16730350) from Japan Society for the Promotion of Science.

379 Written Disclosure and Stress Management Reduce Psychological Distress in Ovarian Cancer

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Arden-Close EJa, Gidron Ya,b, Moss-Morris REa, Bayne Lc a School of Psychology, University of Southampton, Southampton, United Kingdom; bDepartment of Psychology and Health, Tilburg University, Tilburg, The Netherlands; cOvacome (ovarian cancer charity), London, UK PURPOSE: This pilot intervention study assessed the effectiveness of guided expressive writing of their diagnosis and treatment (the Guided Disclosure Protocol (GDP)) and a 30 minute telephone stress management intervention on reducing distress and improving quality of life in ovarian cancer. METHODS: Twenty-seven ovarian cancer patients wrote about their diagnosis and treatment following the GDP protocol, for 15 minutes per day over 3 days and participated in a 30 minute telephone stress management programme on coping skills. Following two baseline measures one month apart, the participants were randomized to either stress management or written disclosure first. They completed the interventions over a period of two weeks, and were reassessed one month following the final intervention. Measures included the Perceived Stress Scale, the Impact of Event Scale (intrusions subscale), the Functional Assessment of Cancer TherapyOvarian, and selected subscales from the Brief COPE. RESULTS: Intrusions ðp ¼ 0:016Þ diminished from second baseline to follow-up, and physical quality of life ðp ¼ 0:01Þ improved, as shown by ANOVA. Content analyses of the writing using Linguistic Inquiry and Word Count showed improvements correlated positively with increased use of negative emotion words on Day 2 (perceived stress: r ¼ 0:42Þ and Day 3 of the writing (intrusions r ¼ 0:37), and increased use of causality words on Day 3 (perceived stress: r ¼ 0:57). CONCLUSIONS: The Guided Disclosure Protocol may be beneficial in reducing distress and improving quality of life in ovarian cancer patients. Benefits were enhanced by use of negative emotion and causality words.

380 Does Four Weeks of Daily Assessments of Anxiety, Depression and Activity Reveal more than the Hospital Anxiety and Depression Scale? Arving Ca,b, Glimelius Bb,c, Brandberg Yc a Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; bDepartment of Oncology, Radiology and Immunology Uppsala

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University, Uppsala, Sweden; cDepartment of Oncology-Pathology, Radiumhemmet, Karolinska Institutet, and Hospital, Stockholm, Sweden PURPOSE: To explore to what extent the HADS mirror daily registrations of anxiety, depression and activity in a prospective continuous dairy. METHODS: Consecutive patients about to start adjuvant therapy were included in a randomized intervention study ðn ¼ 179Þ: Self-administered HADS questionnaires were sent to patients approximately 3 and 12 months after inclusion. Daily registrations of anxiety, depression and activity on VAS-scales were completed during two weeks just before and after the 3 and 12 months HADS assessments. The end-points ‘Calm’, ‘Happy’ and ‘Active’ were valued 10 and ‘Worried’, ‘Sad’ and ‘Passive’ were valued 0. RESULTS: The registrations of anxiety, depression and activity in the ‘dairy’ and scores on the HAD subscales as well as the total HAD-Scale showed moderate and positive correlations, which were statistically significantly (p50.00) at both assessments. The daily registrations were consistent over 4 weeks and did not differ between assessments. Mean scores at the three and 12 months assessment on the HAD anxiety subscale were 4.00/5.07 and 3.61/3.23 for the depression subscale, respectively. The means of the dimensions Calm/worried, Happy/sad and Active/passive in the diary for the ‘HADS week’ were 6.81/ 6.65, 6.61/ 6.55 and 6.18/6.64, respectively, at the three and 12 months assessment. CONCUSIONS: The HADS captured to a high extent the patient’s mood assessed in daily registrations. ACKNOWLEDGEMENTS: The study was supported by Grants from the Swedish Cancer Society.

381 Depressive and Anxiety Disorders Among Cancer Patients: Screening Methods by Using the Distress Thermometer Compared to the ICD-10 Grassi L, Sabato S, Rossi E, Marmai L, Biancosino B, Gatti M Section of Psychiatry, Department of Medical and Surgical Sciences of Communication and Behavior, University of Ferrara, Italy BACKGROUND: The assessment of mood and anxiety disorders secondary to cancer and its consequences (e.g. risk of suicide, lower pain threshold, reduced compliance to treatment) has

Copyright # 2006 John Wiley & Sons, Ltd.

been the object of intense research. PUROPOSE: The aim of this study was to examine the accuracy of a short screening instrument (Distress Thermometer) (DT) in detecting mood disorders in Italian cancer patients. METHODS: The sample consisted of 109 cancer outpatients who were administered the ICD-10 psychiatric interview (CIDI), the DT and the Hospital Anxiety Depression Scale (HADS). RESULTS: Forty-four patients (40.4%) met the criteria for an ICD-10 diagnosis (Adjustment Disorders:24.8%; Affective Disorders:14.85%; Anxiety Disorders:2.7%). ICD-10 cases were identified by a score of 4 on the DT (sensitivity ¼ 79:5%; specificity ¼ 75:4%) and a score of 11 on the HADS total (sensitivity¼ 86%; specificity ¼ 81:5%). When analyzing the subgroup of patients with major mood disorders (F32, F34), a score of 5 on the DT and 15 on the HADS total maximized sensitivity (DT 78.6%; HADS 85%) and specificity (DT 83.1%); HADS 96%). CONCLUSIONS: The DT showed to be a valid instrument in assessing both general morbidity and the single sub-groups of mood disorders, although the HADS outperformed DT in sensitivity, specificity and correct classification rate. The results confirm the feasibility of simple instruments in order to facilitate the recognition of mood and anxiety disorders among cancer patients. ACKNOWLEDGEMENTS: Project funded by the European Commission Health and Consumer Protection}Commission on Cancer agreement University of Ferrara, Italy SI2.307317.2000CVG2-026.

382 An Evaluation of a Support Group Facilitator Training Program for Nurses Part 2: Moderators of Program Effect and Factors to Improve Volition Asakura Ta, Morita Mb, Yoshida Mb, Endo Kb, Okuhara Hc a Laboratory of Health and Social Behavior, Tokyo Gakugei University, Tokyo, Japan; bSchool of Nursing, The Japanese Red Cross College of Nursing, Tokyo, Japan; cSchool of Nursing, The University of Shizuoka, Shizuoka, Japan PURPOSE: We examined whether demographics and clinical experiences moderated the effect of our program on Concern on the Group Scale and Self-efficacy on the Group Scale. Next, associations between participants’ volition to run a support group assessed after the program and

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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independent variables including background, change in Concern on the Group Scale, change in Self-efficacy on the Group Scale, and change in the basic knowledge of a support group were examined. METHODS: Participants were 61 registered nurses. To investigate moderators, two-way ANOVA including an interaction was performed. Employing a multivariable regression analysis, associations between participants’ volition and independent variables were examined. RESULTS: ‘Work experience or educational training related to mental health care’ moderated the effect of our program on Concern on the Group Scale and Self-efficacy on the Group Scale. Nurses who had never had any experiences related to mental health care showed a greater decrease in Concern on the Group Scale and a greater increase in Self-efficacy on the Group Scale in comparison with the counterpart. Those who attended our program to run a support group, those who had a greater increase in their basic knowledge score, and those who had a greater decrease in concern over difficult group situations, showed relatively stronger volition. CONCLUSION: Our training program showed good effectiveness especially for nurses with less experience in mental health care. To improve volition to run a support group, becoming more knowledgeable about a support group and mitigating concern on difficult situations are imperative.

383 Evaluation of Multi-Disciplinary Intervention Strategies with Gastro-Intestinal Cancer Patients Fishniak La, Yagil Yb, Figer Ac a Oncology Tel Aviv Medical Center, Tel Aviv, Israel; bOncology Tel Aviv Medical Center, Tel Aviv, Israel; cOncology Tel Aviv Medical Center, Tel Aviv, Israel BACKGROUND: The literature indicates the importance of multi-disciplinary consultations regarding bio–psycho–social needs and concerns of cancer patients. In our unit, doctors meet patients during their first visit to the clinic, inform them of their diagnosis and provide information regarding necessary treatment. This meeting is traumatic for the patient who needs to cope with this information and the underlying threat. Immediately following the session with the doctor, patients are referred to the multi-disciplinary team of who assess the understanding of information received, the patient’s current emotional state,

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coping mechanism, and plan future interventions. OBJECTIVE: To assess this multi-disciplinary intervention. METHODS: Between December 2003 and December 2004, all patients referred to the multi-disciplinary team were investigated ðn ¼ 36Þ: The control group ðn ¼ 22Þ included all patients concluding their chemotherapy treatment who had not been in contact with the multidisciplinary team. The patients treated by the team were investigated at two stages. One followed their meeting with the doctor and prior to the multidisciplinary team intervention. The second took place 6 weeks later. Questionnaires used were the MHI for measuring emotional welfare and the BSI for emotional distress. RESULTS: Indicated a significant reduction in anxiety in patients receiving multi-disciplinary intervention. These patients also showed less emotional distress than patients in the control group. CONCLUSIONS: Multidisciplinary intervention which occurs when the patients first come to the clinic can be successful in reducing stress, and improving mental and social welfare of gastro-intestinal cancer patients.

384 Sex Differences in Psychiatric Diagnoses of Cancer Patients Athanasiadis La, Tsiara Nb, Stravoravdi Pb, Karamitrou Vb, Drakopoulu Fb a 1st University Psychiatric Department, Greece Aristotle University of Thessaloniki, Thessaloniki, Greece; bPsychosocial Service, Research Department ‘Theagenion’ Cancer Hospital of Thessaloniki, Thessaloniki, Greece PURPOSE: To investigate whether there are significant sex differences in psychiatric diagnoses in a sample of cancer inpatients referred to the Psychiatric Service. METHOD: A random sample of 46 male and 54 female inpatients at the Thessaloniki NHS Cancer Hospital in N. Greece was used in the study. All patients were referred to the Psychiatric Service of the hospital by their corresponding ward. The study looked at the relationship between the DSM IV TR psychiatric diagnosis (re-coded as depression/anxiety, organic/agitation, adjustment disorder) or lack of a positive diagnosis, and the sex of the patients. The analysis of the data was performed by the SPSS 11 statistical package. RESULTS: The patients’ mean age was 54, 12. In (a) males and (b) females the corresponding counts were for depression/ anxiety (a) 21 and (b) 33, for organic/agitation

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(a) 2 and (b) 8, for adjustment disorder (a) 10 and (b) 4 and for lack of a positive diagnosis (a) 12 and (b) 7. The analysis (crosstabs) showed that 3 cells had expected count less than 5, so an exact significance test was selected for Pearson’s chisquare. It was observed that there was a relationship between sex and psychiatric diagnosis (x2 ¼ 9:911; df ¼ 4; exact p ¼ 0:035). CONCLUSIONS: A relationship between sex and psychiatric diagnosis was found in this study. Further investigation in bigger samples is needed in order to support, in a statistically significant way, these findings.

385 Reasons for Referring Cancer Inpatients to the Psychiatric Service Athanasiadis La, Tsiara Nb, Stravoravdi Pb, Konsta Aa, Vasiliki Ha a 1st University Psychiatric Department, Greece Aristotle University of Thessaloniki, Thessaloniki, Greece; bPsychosocial Service, Research Department ‘Theagenion’ Cancer Hospital of Thessaloniki, Thessaloniki, Greece PURPOSE: To explore issues regarding the reasons that make oncologists refer their cancer inpatients to the Psychiatric Service. METHOD: The study randomly selected one hundred inpatients (46 males and 54 females) at the Thessaloniki NHS Cancer Hospital of N. Greece, who were referred to the Psychiatric Service. The researchers looked at the psychiatric diagnoses given to the patients and they also explored the reasons for referral by asking the referring physician to fill in a tailor-made questionnaire. The analysis of the data was performed by the SPSS 11 statistical package RESULTS: 35 patients were suffering from a depressive and 17 from an anxiety disorder, 14 presented with an adjustment disorder, 10 were disorientated/delirious due to organic reasons and 19 were free of major psychopathology. 23 males and 24 females were referred for psychological support in order to achieve better adjustment, 8 males and 7 females were presenting management problems (mainly compliance problems), 6 males and 7 females appeared to be}according to the referring oncologist}depressed/anxious (2 of them potentially suicidal) and the rest of the patients were referred for other reasons (substance abuse, pain management, other). CONCLUSIONS: A number of reasons make the oncologist refer the cancer patient to the Psychiatric Service.

Copyright # 2006 John Wiley & Sons, Ltd.

These reasons include emergencies (suicidal, other) and practical issues (management). In addition to these reasons the oncologists often detect the patients’ difficulties and request psychiatric input in order to support the patient achieve better adjustment and possibly better quality of life.

386 Marital Functioning and Family Cohesion in Early Adjustment to Breast Cancer Auba Ea, Forjaz MJb, Cano Ac, Cervera-Enguix Sd a Psychiatry and Medical Psychology Clinica Universitaria, Universidad de Navarra, Pamplona, Spain; bNeuroepidemiologia Instituto de Salud Carlos III, Centro Nacional de Epidemiologia, Madrid, Spain; cPsychiatry and Medical Psychology Clinica Universitaria, Universidad de Navarra, Pamplona, Spain; dPsychiatry and Medical Psychology Clinica Universitaria, Universidad de Navarra, Pamplona, Spain OBJECTIVES: Cancer produces changes in family dynamics and in the marital relationship. However, the chronology of changes of the factor that may influence has not been sufficiently studied. The objective is to study marital functioning and family cohesion in the months following breast cancer diagnosis, in order to assess the effect of cancer and its eventual interactions. METHODS: The evolution of a sample of 42 patients with breast cancer was studied during the six months after diagnosis, comparing it with a control group of healthy patients taking part in an early breast cancer detection program. All participants filled in the Dyadic Adjustment Scale (DAS), and the Family Adaptability and Cohesion Evaluation Scale (FACES III) at three different moments: just after breast cancer surgery (T1); two (T2) and six months later (T3). RESULTS: An interaction between family cohesion and the breast cancer diagnosis was found on marital adjustment in T1 and T3 (p50.001) after doing a two-way ANOVA. The effect of family cohesion on marital adjustment is not the same in breast cancer patients as in healthy participants. Marital functioning was meaningfully worse in the cancer patients belonging to groups with low cohesion (disengaged, separated). Marital functioning was found to be worse in families with low levels of family cohesion. CONCLUSIONS: Marital functioning after breast cancer diagnosis depends on the type of family cohesion. Families

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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with a low family cohesion are especially at risk of suffering a marital dysfunction, therefore they could benefit from early interventions.

387 Analysis of Cancer Patients Auto-biographies. An Attempt to Cope with Cancer and Transcend Destiny Bacque´ MF Psychologie Universite´ Louis-Pasteur, Strasbourg, France INTRODUCTION: Psychoanalytic research is based on ethical respect of individual subjectivity. Its scientific method uses longitudinal follow-up of individuals in monographic observation or autoassessment. PURPOSE: (1) To determine conscious and unconscious needs of cancer patients writing their biography. (2) To bring to medical community more accurate observations on patients’ feelings. MATERIAL AND METHODS: 20 published autobiographic documents (individual and collective books) written after 2000. All authors are French women (8) or American (12). CLINICAL INSTRUMENT: thematic analysis. RESULTS: Principal thematic: Dualism between dominance (of cancer on person, of body on soul, of medical team on patient) and subordination. Many are fed up of the ‘Battle discourse’ with the ‘enemy’ (estimated as a male speech). But majority doesn’t want standardization of cancer. Transparency of the body (medical iconography). Transparency of soul submitted to biology. Losses of life lightness, senses pleasures and life projects. Passivity (waiting, always waiting!), regression facilitates magic thinking and waiting for miracles. Feeling of condemnation to death (mortality is sure and approach now!). Transcendence: cancer is a special event that totally changes life. Cancer permits to discover real personality. Perspective of death gives its value to life. CONCLUSION: Americans are more pragmatic than French (centred on literary writing). Americans are more interdependent (they associate other people in altruistic movements). All writers experiment real satisfaction to write and to testify. Why not create hospital writing workshops to help patients to begin such mentalisation work?

388 Tolerance, Stability, Change and Sense of the Limit: A Three-year Experience of Supervision to a Cancer-care Team

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Bagnulo Aa, Gasparini Ib, Zoboli Aa, Ferretti Ga, Buda Pc a Internal Medicine, San Sebastiano Hospital, Correggio (RE), Italy; bInternal Medicine}Psychoncology Unity, San Sebastiano Hospital, Correggio (RE), Italy; cPsycho-Oncology Consultant, Rimini, Italy In our Day-Hospital the moments of supervision to the team are well consolidated. They consist in residential workshops in which thematic detailed topics, previously chosen by our group, are faced and developed. They can regard problematic careplans, managerial and/or organizational aspects and discussion about complex cases. Through activations, simulated role-games we have recently faced the topic of the tolerance as effective instrument used by the team which has to experiment the consequent aspect of the sense of the own limit. The utilization of the video-camera and the recording of some activations have allowed to the supervisor and the group of being able to use the following vision as instrument of reflection and analysis of what it wasn’t obviously possible to pick when you are ‘within’ to the group. Therefore the group has had the possibility to discuss and see again some of main psychic and group’s dynamics through the redefinition of concepts like ‘stabilities’, ‘change’, ‘participating style’ and ‘fellow-feeling style’. The analytic and critic ability of everyone has appeared good. Each participant has actively contributed to the success of the event putting in evidence mobilization capacities about some rigidities and facilitating a good climate of group. The possibility to work on symbolic and reality levels has helped to express the own feelings and to develop a group-job very articulated and totally shared.

389 ‘All Aboard?’ How Good Are Cancer Doctors in Identifying Patient Concerns? Baile WFa, Parker Pb, Palmer Lc, Bruera Ec a Department of Psychiatry, University of Texas, M.D. Anderson Cancer Center, Houston, USA; b Department of Behavioral Science, University of Texas, M.D. Anderson Cancer Center, Houston, USA; cDepartment of Palliative Care and Rehabilitation, Medicine University of Texas, M.D. Anderson Cancer Center, Houston, USA Cancer physicians can potentially impact the adjustment of their patients by identifying and

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addressing patients’ most important concerns. We examined cancer patients concerns using a Concerns Check List (CCL) and their report of anxiety and depression using the Hospital Anxiety and Depression Scale. These were administered immediately before their medical visit. Physicians completed a CCL for each patient so that comparison could be made between patients’ and physicians’ ratings. The 94 study patients were attending a palliative care and rehabilitation medicine clinic. They were an average of 58.2 years (SD 12.7) old. Fifty-six percent were female and most were Caucasian (67%), married (60%) and had some college education or higher (69). Most had advanced disease (stage III–IV). Patients had the following cancers: 26% lung, 20% GI, 17% GU, 10% breast and 27% other. Rated on a 0–3 scale (0 ¼ not at all, 3 ¼ very much) patients indicated having the most concern about functional impairment and also about caring for themselves. There was little agreement between physician and patient ratings of concerns (k ranged from 0.06 to 0.26) with highest concordance being between ‘caring for oneself’ ðk ¼ 0:26Þ and lowest for ‘spiritual/religious issues’ ðk ¼ 0:06Þ and relationships with important others ðk ¼ 0:01Þ: Patients who reported more concerns reported greater anxiety (r ¼ 0:54; p50:001) and depressive (r ¼ 0:28; p50:01) symptoms. These results suggest that interventions to improve study physicians’ ability to identify and address patient concerns could lessen patient distress and improve their coping.

and several times thereafter. Scores for the 15 scales range from 0 to 100, higher scores reflecting better functioning and higher symptom distress, respectively. RESULTS: Number of cases decreases over time: 140 (pretransplant, T1)–108 (discharge, T2)–73–65–53–51–50–47 (about 26 months postHSCT). 72 patients died during follow up, most of them during the first six months. In general, decrease in functioning and increase for symptoms is seen during the first 3–6 months. Most pronounced changes from T1 to T2 (difference of mean scores 4 20) are seen for role functioning and appetite loss. Recovery to pretransplant scores is reached at about one year post HSCT. There seems not to be much more improvement thereafter. Fatigue and insomnia have remarkable levels at T1 (mean score 41.7 and 31.4, resp.), mean scores at later measure points do not fall below them. The poster presents curves for the scores over time for QLQ-scales. CONCLUSIONS: As a frame, one year is needed to regain the pre-transplant (T1) functioning level. Fatigue and insomnia are persistent problems that should be anticipated. ACKNOWLEDGEMENTS: Supported by German Jose´ Carreras Leukaemia-Foundation.

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PURPOSE: It has been suggested that all cancer patients should be screened for distress at multiple points in their process through the cancer continuum. The recent introduction of very brief screening tools has made this more feasible. However, none of these tools were developed or validated in the New Zealand context. This research seeks to validate one of these tools (the Distress and Impact Thermometer) with minor modifications of wording made to suit the New Zealand culture. METHOD: The Distress and Impact Thermometer (DIT) asked patients to rate their level of distress and the impact of this is stress. Three Hundred Cancer patients were asked to complete a questionnaire that included the DIT, the Brief Symptom Inventory}18 (BSI-18), and the Hospital Anxiety and Distress Scale (HADS) and the Profile of

Quality of Life During the First Two Years after Allogeneic Haematopoietic Stem Cell Transplantation Bailer Ha, Larbig Wb, Ka¨chele Ha, Grulke Na a Psychosomatic Medicine and Psychotherapy, University Hospital of Ulm, Ulm, Germany; bMedical Psychology, University of Tu¨bingen, Tu¨bingen, Germany PURPOSE: To study the course of QoL during the first two years post HSCT using the EORTC QLQ-C30. METHODS: From 9/1999 to 12/2001, 140 patients were recruited from the transplant units at the university hospitals in Ulm and Tu¨bingen, Germany. Each patient was to be followed-up on for at least two years. Patients were administered the QLQ-C30 before HSCT

Copyright # 2006 John Wiley & Sons, Ltd.

391 Validation of the Distress and Impact Thermometer in the New Zealand Context Baken DM, Woolley CC, Kent LM School of Psychology, Massey University, Palmerston North, New Zealand

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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Mood States (POMS). RESULTS: The DIT was found to correlate moderate–strongly with the subscales of the BSI}18, the HADS and the POMS. ROC analyses suggested similar cut-off scores to those reported previously. CONCLUSIONS: The DIT is valid for use in New Zealand and the minor modifications to suit the New Zealand cultural context did not adversely affect its validity. ACKNOWLEDGEMENTS: This research was funded by a Grant from The Mid Central District Health Board.

392 Attitudes Towards Genetic Testing by Patient with Hereditary Colorectal Cancer Balck F, Berth H Universita¨tsklinikum Carl Gustav Carus, Dresden Medical Psychology and Medical Sociology, Dresden, Germany Advances in molecular medicine and genetic testing will increase the provision of presymptomatic gene tests. The utilisation of such tests depends on medical and psychological factors like personal attitudes towards genetic testing. This study examines the intention to be tested for a mutation. Which are beliefs about the benefits and barriers for such a test? Do these beliefs change after the consultation? Established by the German Cancer Foundation this project offers genetic counselling and testing patients with colorectal cancer and persons at risk for hereditary nonpolyposis colorectal cancer (HNPCC). Before and after counseling (2 weeks) the participants were asked with a attitudes-questionnaire. The attitudes were divided in benefits and barriers in relation to the health belief model. In the study are 80 participants. 24 persons are patients, 54 counselees were persons at risk. The attitudes toward the genetic testing are divided in benefits and barriers. There are no differences in emotional and healthy aspects of these beliefs between the patients and persons at risk. There is a difference between the two aspects of benefit and barriers of genetic testing. As well in emotional as in healthy aspects of beliefs the benefits are in both times at a higher level as the barriers. The benefits are at a higher level. The attitudes are not correlated with the risk perception, but with self-efficacy. The results show the importance of attitudes in the counselling process. Topic like worrying about symptoms

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or knowledge about genetic testing should be main topics.

393 Women’s Discussions about Self-obtained Samples for HPV Testing: A Focus Group Study Barata PCa, Stewart DEa, Howlett Rb, Gagliardi Ac, Mai Vd a Women’s Health Program, University Health Network, Toronto, Canada; bCervical Screening Program Cancer Care Ontario, Toronto, Canada; c Ontario HPV Pilot Study, Cancer Care, Ontario, Toronto, Canada; dDepartment of Preventative Oncology Cancer Care, Ontario, Toronto, Canada PURPOSE: There is now a clear link between human papillomavirus (HPV) and cervical cancer. Patient collected samples for HPV testing have shown promise and thus open up the possibility of self sampling for cervical cancer screening in populations that are currently under utilizing screening. The purpose of this study was to explore women’s views about collecting their own HPV samples. METHODS: Three focus groups were conducted with women representing hard-to-reach populations. One group included women from a small under serviced Northern city, one included multicultural immigrant women from a large urban city, and one included multicultural immigrant women in a medium sized under serviced city. Transcripts were coded in QSR NUDIST using open and axial coding (Strauss and Corbin, 1998) as well as focused coding (Esterberg, 2002) procedures. Code categories were collapsed and expanded as more complex connections between the codes emerged into themes. RESULTS: Six overriding themes emerged: A need for education about basic information (HPV, cervical cancer, etc.); Selfobtained samples have the potential to increase cervical cancer screening rates for some women; Self-obtained samples should be optional because some women prefer physician-collected samples; A number of concerns need to be addressed; Logistical questions remain unanswered and there is a need for education and promotion around self-obtained samples. CONCLUSION: Some women would likely benefit from the introduction of self-obtained samples, but a number of concerns and issues must first be addressed. ACKNOWLEDGEMENTS: This research was funded by the Ontario Women’s Health Council.

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394 Is There any Discrepancy Between Professionals and Patients in the Perceived Threat Degree (PTD) Related to Stressful Events? Barbero J, Lo´pez-Fando T, Garcı´ a-Llana H, Diaz-Sayas L, Herna´ndz-Navarro F Hematology Hospital, Universitario La Paz, Madrid, Spain PURPOSE: 1. To evaluate the degree in which professionals of the interdisciplinary team and patients perceive threat within four categories: A. Changes in health outcomes; B. Uncertainty due to information not yet available; C. Changes in the temporal expectation; D. Unpleasant diagnosis tests. 2. To explore other threatful categories. 3. To estimate the difference in the PTD. METHOD: Professionals (33 clinicians; 11 nurses; 33 psychologists) and 21 patients were administered an ad hoc questionnaire. The PTD was assessed through a Likert scale (0–100). RESULTS: The mean and standard deviation of the PTD related to the four categories and the other threatful categories identified will be shown during the IPOS meeting. Statistically significant differences were found between psychologists and patients (A, Z ¼ 2:48; p50:05; B, Z ¼ 2:70; p50.01; C, Z ¼ 3:13; p50.01 and D, Z ¼ 3:41; p50.01) and between nurses and patients (A, Z ¼ 2:40; p50.05; C, Z ¼ 3:37; p50.01 and D, Z ¼ 2:5 5; p50.01). No differences were found between clinicians and patients. CONCLUSIONS: Clinicians seem to be more adjusted to patients PTD than psychologists and nurses. These results might be due to: clinicians might have a more homogenous opinion because they elaborate a cognitive evaluation not giving attention to the emotional sphere; Psychologists and nurses might have a more vivid evaluation due to their emotional work with patients. Therefore, new research is needed in order to clarify which process is taking place.

395 Psychopathologic Morbidity and Satisfaction with Care in Cancer Patients in a General Hospital Barbosa F, Santos N, Barbosa A Consultation Liaison Psychiatry Unit, University Psychiatric Department/Santa Maria Hospital, Lisbon, Portugal PURPOSE: To compare the satisfaction with care and the psychopathological co-morbidity prevalence of cancer patients with all the other patients

Copyright # 2006 John Wiley & Sons, Ltd.

of a general hospital compared with sample. METHODS: A sample of 374 inpatients (cancer patients; N ¼ 71) were studied by means of a socio-demographic and clinical questionnaire, HADS (Snaith, 1989), CAGE (1971), and WAS (Moos, 1972) including all the patients who were in a health status allowing and consenting to participate. RESULTS: Cancer patients didn’t differ in socio-demographical variables, but showed higher level of anxiety (p50.05) and depression (p50.02) than the other patients. We found no differences concerning alcoholic habits. There were also significant statistical differences in some dimensions of satisfaction with care: less spontaneity (p50.004) practical orientation (p50.025) in patients with cancer. The sub-group of solid tumours had lesser levels of anxiety and depression than the liquid ones. CONCLUSION: The co-morbidity profile of cancer patients exhibit a more severe level of psychopathology (mainly in the group with leukaemia and lymphoma) and lesser levels in some dimensions of satisfaction with care. Those findings are important to be integrated in the development of specific strategies and processes of human resource allocation for oncology departments in the general hospital.

396 Quality of Life and Psychopathological Co-morbidity in Cancer Patients on Radiotherapy Barbosa F, Mendonc¸a V, Barbosa A, Monteiro Grilo I Consultation Liaison Psychiatry Unit, University Psychiatric Department/Santa Maria Hospital, Lisbon, Portugal PURPOSE: To detect which factors contribute to quality of life in cancer patients on radiotherapy METHODS: A sample of sequential cancer outpatients (2nd week of treatment) of the Radiotherapy Service of an University General Hospital were studied by means of a socio-demographic and clinical questionnaire, HADS (Snaith, 1989), BSI (Derogatis, 1987), and SF36 (Ware, 1993) RESULTS: The radiotherapy cancer patient’s sample ðN ¼ 210Þ with 58.1% male, 72.4% married, 57.1% retired, mean age 61.1 mainly suffering from breast, prostate and gastrointestinal cancer with previous treatments of surgery (49.5%), chemotherapy (62.4%), 36.2% without co-morbidity, Karnofsky X ¼ 94:2; showed high level of depressive (44.2%) and anxiety (43.9%) symptoms. We found a strong negative correlation

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between co-morbidity and quality of life, (namely physical and emotional well being) and psychopathological symptoms. CONCLUSION: The general level of quality of life was good but it was worsened by psychopathological and co-morbidity factors and not influenced by disease stages. A psychological screening is strongly advised in order to promote quality of life in cancer patients on radiotherapy.

variables, personal characteristics, and health behaviours were not meaningfully linked with insomnia in these women. Rather, vasomotor symptoms and psychological distress predicted women meeting clinical criteria for insomnia. ACKNOWLEDGMENTS: Susan Komen, Lance Armstrong, Walton Family Foundations; NCICA69375; NIH-M01RR00070, M01RR00079, M01RR00827.

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Cancer-Specific Variables do not Predict Insomnia in Women Treated for Early-Stage Breast Cancer Bardwell Wa,c, Casden Da, Rock Cb,c, Thomson Cd, Perce Jb,c a Symptom Control Program, Moores UCSD Cancer Center La Jolla, CA, USA; bPrevention & Control Program, Moores UCSD Cancer Center La Jolla, CA, USA; cWomen’s Healthy Eating & Living (WHEL) Study, USA; dArizona Cancer Center, University of Arizona, Tucson, AZ, USA

The Distress-barometer: The Implementation of a Rapid Screening Instrument for Distress in Oncology Hospital Practices Bauwens SMGa, Baillon Ca, Distelmans WKHMa, Theuns Pb a Oncology Centre, Academic University, Free University Brussels, Brussels, Belgium; bFaculty of Psychology Free University Brussels, Brussels, Belgium

PURPOSE: To determine the relative importance of predictors of insomnia in breast cancer. METHODS: 2614 women who completed initial treatment 54 years previously for Stage I–IIIA breast cancer were studied. At baseline, participants completed questionnaires assessing personal characteristics, health behaviours, physical functioning/symptoms, and psychosocial functioning. Cancer stage, treatment, and time since diagnosis were verified via chart review. Insomnia was assessed using the Women’s Health Initiative Insomnia Rating Scale (WHIIRS): total score >9 (sum of 5 items, each scored 0–4) indicates clinically significant insomnia. Used binary logistic regression analysis with WHIIRS Total 59 vs >9 as the outcome variable. RESULTS: 39% of participants had WHIIRS scores >9. The overall logistic regression model was significant (R2 ¼ 0:198; p50.001). The amount of variance in WHIIRS status explained by each category of predictors was: cancer-specific variables, 0.4% (ns); personal characteristics, 0.9% (ns); health behaviours, 0.6% (ns); physical functioning/symptoms, 13.4% (p50.001); psychosocial factors, 4.5% (p50.001). Increased risk for clinically significant insomnia was associated with more severe vasomotor symptoms (OR ¼ 1:67; p50.001), while greater emotional well-being was protective (OR ¼ 0:97; p50.001). CONCLUSION: Insomnia is common in early-stage breast cancer, even years after completing initial treatment. Cancer-specific

Copyright # 2006 John Wiley & Sons, Ltd.

PURPOSE: The purpose of the project is to develop a rapid and convenient distress screening instrument to optimize the communication between doctors and their patients in consultations and more specifically to facilitate the disclosure of patients about their experienced distress and their needs for information and support. METHODS: After exploration of the existing English screening instruments, the distress barometer was developed for the Fleish oncology practices. Following a pilot study, the screening instrument will be adapted after evaluation by patients as well as by medical oncologists. In a further main study the instrument will be introduced and validated in several Flemish oncology centres. RESULTS: The evaluation by patients and doctors in the pilot study will be reported and the adapted ‘distressbarometer’ screening instrument will be presented. CONCLUSIONS: The appraisal of doctors and patients will be an indication of the usefulness of the ‘Distress barometer’. The use of the instrument may support the detection of distress in routine clinical practice. Difficulties in implementation will be discussed. ACKNOWLEDGEMENTS: This project is granted by the national society ‘Vlaamse Liga tegen Kanker’.

399 Cognitive Functioning After Adjuvant Chemotherapy for Localized Breast Cancer Beadle GFa,Wright MJb, Kennedy KJc, Jones TJc

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a

Translational Research Laboratory, Queensland Institute of Medical Research, Herston, Australia; b Genetic Epidemiology Laboratory, Queensland Institute of Medical Research, Herston, Australia; c Cognition in Breast Cancer Study, Wesley Research Institute, Toowong, Australia PURPOSE: To assess cognitive functioning before and after adjuvant chemotherapy for localized breast cancer. METHODS: A longitudinal, prospective, repeated measures design has been developed to assess cognitive functioning in an approximate 0.5 hour testing protocol before chemotherapy (T1), 4 weeks post-chemotherapy (T2), 6 months post-chemotherapy (T3), and 18 months post-chemotherapy. RESULTS: Of 128 participants recruited to date, 54 have completed 3 assessments. Repeated measures ANOVAs indicate significant differences in memory, some tasks of executive functioning and one task of attention. Consistently poorer performances between T1 and T2, with no improvement at T3, have been documented on 5 learning trials, an immediate recall trial, and one test of dual tasking ability. On measures associated with delayed verbal memory and cognitive switching, poorer performances have been identified between T1 and T2, with evidence of recovery at T3. Improvements in performance, possibly reflecting practice effects, have been documented on tasks associated with visual memory, planning time, the Tower of London Test, and Matrix Reasoning. CONCLUSIONS: These preliminary results indicate difficulty with verbal memory and dual tasking following chemotherapy. Improvements of executive functioning may be due to practice effects. Further recruitment is necessary to fully explore the nature and extent of cognitive change after adjuvant chemotherapy for localized breast cancer. ACKNOWLEDGEMENTS: The authors acknowledge the partnership and support by women with early breast cancer who have volunteered to participate in this study, and the multi-disciplinary collaboration between medical oncologists and research neuropsychologists required for the successful recruitment and conduct of this study.

400 Adolescent Cancer Patients and their Mothers: Factors Influencing their Distress Beckers Ja, Libert Yb, Lieutenant Fb, Merckaert Ia,b, Razavi Da,b

Copyright # 2006 John Wiley & Sons, Ltd.

a

Unit of Psychosomatic and Psycho-oncology Universite´ Libre de Bruxelles, Bruxelles, Belgium; b Clinic of Psycho-oncology and supportif care Institut Jules Bordet, Bruxelles, Belgium

Little is known about the impact on adolescent cancer patient’s distress of mother’s characteristics. Little is known also about the impact on mother’s distress of adolescent cancer patient’s characteristics. The first aim of this study was to assess adolescent cancer patients’ and their mothers’ distress. The second aim was to identify adolescent cancer patients’ characteristics (medical, social and psychological variables) which reassociated with their mothers’ distress. The third aim was to identify mothers’ characteristics (social and psychological variables) which are associated with adolescent cancer patients’ distress. This is a cross-sectional study assessing consecutive, hospitalized or not, adolescents and their mothers. Seventy-five adolescents and their mothers completed a socio-demographic questionnaire, the Hospital Anxiety and Depression Scale, the Ways of Coping Checklist and a revised and adapted version of the Cancer Rehabilitation Evaluation System. Moderate to severe distress levels were found in 18 percent of adolescents and 62 percent of mothers. Nearly all medical, social and psychological adolescent’s variables are correlated with mother’s distress (correlations ranged from r ¼ 0:23 ðp ¼ 0:047Þ to r ¼ 0:51 ðp ¼ 0:000Þ). Nearly none of social and psychological mother’s variables are correlated with adolescent’s distress: only mother’s emotion-focused coping is correlated with adolescent’s distress (r ¼ 0:23; p ¼ 0:050). Mothers are highly distressed and highly sensitive to their adolescent’s difficulties. It appears also that they meanwhile succeed in protecting their adolescent from their own difficulties.

401 Prospective Quality of Life Study in Adults with High-grade Gliomas Bellver-Pe´rez Aa, Reynes Muntaner Gb, Ponce Lorenzo Jb, Martı´ n Ureste Mb, Diaz-Beveridge Rb a Psycho-Oncology Unit Junta Asociada Provincial, A.E.C.C. of Valencia, Valencia, Spain; bMedical Oncology Unit, University Hospital La Fe, Valencia, Spain PURPOSE: To assess the quality of life and cognitive function, furthermore we evaluated the

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relation of these variables with the prevalence of psychological disorders (anxiety and depression). The medical variables and their interaction on anxiety and depression were analysed too, during diagnosis and medical treatment. METHODS: We prospectively studied: 99 patients (47% female, 53% male) aged 18–77, from the University Hospital La Fe of Valencia who had been diagnosed of brain cancer. A total of 76.5% of patients were evaluated at the moment of initial diagnostic and 23.5% in recurrence after treatment. The evaluation was realized before irradiation and 3 months later during chemotherapy. Patients were evaluated with the Mini-mental Status Examination, the EORTC QLQ-C30, the EORTC Brain Cancer Module BN20 and the Hospital Anxiety and Depression Scale (HAD). RESULTS: Baseline quality of life data and subsequent evaluation was available for 63 of the 99 patients (63.6%). A significant proportion of patients had a poor quality of life 19% (QoL550). The results showed a high prevalence of psychological disorders: anxiety and depression symptoms about 37.4% of all patients. The same prevalence of distress was found at baseline and at subsequent evaluation. There were inverse interrelates between distress symptoms and cognitive function. CONCLUSIONS: There is a high prevalence of impaired on neuropsychological function in the patients with high-grade gliomas. It is important to include neuropsychological and quality of life evaluations in the follow-up of these patients, in order to develop specific interventions like neuropsychological rehabilitation.

402 Effect of Group Psychotherapy in Women with Breast Cancer Bellver-Pe´rez A, Almonacid Guinot V Psycho-Oncology Unit, Junta Asociada Provincial, A.E.C.C. of Valencia, Valencia, Spain PURPOSE: The aim of this study was to evaluate the effect of group psychotherapy interventions on quality of life and its impact on distress response of women with breast cancer. Furthermore, we analyzed the differences between two types of group psychotherapy in the same variables. One group were working self-esteem and communication abilities, and the other were training cognitive behavioural techniques. METHODS: The sample consisted of 73 women (mean age 49.6, SD ¼ 8:2) with non-metastatic breast cancer who received

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group psychotherapy after medical treatment, 80% were married. The women were divided into two groups: self-esteem and communication abilities ðn ¼ 29Þ and cognitive behavioural therapy ðn ¼ 44Þ: The women completed the Functional Assessment of Cancer Therapy-Breast FACT-B (4th version) and the Hospital Anxiety and Depression Scale (HADS) and satisfaction with psychotherapy at beginning, at the end and three months after finished the group psychotherapy. The statistical analyses were MANOVA repeatedmeasures and design factorial mixed. RESULTS: The results show statistical significant improvements in all domains of quality of life and significant decrease in distress symptoms during the group psychotherapy which were largely maintained at 3 months’ follow up. Comparative analyses between group treatments don’t show statically significant differences on quality of life, anxiety and depression. CONCLUSIONS: Both groups are associated with significant benefits. Our results demonstrate evidence for the effectiveness of both group psychotherapy for women with breast cancer, increasing quality of life and decreasing anxiety and depression. The results and women satisfaction dates indicate that this program meets the needs of woman and can be regarded as a successful intervention in after oncology treatment.

403 Validation of a Very Short Distress Questionnaire for Presurgical Use in Patients with Gastrointestinal Cancer Berend M Reference Center Quality of Life in Oncology, University Medical Center, Schleswig-Holstein, Campus Kiel, Kiel, Germany PURPOSE: Psychosocial support should be available promptly for cancer patient at all stages of disease. Common diagnostic screenings focus often psychiatric diagnoses and do not meet the special problems of cancer patients. With the ‘Hornheider Fragebogen’ (HFK) a short indication instrument (9 Items) was developed to the specific psychooncological intervention with skincancer-patients. This questionnaire was adapted to the needs by patients with gastrointestinal cancer in the presurgical phase. Psychometric properties of this modified HFK were analyzed in this study. METHODS: For assessment of psychometric properties a consecutive sample was

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realised in 2003 ðN ¼ 66Þ: The Brief Symptom Inventory (BSI) was used as a ‘gold standard’. Internal consistency, validity, sensitivity and specificity of the instrument were determined. The evaluation sample forms a group of patients who were operated in the period 1998–2001 ðN ¼ 361Þ: Concurrent validity was established using QLQ-C30 scales ‘emotional functioning’ and ‘global health’. RESULTS: The ‘HFK’ in his revised form turned out as a practicable, reliable (Cronbach’s Alpha ¼ 0:86) and valid (correlation BSI ¼ 0:74) screening-instrument. The need for psychological support can be illustrated very well on the basis of four Items. Due to the representative sample the questionnaire can be valuable for screening patients with similar diagnoses. CONCLUSIONS: The adaptation of ‘HFK’ to the situation of patients with a gastrointestinal cancer can be considered as successful, besides, psychometric properties were even improved. The introduced questionnaire contains no disease specific wording and therefore is transferable on other diagnosis groups.

404 Preoperative Distress as a Predictor for the Length of Hospital Stays in Patients Undergoing Surgical Treatment for Gastrointestinal Cancer Berend M Reference Center Quality of Life in Oncology, University Medical Center, Schleswig-Holstein, Campus Kiel, Kiel, Germany PURPOSE: Previous studies indicate that distress may affect the patients’ convalescence and may lead to a prolonged length of stay and an increased risk of complications. Therefore, the aim of this study was to examine possible correlations between psychosocial stress on the one hand, and length of hospital stay and complication rates on the other hand, in patients undergoing surgical treatment for gastrointestinal cancer. METHODS: The sample consists of N ¼ 361 patients who underwent surgery between 1998 and 2001. For assessment of pre-operative distress a revised version of the ‘Hornheider Fragebogen’ (9 items) was administered to the patients. Statistical methods used were w2-test, multiple linear regression analysis, and univariate analysis of covariance (ANCOVA). RESULTS: The analysis revealed a regression model explaining 20% of the variance for post-operative length of stay. Aside from ‘typical’ variables such

Copyright # 2006 John Wiley & Sons, Ltd.

as operation time and preoperative risk score (Charlson Comorbidity Index), pre-operative distress appeared to be a significant predictor for overall length of stay. Comparing the overall length of stay of patients with or without a high amount of distress, a difference of up to 2.9 days was found. These differences cannot be attributed to medical complications in one of the groups. CONCLUSIONS: Altogether, the results of this study show that pre-operative distress may lead to prolonged length of hospital stay. These findings should be reanalysed in future studies, focusing especially on regression model with a higher proportion of variance explained.

405 The ‘Kiel model’: A Psychooncological Support Program Following International Standards Berend M, Teren K, Malchow B, Bestmann B, Ku¨chler T Reference Center Quality of Life in Oncology, University Medical Center, Schleswig-Holstein, Campus Kiel, Kiel, Germany PURPOSE: Nationwide and internationally there are efforts to develop guidelines and standards for the psychosocial care of cancer patients. In Germany the development of guidelines is not concluded yet. Therefore, the ‘Kiel model’ of psychooncological care follows the guidelines of the NCCN (2005) and realises these recommendations almost completely. METHODS: At present a psychooncological program at the UK S-H Campus Kiel accompanies patients (gastrointestinal and bronchial carcinoma) from the time they are diagnosed to two years postoperative, with the main focus on the phase of hospital stay. Already at the time when the diagnosis is delivered, patients and their relatives are invited to an informative meeting (interprofessional, general medical and psychological information). Every patient is screened for type and amount of distress. The evaluation (QoL) takes place over a period of two years. The psychological treatment is partly financed by health insurance companies. RESULTS: Patients perceived this support-program as very positive. Thus, the number of patients and relatives who make use of the informative meeting is very high (>40%). Altogether over 30% of all cancer patients make use of some type of psychological support. The psychological understanding and knowledge of the hospital team on the other side is growing

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continuously. CONCLUSIONS: In this process orientated model screening, diagnostic, indication, support and aftercare are connected with the evaluation of quality of life. At the same time it is practicable and highly accepted by patients and their relatives. With the necessary modifications this model can be transferred to other facilities.

406 Therapeutic Concepts for Fear of Progression (FOP); A Randomized Evaluation Study Berg Pa, Duran Ga, Engst-Hastreiter Ub, Waadt Sa, Herschbach Pa a Clinic of Psychosomatic Medicine, Technical University Munich, Munich, Germany; bRheumatology Rehabilitation Centre, Federal Insurance Institute for Salaried Employers, Bad Aibling, Germany Fear of progression (FOP) is a construct, which includes all kinds of fear connected to a possible worsening of a disease. Clinical experience and several studies have shown this fear to be one of the most important causes of distress in cancerpatients. It has to be differentiated from irrational fears and can affect quality of life in such an enduring way, that it has to be treated. The far reaching consequences of FOP lead to the development and psychometric testing of a specific questionnaire (FOP-Q; Herschbach et al., 2005) and conceptualisation and evaluation of a specific therapy for dysfunctional FOP. Two therapeutic concepts were designed: one rather non-directive encounter group and one group based on cognitive behaviour therapy. In the first, patients select the therapeutic topics, share common emotional experiences and social support. In the latter, a patient learns to confront himself with his fear, learns to think it out and to cope with it. Both therapies aim at enabling the patient to manage his fear rather than to eliminate it, so that he can win back quality of life. The evaluation is based on a prospective control group design with external randomisation. The data (FOP-Q, HADS, FLZM, SF-12) from 256 cancer- and 256 rheumatism-patients were evaluated. The measures were done pre, post, 3 and 12 month after treatment. We shall present the results of the therapy evaluation study. The data point at a significant ad meaningful decrease of FOP-Scores over one year.

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407 Burden of Disease and Participation in Cancer Rehabilitation: Psychosocial Characteristics of Participants and Non-participants Bergelt C, Lehmann C, Koch U Institute of Medical Psychology, University Clinic Hamburg, Hamburg, Germany PURPOSE: A core objective of cancer rehabilitation is the improvement of psychosocial variables and quality of life. In Germany rehabilitation is traditionally carried out in the inpatient setting, outpatient programs are rare. This study investigates psychosocial characteristics of patients who do or do not participate in inpatient or outpatient cancer rehabilitation. METHODS: Three patient groups (inpatient rehabilitation vs outpatient rehabilitation vs non-participation) were investigated with a self-administered questionnaire at the end of primary treatment when patients are eligible for subsequent rehabilitation. Assessed variables included distress (distress thermometer), anxiety and depression (HADS), quality of life (EORTC-QLQ) and social support. RESULTS: So far 286 breast and prostate cancer patients have been included (78 inpatients, 142 outpatients, 66 non-participants), 55% of them prostate cancer patients. Inpatients are significantly older ðM ¼ 65Þ than outpatients ðM ¼ 59Þ and non-participants (M ¼ 61; p(ANOVA) 50.001). Among breast cancer patients non-participants are significantly less distressed and depressed and report higher quality of life than participants. Outpatients show better scores than inpatients, who also report the least social support of all groups. The prostate cancer groups do not significantly differ with regard to anxiety, depression, quality of life and social support. Inpatients comprise the highest rate of distressed patients. CONCLUSIONS: The psychosocial profiles indicate for breast cancer patients (but not for prostate cancer patients) that participation in cancer rehabilitation is associated with higher psychological burden and that inpatients are more distressed than outpatients. Gender effects may at least partially explain these differences.

408 Impact of Communication Skills Trainings (CST) on Clinician’s Defense Mechanisms Bernard Ma, Favre Nb, Despland JNa, De Roten Ya, Stefel Fb

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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a

Division of Psychotherapy, Research Department of Psychiatry, University of Lausanne, Lausanne, Switzerland; bPsychiatry Service, University Hospital (CHUV) of Lausanne, Lausanne, Switzerland BACKGROUND AND AIMS: Based on our experience of CST for oncology clinicians, we hypothesized that improvement in communication may be mediated by a modification of clinician’s defence mechanisms. In order to test this hypothesis, 120 oncology clinicians’ interviews with simulated patients (60 interviews pre- and 60 interviews post-CST with a 6 months interval) are analyzed and compared to 120 interviews with simulated patients of a control group of 60 oncology clinicians who did not undergo CST (interval of 6 months). METHODS: Up to now 20 oncology clinicians of the CST group and 10 of a control group were included. Verbatim transcription of video-taped interviews were evaluated with the Defence Mechanism Rating Scales for therapists (DMRS-T), an adapted version of the DMRS. RESULTS: The number of specific defence mechanisms in the 60 interviews ranged from 10 to 35 (M ¼ 20:93; SD ¼ 5:7). The three most frequent mechanisms were displacement (20.3%), intellectualisation (19.6%) and rationalization (16.1%). RESULTS indicated: A significant increase of the Overall Defence Functioning (ODF) score (ODF 4.29 ðSD ¼ 0:51Þ vs ODF 4.67 ðSD ¼ 0:36Þ; z ¼ 2:95; p ¼ 0:003) in the CST group. But no significant increase of the ODF score in the control group (ODF 4.02 ðSD ¼ 0:32Þ vs ODF 4.29 ðSD ¼ 0:53Þ; z ¼ 1:24; p ¼ 0:210). A significant increase of neurotic defence mechanisms (50.15% ðSD ¼ 1:41Þ vs 56.99% ðSD ¼ 0:98Þ; ¼ 2:27; p ¼ 0:023) and a decrease of immature defines mechanisms (45.21% ðSD ¼ 1:28Þ vs 36.46% ðSD ¼ 1:12Þ; z ¼ 2:84; p ¼ 0:005) in the CST group. A significant increase of the mature defences in the control group (1.86% ðSD ¼ 0:43Þ vs 8.75% ðSD ¼ 0:91Þ; z ¼ 2:37; p ¼ 0:018). No differences between the CST and the control group according delta (interview-post–interview-pre) for ODF score and delta for defences categories. CONCLUSIONS: Preliminary results foster the hypothesis that CST may have an impact on the level of defence mechanisms.

409 Comparing Informal Caregiver and Patient Ratings of Pain in Advanced Lung Cancer Patients: Are Differences Clinically Significant?

Copyright # 2006 John Wiley & Sons, Ltd.

Bernard-DuBenske LLa, Cleary JFb, Buss MKc, Gustafson DHa, McTavish FMa a Center of Excellence in Cancer Communication Research, University of Wisconsin, Madison, WI, USA; bDepartments of Oncology and Palliative Care, University of Wisconsin Comprehensive Cancer Center, Madison, WI, USA; cLowe Center for Thoracic Oncology, Dana Farber Cancer Institute, Boston, MA, USA PURPOSE: Illness progression can reduce patients’ ability to report symptoms. Patient (PT) and caregiver (CG) ratings of PT symptoms can be discordant, yet few examine the clinical significance of discordant ratings. We compared agreement in PT pain when utilizing clinically relevant categories versus a numeric rating scale (NRS). METHODS: Data are from baseline pain measures of 123 lung cancer PT and CG dyads enrolled in a clinical trial. Patients and caregivers rated PT pain on a 0–10 NRS. We divided this scale into categorical ratings of mild, moderate, and severe pain, with demonstrated clinical utility for managing pain according to established practice guidelines. RESULTS: Dyads were primarily spouses (65.9%), Caucasian (93.5%), with average ages of 56.2 (CG) and 63.2 (PT). CG ratings of PT pain were compared to PT self-report. For the NRS, 25.3% of CGs agreed, 30% underestimated and 45.1% overestimated PT pain. For categorical ratings, 55.1% of CGs agreed, 20.2% underestimated, and 24.7% overestimated PT pain. CGs significantly overestimated PT pain on NRS (t ¼ 2:21; p ¼ 0:03). There was no difference for categorical ratings (t ¼ 1:10; p ¼ 0:27). CONCLUSIONS: While PT and CG pain ratings differ significantly on an NRS, most CGs accurately report PT pain using a clinically relevant categorical rating. When relying on proxy pain reports, use of categorical measures may yield more clinically reliable results than NRS. Further work is needed to explain clinically significant differences between PT and CG pain ratings. ACKNOWLEDGEMENTS: Supported by National Cancer Institute, 1 P50 CA095817-01A1.

410 Differences in Caregiver Burden across Informal Caregivers of Advanced Lung, Breast and Prostate Cancer Patients: Artefact of Patient Performance Status Bernard-DuBenske LLa, Cleary JFb, McTavish FMa, Dinauer SKa

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a

Center of Excellence in Cancer Communication Research, University of Wisconsin, Madison, WI, USA; bDepartments of Oncology and Palliative Care, University of Wisconsin, Comprehensive Cancer Center, Madison, WI, USA

a

PURPOSE: Limited research has examined the psychosocial state of caregivers of advanced stage cancer patients. Various forms of cancer impose unique illness experiences that may differentially impact caregiver adjustment. This study compares the psychosocial status of caregivers of advanced stage lung (LC), breast (BC), and prostate (PC) cancer patients. METHODS: Data are from baseline measures of caregivers of advanced LC ðn ¼ 123Þ; BC ðn ¼ 71Þ; and PC ðn ¼ 49Þ patients participating in a clinical trial. RESULTS: Caregivers were primarily female, spouses, Caucasian, with mean age of 56.3. Measures of caregiver load, burden, negative affect, coping, and patient symptom distress and performance status were compared across cancer type. LC caregivers had greater caregiver load ðF ¼ 7:92Þ and physical burden ðF ¼ 3:90Þ than PC caregivers, p50.05. LC and BC patients had greater distress in several symptoms and poorer overall performance status than PC patients. Performance status correlated with caregiver load (r ¼ 0:47; p ¼ 0:000) and physical burden (r ¼ 0:33; p ¼ 0:000). Analysis of covariance revealed performance status accounted for 20% variance in caregiver load while cancer type explained an additional 4.6%, and accounted for 9.5% and 2.5% variance in physical burden, respectively. CONCLUSIONS: Differences in caregiver experience of caregiver load and physical burden are explained more directly by patient’s performance status than by cancer type. Caregiver research can benefit from more generalized sampling across cancers, with consideration toward patient functioning. Patient status is likely an important clinical marker for caregiver support service referrals. ACKNOWLEDGEMENTS: Supported by National Cancer Institute, 1 P50 CA095817-01A1; National Institute of Nursing Research, R01 NR008260-01.

PURPOSE: The delivery of genetic information is limited to the individual seeking services. Responsibility for disclosing genetic information to family members lies with the individual. Having undergone genetic counselling, people at risk for developing hereditary colorectal cancers (HNPCC, Lynch-Syndrome) are expected to share this information with relatives who were identified as possible mutation carriers during the counselling process. This study investigates the extent and determinants of family communication about genetic counselling. METHODS: N ¼ 76 people who were interested in knowing their carrier status (64.5% female, mean age M ¼ 41:8 years) were assessed about two weeks prior to genetic counselling. They provided data on family cohesion, family adaptability, and psychological distress. Two weeks after the counselling session, the participants were asked about the number and relationship of relatives informed. These data were compared with the number of relatives who should have been informed in light of the personal family tree and objective risk characteristics (Amsterdam/Bethesda criteria). RESULTS: On average, the participants informed M ¼ 3:4 family members. In many cases, participants did not inform relatives who were identified being at increased risk for developing HNPCC. Disclosure of information was influenced by Sociodemographic characteristics (age, gender), status (index patient vs healthy consumer), degree of relationship, psychological distress, and family characteristics (cohesion). CONCLUSION: There is a need for genetic counselling strategies that address communication with relatives identified as at-risk persons. ACKNOWLEDGEMENT: The authors would like to thank the Deutsche Krebshilfe for their financial support.

Universita¨tsklinikum Carl Gustav Carus Dresden Medizinische Psychologie und MedizinischeSoziologie, Dresden, Germany; bUniversita¨tsklinikum Carl Gustav Carus Dresden Institut fu¨r Klinische Genetik, Dresden, Germany

412 411 Factors that Influence Family Communication about Genetic Counselling for Hereditary Colorectal Cancer Berth Ha, Dinkel Aa, Kru¨ger Sb, Bier Ab, Blck Fa

Copyright # 2006 John Wiley & Sons, Ltd.

A Theatre Intervention to Encourage Non-Smoking Among Middle School Students Brusa Ma, Angelini Ca, Ercole Gb, Rapetti Alb, Betta PGb a Health Education Group ASL 21 Regione Piemonte, Casale Monferrato, Italy; bItalian League

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for the Fight against Cancer}Alessandria branch, Alessandria, Italy For the last few years the Alessandria branch of the Italian League for the Fight against Cancer has been promoting the project ‘Let’s smoke out smoking’ in collaboration with the Local Health Authority of Casale Monferrato. This project targets middle school students (11–14 years old) and aims at awakening them to the dangers of smoking and providing consciousness, understanding and endorsement of the reasons not to smoke. The theatre can be a potent form of information, education and communication because of the stimulating and co-operative atmosphere among the participants and its wealth of expressive capabilities. A theatre lab was organized in 2005 involving two third-year classes in a middle school. The ‘Tom’ play was staged as an adaptation of the novel ‘The Adventures of Tom Sawyer’ by Mark Twain and portrayed the growth of Tom and his friends, including their introduction to smoking, based more on experience than on advice: growing up means especially making choices with awareness; it is not yet important to decide what is best, but to look for the best way of choosing and put it into practice. The production also included some educational classroom meetings on tabagism and follow-up activities for teachers to use with their students. The visible fruit of the project was an anti-smoking message addressed by the students to their peers; however, the health operators were above all interested in the educational path which provided these adolescent with some additional tools to achieve wellbeing in adulthood.

413 Boldrini’s Station}Humanizing the Waiting Hours Bettega BPa, Perina Eb, Borges MRLc, Brandalise SRd a Boldrini’S Research Institute, Campinas, Brazil; b Psychology Boldrini’S Children Center, Campinas, Brazil; cSocial Service Boldrini’S Children Center, Campinas, Brazil; dDepartment of Oncology, Boldrini’s Children Center, Campinas, Brazil Idealized by the Boldrini’s Children Center, it proposes an innovative action of social nature reorganizing the line of care and health, with an impact on integrity, so that health attention be of better quality. The hospital is located in Campinas, a privileged city in Brazil, that serves

Copyright # 2006 John Wiley & Sons, Ltd.

neighboring cities. The health services in Brazil, mainly those of high complexity, in which pediatric oncology is included, are concentrated in the metropolis. Therefore populations of smaller cities migrate in search of specialized care, facing a dependency on public transport, either from the municipality or from the supporting web of the community. Boldrini Station was built to shelter these commuters while waiting for their transport back to cities of origin. It is a project of social impact, humanized, focusing on the dignity of patients destitute of funds. Three actions are developed at the Boldrini Station: The Concept of the Municipality, Friend of Children and Adolescents, which studies the quality of the service offered by these cities and its connection to the adherence to treatment; the Programme of Parents Guidance and the Coloring My Day Programme, optimizing the waiting time. 6.178 patients, in 2005 and 1.953 (up to April) in 2006, have been attended. Pedagogic Support, Entertainment Activities and Handicrafts are offered by volunteers, as well as a fast meal. For the past 6 months a joint project with partners such as IBM, offers the opportunity for children aged between 4 and 8 to play educative games in the computer.

414 Psycho-Oncology in Catalonia (Spain): Overview of its History Bierge Ca, Estape´ Tb, Fuentes Sc, Gondon Nd, Juan Ee a Oncology Hospital general d’Hospitalet de LLobregat, (Barcelona), Spain; bPsychooncology FEFOC, Barcelona, Spain; cPsychooncology Hospital Sant Jaume, Calella (Girona), Spain; dPsychology Gabinet Jouell, Barcelona, Spain; eOncology Hospital de Sant Pau, Barcelona, Spain PURPOSE: Catalonia is an Autonomous Community in Spain, which has its own sanitary system. Catalan Psycho-oncology has experienced a growth in the last decades, since the eighties. Our goal is to find out the roots and development of Psycho-oncology in Catalonia. METHODS: The authors have decided to divide their historical research in three main branches which define a speciality: practical assistance, research and training activities. For that they have been seeking information available in books, articles (indexed works in Medline, Psychlit, Cuidatge, Psicoinfo and Cuiden) and from knowledge of Psychooncology services existence in main health

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care centres and hospitals. RESULTS: In spite of some outstanding professionals began to mention psychosocial aspects in books, articles or training courses in 1970, professional Psycho-oncology development in Catalonia may be emplaced to 1980 decade. Since then it has grown slowly. Most is reflected in training courses (specific or on general oncology or psychology), some but few indexed articles and, lastly, practical assistance. CONCLUSIONS: In Catalonia (Spain) Psychooncology has experienced a development slow but firm. More practical assistance and sound research are needed to consolidate this discipline. ACKNOWLEDGEMENTS: The authors are grateful to Melinda Gonza´lez, nurse and psychologist, for her priceless help in reviewing part of research information and to ISEP (Institut Superior d’Estudis Psicolo`gics) for sponsoring this work.

415 Somatic, Affective and Cognitive Symptoms for Diagnosing Mood Disorders in Cancer Patients Binaschi La, Berra Ca, Caldera Pa, Torta Ra, Mussa Ab a Psycho-Oncology Unit, University of Turin, Turin, Italy; bOncological Surgery, University of Turin, Turin, Italy PURPOSE: The role of somatic symptoms for diagnosing mood disorders in course of organic comorbidities, is still discussed. Recent studies emphasize the diagnostic significance of somatic symptoms for detecting affective disorders in cancer patients. Aim of the study is to assess the significance of somatic symptoms for diagnosing mood disorder in oncological population. METHODS: The study included 151 oncological inpatients, evaluated with Montgomery Asberg Depression Rating Scale (MADRS) and Hospital Anxiety and Depression Scale (ADS) to identify the relevance of physical, affective, and cognitive symptoms, investigated by MADRS’ sub-items, in patients scoring above or below the HADS cut-off for depression (cut-off ¼ 8). We analysed which MADRS symptoms were more represented and if there were differences between depressed or not depressed patients. RESULTS: HAD scores identified 58.3% of patients as depressed (D) (mean HADS  SD ¼ 12:63  3:73), and 41.7% as not depressed (ND) (mean HADS  SD ¼ 3:73 2:31). Statistical analysis suggested significant differences ðp50:001Þ between D/ND groups, not only in affective and cognitive symptoms,

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but also in somatic cluster. In depressed group, MADRS affective (mean 13.21  4.98) and somatic (mean 9.06  4.12) symptom clusters showed a higher severity degree in comparison with cognitive symptom cluster (mean 6.21  3.85). CONCLUSIONS: Data suggest that, even in presence of organic comorbidity, somatic symptoms should be considered in diagnosing mood disorder, at least as affective ones, while cognitive cluster seems to be a weaker diagnostic criterion.

416 Referral to Psychosocial Health Care Providers During Genetic Counseling for Cancer: A Nationwide Study Bleiker Ea, Hahn Db, Vijlbrief Sb, Groenendijk Mb a Dutch Society for Psychosocial Oncology, Working group of Familial Cancers; bThe Netherlands Cancer Institute}Antoni van Leeuwenhoek Hospital, Department of Psychosocial Research and Epidemiology PURPOSE: Genetic counseling for cancer may have a significant impact on the psychosocial wellbeing of the counselees and their relatives. The present study investigated the extent to which professional psychosocial support is actually offered during the genetic counseling for cancer. METHODS: In this nationwide study, professionals (clinical geneticists, genetic nurses, psychosocial workers) working in one of the nine Family Cancer Clinics in The Netherlands were invited to participate in the study by completing a questionnaire on the organization of, and referral to, psychosocial services. RESULTS: Of the 108 individuals invited for the study, 81 (75%) completed the questionnaire. In all clinics, a psychologist and/or social worker specialized in cancer-genetics was available for counselees. Availability of psychosocial support was introduced in one-third of the initial counseling sessions. Few used a ‘checklist’ or diagnostic instrument in their decision to refer to a psychosocial health care provider, many indicated they would appreciate such an instrument. Most important reasons for referral were: doubts of the counselee about continuing genetic testing, problems of the counselee in coping with genetic test results, history of psychopathology, complex family situation, grief over own or relative’s cancer, and doubts about preventive options. CONCLUSIONS: All family cancer clinics in

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The Netherlands have professional psychosocial health care providers who offer support upon request. Most referrals are based on personal experiences of clinical geneticists and genetic nurses. The majority of these professionals indicate that availability of a checklist for referral for psychosocial care would be appreciated. ACKNOWLEDGEMENT: We are thankful to the contact persons of the Working Group in the nine clinics (B. Dols-Caanen, E. van Gelder, D. Hahn, J. Hoekstra-Weebers, K. Lansbergen, L. Van der Meer, I. Van Oostrom, R. Richard, H. Van Spijker) and their colleagues who participated in this study.

417 Study on Depression in Terminal Patients Rega R, Luciano G, Longo V, Boccia V, Rivieccio E Fisiopatologia, Terapia del Dolore e Cure Palliative A.O.R.N. ‘A. Cardarelli’, Naples, Italy PURPOSE: In several studies on terminal patient’s disease consciousness, is frequently highlighted an high incidence of depression. This definition is reported both to simple state of mind both to a psychiatric diagnosis, lacking often, the support of accurate data concerning diagnosis modality and appearance frequencies. METHODS: The authors wanted to investigate the frequency of depressive state of mood presence in terminal patients utilizing the B.W. Rockliff’s Self-Rating Questionnaire for Depression (SRQ-D). These data are reported to age, sex, education, KPS, disease duration, possible precedent depressive pathology. Finally the accordance of frequency between diagnosis of depressive state and presence of depressive state of mind surveyed with MO.LO.RU. was examined. Sixteen patients were studied. RESULTS: According to depression test utilized, first results highlight a median without sign of severe depression but put in evidence a median value with a trend higher than normal in: Patients that should have known their neoplastic disease but refer their symptoms to another nonneoplastic pathology, indicated with ‘B’ in MO LO RU assessment. Patients that express anger: ‘16’ in MO LO RU. Patients that are alive to imminence of their death: ‘8’ in MO LO RU. Patients that aim at living alone with their problem: ‘12’ in MO LO RU. CONCLUSIONS: There are no signs of severe depression but there is a median value trend higher in patients indicated with ‘B’, ‘16’, ‘8’, ‘12’ in MO.LO.RU assessment.

Copyright # 2006 John Wiley & Sons, Ltd.

418 MO.LO.RU. Disease and Prognosis Awareness Assessment Tool Rega R, Longo V, Luciano G, Boccia V, Rivieccio E Fisiopatologia, Terapia del Dolore e Cure Palliative A.O.R.N. ‘A. CARDARELLI’ Naples, Italy PURPOSE: Understanding the oncologic patient awareness and his frame of mind and relatives behavior about his disease and prognosis, is a primary target for approaching in a right manner to this patient. METHODS: We have developed a proposal of awareness sequence, called MO. LO.RU, divided in two sections. In first, the six awareness levels are indicated, each characterized both with a letter and a color, from unawareness about the disease to total and complete awareness. A colorimetric method was used. In the 2nd sector: five groups of information on familiar behavior, patient and psycho-emotional reality, on group’s components were given. Different possible answers are indicated by an alphabetical or numeric values. For each patient the individuation of alphanumeric values is made, first of all, questioning the relative with direct questions. RESULTS: 109 patients were investigated. Statistical analysis of awareness shows a polarization to two extreme: A (total unawareness) and D þ F (total awareness). Sex factor: Females have higher awareness level than male. Age factor: Elderly have more unawareness than young. CONCLUSIONS: This proposed method does not think to exhaust all possible shade of several situation and is therefore, improvable, but is useful to give a behavioral address. We wish to underline that evaluation should be made not only by physician, but also by nurses and by whole therapeutic e´quipe: Only in this way a planned and finalized intervention which is really efficient and incident on patient and family reality will be possible.

419 ‘Dalla parte dei bambini’ (‘On the children’s side’): A Project to Provide Children with Cancer and their Families with Psychological Support in their Own Local Area Bolis Ta, Dell’Agostino Kb, Punzi Sa, Vanotti Bb a Spazio Prevenzione ONLUS Osnago (LC), Italy; b Divisione Oncologia Medica A.O. Valtellina e Valchiavenna Sondrio, Italy Cancer in children, besides causing major changes in everyday life, gives rise to deep emotional

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distress in the children and their families. Psychological distress is present in all the stages of the disease: diagnosis, treatment, follow-up and social reintegration. The psychological problems that frequently occur significantly affect the children’s quality of life and can negatively influence their compliance with pharmacological and rehabilitative treatment. In such situations of physical and psychological anguish there is a need for psychological treatment; this intervention should follow all the disease’s stages, but with time-frames and ad hoc methods that do not always coincide with the clinical situation. The project ‘Dalla parte dei bambini’ aims to make the children and their families the focus of the therapeutic intervention; its objective is to provide, where appropriate, psychological intervention inside and outside the hospital, in the areas where the children and their families live. The intervention needs to be personalised according to the individual, and take account of the different stages of the disease and of the child’s psychological and physical growth; it has to be carried out in coordination and in agreement with the different professionals who deal with the disease in all its specific stages. The aim is to create for each child an integrated network among services and the professionals working in these services, and to establish cooperation between them and network of psychologists and psychotherapists, working in many Italian towns, who have received appropriate personal and professional training.

420 Self-perception and Body-image of Children with Leukaemia: A Qualitative Study Based on Drawings and Projective Interpretation Boman KK, Engstro¨m E Department of Woman and Child Health, Karolinska institutet, Childhood Cancer Research Unit, Stockholm, Sweden PURPOSE: To study the impact of illness and treatment on body-image and self-perception in young children undergoing treatment for leukaemia. METHODS: Five children, age 8–14 years, in treatment for leukaemia were studied. Assessments included the Draw-A-Person (DAP) test, and 2 additional drawing tasks: a free drawing, and one where the child was asked to make a drawing catching an essential characteristic of the having-leukaemia condition. Drawings were analysed in a combined approach including projective

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interpretation, and qualitative thematic analysis of themes of drawings, and of the interviews that were part of the administration of the DAP test. RESULTS: Vis-a´-vis identity and self-image, drawings demonstrated signs of lowered selfesteem, feeling of insufficiency, and being exposed to vulnerability. Illness-related themes included expressions of strength, courage, and to not show fear. Sorrow and experienced threat where other prominent themes. Occasionally, themes concerned life and death, and single themes also related to illness-related positive experiences. Body-image appeared as un-influenced by the illness condition. CONCLUSION: Leukaemia and treatment influence self-image of children. Vulnerability in terms of feelings of loneliness, isolation, and being tied up by the treatment are themes of children undergoing treatment. Experienced threat may be present, although accompanied also by themes indicating adaptive strategies for coping, and positive aspects of the present illness condition. The clinical implications of findings are that they show the complexity of how children are affected psychologically. Drawing techniques are useful tools in psychological assessment and communication with young children suffering from cancer.

421 Screening of Psychological Distress in Cancer Patients Bonacchi Aa, Rossi Aa, Bellotti La, Doni Lb, Rosselli Ma a Dipartimento di Medicina Interna, Servizio di Medicina Psicosomatica Universita` degli Studi di Firenze, Firenze, Italy; bU.O. Oncologia Medica Azienda Universitaria Ospedaliera di Careggi, Firenze, Italy PURPOSE: To optimise a method of screening psychological distress in cancer patients in terms of cost/benefit and clinical efficacy. METHODS: The clinical intervention evaluated took place over one year in the ward for Medical Oncology and included three levels: Level I}psycho-oncological screening of all compliant in-patients: preliminary meeting of patients with staff member, interview, filling in questionnaires. Level II}diagnostic investigation of selected patients: questionnaires revealing a deeper understanding of a patient’s psychological and emotional state, second interview, psychiatric consultation. Level III}psychological and/or pharmacological support 285

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patients were admitted to the screening program, 137 completed questionnaires (PDI-Psychological Distress Inventory, HADS, MHQ), 17 received specific support intervention. Results of tests and interviews were clinically and statistically evaluated. RESULTS: High levels of distress (measured by PDI) are related to anxiety and depression (evaluated by HADS and MHQ) and presence of somatic symptoms, hysteric and obsessive traits (MHQ). A consistent number of patients with non-relevant clinical distress, evaluated by tests, also received psychological support. This indicates that significant requests for support may emerge during interviews, even when the previous answers to a questionnaire indicate the absence of severe symptoms. CONCLUSIONS: In terms of cost/ benefit and clinical efficacy, a method of screening of psychological distress in cancer patients should include: (1) a single questionnaire evaluating distress (PDI); (2) a subsequent clinical interview. The interview has a pivotal role in clinical assessment and access to psychological support and cannot therefore be substituted by evaluation based on tests alone.

cargo 42, control 45, values 45, change 45, competences development 45); workers in neuroscience (change 44). Better situations: Type of contract: collaboration contract (acknowledgment 56, impartiality 56, change 58, leadership 58, competence development 59); part-time contract (change 59, leadership 57, competences development 59); Mean education (control 56); Workers from 51 years (leadership 57). Critic areas (most elevated correlations between work life areas and burnout dimensions): energy/exhaustion and values (0.52); involvement/cynicism and values (0.37); efficiency/inefficiency and control (0.46). Force points (most elevated correlations between management process and work life areas): values and competences development (0.70); impartiality/ leadership (0.68); social integration and cohesion (0.67). Main changing predictor: energy/exhaustion (0.42). CONCLUSIONS: From results seem to emerge that to create an effective preventive burnout project for Regina Elena Cancer-Institute is useful to concentrate on energy/exhaustion and to consider that main problem of subjects is work cargo (0.48), main resource is acknowledgment (0.50).

422 Organizational Check-up Survey (OCS): Research in a Cancer Institute Bongiorno La, Vigna Ca, Arcidiacono Sb, Caruso Aa a Department for Prevention and Formation in Psycho-Oncology, Regina Elena Cancer Institute, Rome, Italy; bLega Italiana Per La Lotta Contro i Tumori, Rome, Italy PURPOSE: Identify main causes of burnout/ engagement bounded to the organizational context; highlight individual and organizational problems and resources; create a specific and effective prevention burnout project for health care professionals who work in oncology. METHODS: The OCS has been distributed to 500 health care professionals (248 physicians, 252 nurses) who work in Regina Elena Cancer Institute-Rome. RESULTS: Collected questionnaires 331. Usable 184. M/F:82/102. Physicians/Nurses:81/103. Samples scores are not different from normative sample (range 48–52). Problematic situations: Age: 526 years old (control 41, group cohesion 43), >55 years old (cynicism 45, control 43, change 43, leadership 44, competences development 43); Contact less with patients (exhaustion 45, cynicism 43, values 45); Department: Workers in critic area (exhaustion 44, cynicism 43, work

Copyright # 2006 John Wiley & Sons, Ltd.

423 Burn-out and Training Needs of Physicians and Nurses Who Works in Oncology Bongiorno La, Tramontana Aa, Di Polito Ra, Arcidiacono Sb, Caruso Aa a Department for Prevention and Formation in Psycho-Oncology, Regina Elena Cancer Institute, Rome, Italy; bLega Italiana Per La Lotta Contro i Tumori, Rome, Italy PURPOSES: Survey the burnout level and psychological formative needs of physicians and nurses who work in oncology: verify if health care professionals formative needs are suitable to the possible work stress situation. METHODS: We have given two different questionnaires to 500 health care professionals (248 physicians, 252 nurses) who work for Regina Elena Cancer Institute, Rome. Instruments used are: the Maslach Burnout Inventory}General Survey (MBI}GS) and an appropriately built questionnaire to survey the formative needs. RESULTS: Collected questionnaires 331. Usables 184. M/F: 82/102, physicians/nurses: 81/103.The sample presents a burnout job situation in the mean (range 48–52). Problematic situations regard: subjects more than 55 years old (cynicism: 45); workers in

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critical area department (exhaustion: 44, cynicism: 43); and those who don’t work in direct contact with patients (exhaustion 45, cynicism 44). Considering the formative needs, the sample presents an interest in the psychological training, there are significant statistical differences in comparison with professional category and the gender (Independent sample T-test p50.05). CONCLUSIONS: The nurses are more interested than physicians in the psychological training (technique and experience) furthermore always more than the physicians they think that an experiential formation is useful in the burnout prevention. Females more than males think that an experiential psychological formation is useful both to prevention and to relieve burnout. It is interesting to observe that subjects formation needs perception is the same whether they are in a problematic burnout situation or not.

424 Formation of Health Care Professional in Psychooncology: Impact Evaluation of a Formative Model for Nurses Bongiorno La, Ravenna ARb, Tramontana Aa, Limoncelli Lc, Caruso Aa a Department for Prevention and Formation in Psycho-Oncology, Regina Elena Cancer Institute, Rome, Italy; bFlorence Gestalt Institute Florence Gestalt Institute, Rome, Italy; cItalian Hospital Group, Guidonia, Italy PURPOSE: Impact evaluation of a psychological training model for nurses who work in oncology. METHODS: The search plan previewed the realization of two formative courses both of 100 hours. The courses were identical both for theoretical contents and teachers; only difference was represented by formative techniques. Experimental Sample (ES) had theoretical lessons and experiential groups, while Control Sample (CS) had only theoretical lessons. Subjects performed: socio-cultural characteristics card, questionnaire on learning of theoretical contents (purposely constructed); card of Ministry of the Health to assess effectiveness of formative event and a questionnaire that assesses formation impact and satisfaction degree of students (purposely realized). RESULTS: ES: N ¼ 26; M/F: 5/21; mean age 39 (range 27–55). CS: N ¼ 20; M/F: 5/15; mean age 38 (range 31–51). There are no significant differences between ES and CS about relevance of dealt contents and educational

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quality of course, while effectiveness of formation is higher for ES. There are no differences about theoretical learning while there are significant differences in learning competences (ES 7.27/CS 6.25, p50.03) modality of knowledge transmission (ES 8.27/CS 7.05, p50.02) and satisfaction of students expectations (ES 8.08/CS 7.15, p50.02). CONCLUSIONS: From results it emerges that a formative model that previews also the elaboration of emotional contents bounded to the care activity, answers better to students expectations and seems to be more effective in the acquisition of instruments that improve the relation nurse– patient.

425 Assessing the Risk of Burnout in a Palliative Care Team Using the ‘Care for the Caregivers Exercise’ and the Evaluation of Work-related Stressors Bordin F, Schembri G, Kjellberg C, Trasatti F, Welshman A Palliative Care Unit, Fondazione Sue Ryder Onlus, Rome, Italy Recognition and management of potential stress factors in a Palliative Care team are essential for maintaining effective teamwork and preventing burnout. With the aim of identifying appropriate coping strategies and support for professionals, we examined the most stressful factors in our ‘Hospice at Home’ service, using the ‘Care for the caregivers exercise’ and an anonymous structured questionnaire for all team members. The ‘CFCE’ is an assessment tool for job-related stressors originally developed in Pennsylvania for teams working with victims of crime who are highly exposed to stress and burnout; we added 7 items to the original 8, each with a NRS 0–10. Results show an average low stress level, with some problems in definition of tasks and effective functional leadership, underlying the need for better coordination. Most stressful factors were related to the work environment, such as organizational issues (41% of professionals; mean score 3.8), work overload (11%; ms 3.15), complexities in interdisciplinary teamwork (22%; in particular poorly defined roles ms 3.4; inadequate communication ms 3.2), and financial issues (ms 4.2), rather than related to direct care for patient/family (4%; ms 2) or emotional burden due to daily contact with suffering and dying (15%; ms 2.5). Other results will be presented at the Congress. Furthermore, the need for a more effective

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management of team meetings was suggested, including better recognition of needs, support in debriefing, prevention of conflict and organizational difficulties, rather than focusing mostly on clinical case discussion.

426 Information and Awareness of Disease in Terminal Cancer Patients in Italy: Is Something Really Changing? Bordin F, Schembri G, Tomasso A, Cardinali M, Welshman A Palliative Care Unit, Fondazione Sue Ryder Onlus, Rome, Italy In Italy there is growing attention around the issue of informed consent, greater information about cancer is available and palliative care networks are quickly developing. However, although throughout Europe open communication is considered to be good clinical practice, here both diagnosis and prognosis still remain undisclosed to many patients because of strong resistance from some physicians and especially relatives. This is an update of ongoing research, with the aim of investigating the extent to which recent cultural development in healthcare issues influences trends in diagnostic disclosure. We assessed the degree of knowledge and awareness of disease in 1445 patients referred to our Hospice-at-Home Unit from 1997 until 2005, comparing the results of three different moments in time (2000, 2002 and 2005). On the grounds of ‘what’ patients had been told, 5 subgroups were identified: Informed and aware: 9.9% vs 18% vs 16.8%; Informed but ‘unaware’: 1.6% vs 3.3% vs 3%; Aware of the tumour but not of the current stage: 22.70% vs 20.9% vs 24.8%; Uninformed but ‘aware’: 6.8 vs 9.8% vs 12%; Neither informed nor aware: 59% vs 47.8% vs 43.3%. The elderly highly correlated to a lesser degree of information. A further change in attitude towards more respectful patient information is required, both by physicians and most of all by relatives, who until now are firstly informed instead of the patient, with consequent problematic deceit and collusions in advanced disease.

427 Psychological Intervention and Coping Styles Modification in Cancer Patients Bosisio M, Borreani C, Brunelli C, Tamburini M Psychology National Cancer Institute, Milan, Italy

Copyright # 2006 John Wiley & Sons, Ltd.

PURPOSE: The aim of the study was to describe the coping styles in a population of patients attending a psycho-oncology ward and to compare the data registered at the first and at the last visit for psychological support in order to test if and in which direction coping strategies can be modified. METHODS: 90 consecutive patients, referring to our Psychology Unit, participated in the study. The coping styles were evaluated through the reduced form of the Mental Adjustment to Cancer (MINI-MAC). The questionnaire is made up of 29 items which identify five scales: fighting spirit, hopelessness–helplessness, fatalism, anxious preoccupation and cognitive avoidance. RESULTS: The average level of the MAC scales were 10.9 (FS); 16.4 (HH); 13.1 (F); 22.2 (AP) and 10.4 (CA). With respect to the Italian validation sample (patients followed by oncology outpatients clinics), our sample showed higher HH (p50.001) and AP (p50.001) scores and less FS (p50.001), F (p50.001) and CA (p50.03) scores. When analysing the variation on each scale between baseline and post intervention scores (N ¼ 40), we found statistically significant improvements both on the HH (p ¼ 0:002) and AP (p50.002) while no changes emerged on the remaining scales. CONCLUSIONS: Our population’s coping styles show a profile which is compatible with their request of psychological support. It is also interesting to observe a decrease of HH and AP scores after the psychological intervention as expected.

428 A New Approach On Oncological Pain in Depressed Patients: Data From a Clinical Study Using Brief Adlerian Psychodynamic Psychotherapy Bovero Aa, Torta Ra, Ferrero Mb a Psycho-Oncology Unit, University of Turin, Turin, Italy; bPsycho-Otherapy Unit, Department of Mental Health Care ASL 7, Chivasso (Turin), Italy PURPOSE: This study assesses the efficacy of combined therapy (antidepressant t+ psychotherapy) on cancer pain using a brief psychodynamic approach (Brief Adlerian Psychodynamic Psychotherapy, B-APP). METHODS: Literature on pain is focused on Cognitive–Behavioural Therapy (CBT), while there are no clinical trials with B-APP. In this study we show data of 60 patients with pain and depression (DSM-IV-TR), randomly assigned to antidepressant (30 pts: venlafaxine 75 mg/die) or combined (30 pts: venlafaxine 75 mg/die+B-APP, 10 sessions focused on pain)

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therapy. The sample was evaluated at baseline and after 10 weeks with Visual Analogue Scale, VAS; Questionario Italiano Dolore, QUID; Hospital Anxiety Depression Scale, HADS; Montgomery Asberg Depression Rating Scale, MADRS; Clinical Global Impressions, CGI; Mini-Mental Adjustment to Cancer Scale, MINI-MAC; and European Organization for Research and Treatment of Cancer Quality-of Life Questionnaire. At the endpoint was also administered Verona Service Satisfaction Scale (VSSS-54). RESULTS: At the endpoint, a significant reduction was observed in VAS and HADS scores in subjects treated with B-APP (p50.01). A significant increase was obtained in MINI-MAC scores of Fighting Spirit and Fatalism (p50.005) in patients treated with B-APP. The group treated with combined therapy showed more satisfaction for the treatment at VSSS-54. CONCLUSIONS: This trial confirms the efficacy of combined therapy on oncological pain. This is, to our knowledge the first study using B-APP, that shows an improvement of symptoms control comparable to that observed with CBT treatment.

429 Well-being of Long-term Cancer Survivors: It’s Not All Doom and Gloom Boyes AW, Girgis A, Zucca AC, Lecathelinais C Centre for Health Research & Psycho-oncology, The Cancer Council NSW, University of Newcastle & Hunter Medical Research Institute, Newcastle, Australia PURPOSE: With cancer survival rates improving, the well-being of the growing population of cancer survivors has become increasingly important. We undertook Australia’s first population-based study to identify (i) the psychosocial effects of cancer experienced by survivors five to six years post-diagnosis and (ii) the sub-groups of survivors most at risk of poorer psychosocial outcomes. METHODS: A random sample of 1008 cancer survivors five to six years post-diagnosis was recruited from a Cancer Registry. 863 participants completed a self-report survey including the Hospital Anxiety and Depression Scale, EORTC Quality of Life Questionnaire-Core 30, short-form Supportive Care Needs Survey, MOS Social Support Survey, Mini Mental Adjustment to Cancer scale, demographic, disease and treatment questions. RESULTS: The proportion of longterm survivors experiencing clinically significant

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levels of anxiety (9%) and depression (4%) was similar to the general population. Survivors reported high levels of functioning and low levels of cancer-related symptoms. Survivors’ overall quality of life was high, and neither statistically or clinically different to general population values. Survivors’ need for help was greatest in the areas of physical and daily living needs, sexuality needs and psychological needs. Many survivors’ qualitative comments reported positive effects of cancer. The individual, disease and treatment characteristics associated with ‘poor’ survivorship varied according to the outcome examined. CONCLUSIONS: Five years after a cancer diagnosis, the psychosocial well-being of most cancer survivors is similar to that of the general population. In part, this may reflect a downward ‘response shift’ in survivors’ internal standards and definition of quality of life.

430 Factors that Influence Physicians’ Burnout: Impact of a Communication Skills Training Program Bragard Ia, Libert Yb, Merckaert Ib, Etienne AMa, Razavi Db a Sciences Cognitives Universite´ de Lie`ge, Lie`ge, Belgium; bInstitut Bordet Universite´ Libre de Bruxelles, Bruxelles, Belgium INTRODUCTION: No study has yet assessed the impact of physicians’ skills acquisition after a communication skills training program on their level of burnout. PURPOSE: First, to compare in a randomized design the impact, on the level of physicians’ burnout, of 1-hour theoretical information course followed by two communication skills training programs: a 2.5-day basic training program and the same training program consolidated by six 3-hour consolidation workshops. Second, to investigate contextual factors and communication variables associated with physicians’ level of burnout. METHODS: Physicians, after attending the basic training program, were randomly assigned to consolidation workshops or to a waiting list. Training efficacy was assessed through simulated two-person interviews which were audiotaped at baseline and after consolidation workshops for the consolidationworkshops group, and 5 months after the end of basic training for the waiting-list group. Physicians’ communication skills were assessed according to the Cancer Research Campaign Workshop Evaluation Manual. Physicians’ level

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of burnout was assessed using the Maslach Burnout Inventory (MBI) at the same times. RESULTS: No statistically significant changes over time and between groups in physicians’ MBI subscales scores was observed. Meanwhile some physicians’ communication skills improvements were associated with a decrease of their personal growth. CONCLUSIONS: These results would be important to take into account in developing communication skills training program. ACKNOWLEDGEMENTS: This research program was supported by the ‘Fonds National de la Recherche Scientifique’ of Belgium and by the C.A.M., training and research group (Brussels} Belgium).

431 The Gift of Grief}Elizabeth Ku¨bler-Ross Last Legacy Brando MC Psycho-Oncology, Nossa Casa Psico-Oncologia Sa˜o, Paulo, Brazil On her last book, ‘On Grief and Grieving’ (2005) Elizabeth Ku¨bler-Ross wrote that ‘I has been in anticipatory grief for a long time now and I expect there is more to come’. She says that we have to listen to the dying and that they will tell us everything we need to know about when they are dying. And that it is easy to miss. Ku¨bler-Ross also says that the weaker and more bed-bound she becomes, the more she was learning about receiving love. In this book, Elizabeth Ku¨blerRos describes the anticipatory grief and the five stages the survivor will pass after the death of his/ her loved one (denial, anger, bargaining, depression and acceptance). She had been for nine years on a wheelchair and she would like that it would have a sixth stage, ‘the being angry at God stage’, what it is part of her own anticipatory grief. Our grief is as individual as our lives, and the stages are just frameworks that make us better equipped to cope with life and loss. Besides the five stages, Elizabeth Ku¨bler-Ross and David Kessler (coauthor) also present the inner world of grief, the outer world of grief, specific circumstances and the changing face of grief, where they talk about topics like regrets, tears, resentments, secrets, afterlife, children, anniversaries, sex, multiple losses, etc. And the book ends with a great and marvellous exposition of Ku¨bler-Ross and Kessler about their own griefs, and they give us Ku¨blerRoss last legacy ‘The Gift of Grief’.

Copyright # 2006 John Wiley & Sons, Ltd.

432 Preparation for Chemotherapy: A Randomised Controlled Evaluation of the Effectiveness of a Patient Information Film Brennan JH, Nugent P, Cowderoy S Clinical Health Psychology, Bristol Haematology & Oncology Centre, Bristol, UK PURPOSE: To evaluate the effectiveness of a patient-centred film designed to prepare patients for chemotherapy. METHODS: 132 cancer patients participated in this randomized control trial. All were about to start non-palliative chemotherapy for the first time. Prior to randomisation to either the Film Group (FG) or the Non-film Group (NFG), all participants completed the Hospital Anxiety and Depression score (HAD). FG participants were invited to take the film home to watch. Before their first chemotherapy treatment they completed the HAD again, an ad hoc ‘Preparedness for Chemotherapy’ questionnaire, and FG participants also completed a film evaluation questionnaire. Finally, all participants completed the Memorial Symptom Assessment Scale (MSAS) prior to their second chemotherapy cycle. RESULTS: There were no significant differences between groups in their HAD or MSAS scores. However, a factor analysis of the ‘Preparedness for Chemotherapy’ questionnaire elicited two factors which revealed significant differences: the FG reported more understanding of chemotherapy and less worry about it. Furthermore, 97% of the FG participants believed the film should be available to all pre-chemotherapy patients. CONCLUSIONS: Throughout its production this film tapped into the experiences of patients who have been through chemotherapy, in contrast to traditional professionally-led information films. Results show that this relatively cheap intervention successfully helps prepare patients for chemotherapy by increasing their knowledge and reducing their level of worry. The film is now ready to be distributed free to all UK National Health Service patients preparing for chemotherapy. ACKNOWLEDGEMENTS: Funded by the Friends of the Bristol Oncology Centre.

433 Just in Time}Systemic Cancer Care, A Psychoeducational Programme Brode Ka, Hausmann Cb, Hildenbrand Bc

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Circadian Institute for Applied Psychosynthesis Bergisch, Gladbach, Germany; bProjekt: Contor Scientific Consulting: Project Management, Jena, Germany; cInstitute for Sociology, University of Jena, Jena, Germany Highly advanced medical cancer care frequently leaves patients passive and leads to frustration and discontent. Patient oriented, psycho-educational programmes to improve the patient’s control of his life are not provided. Kristina Brode’s Systemic Cancer Care Programme with its chronopsychological approach gives an answer to the above. The Psyche has its own rhythms and cycles which can be observed in all developmental processes. Observation of the ‘time-windows of the psyche’ in all interactions and interventions determines the coping strategies of the patient, quality of life and a better prognostic outcome. The most recent results of a Pilot Project on Systemic Cancer Care will be presented and discussed. Freshly operated patients with Ma–Ca undergo this psycho-educational learning programme. The programme is phase oriented and half-standardised. Central outcome-variables: Gain in a sense of autonomy, an increase in the quality of life, relational stability, and a feeling of more meaning in life. The aim to enlarge the patient’s coping strategies through timely offers of psycho-educational help has been achieved. METHODS: Qualitative methods (e.g. Narrative interviews) are the core part of the evaluation. Standardised instruments (HADS, KKG, EORTC, SF-36 a.o) are also used in a pre–post design. Time as a co-variate is recorded by an event history design. The project has a duration of two years (2005–2007). It is financed by Siemens Healthinsurance, Munich. The evaluation is undertaken by Project: Contor Jena and the University of Jena.

434 The Ambivalent Deinstitutionalisation of Cancer Care Broom DHa, Burns CMb a National Centre for Epidemiology & Population Health, The Australian National University, Canberra, Australia; bPsychosocial Cancer Services, The Canberra Hospital, Canberra, Australia The diagnosis and management of cancer have changed dramatically in recent decades. Early detection and better treatments mean that increas-

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ing proportions of patients may live for many years with disease that is ‘in remission’ or reasonably well controlled. These changes have been accompanied by developments in the arrangements for delivering treatment, so that now even advanced cancer care often occurs in outpatient settings. Furthermore, families are playing a growing role in supporting patients and delivering bedside care, even in the late stages. The changes in cancer care are similar to the deinstitutionalisation process that has occurred in mental health. Yet unlike the case of mental health, there has been little discussion of the unintended and undesirable consequences of deinstitutionalisation, or how to deal with them. We review the broad epidemiological and medical changes that have redefined cancers from acute conditions to chronic diseases; we describe the social ecology of ambulatory cancer care; and we find difficulties that have arisen as unintended by products of evolution in cancer management. In particular, we identify confusions for patients and their families, and questions for service providers; and we suggest the kinds of improved communication that will be needed on all sides if patients and their families are to be helped to live well with disease, and when the time comes, to experience the dying process in as dignified and humane a way as possible.

435 Impact of Ontological Diagnosis and Treatments on Relational and Sexual–Emotional Life of Women with Breast Cancer Buda Fa, Zaccuri Lb, Svenda Ga, Buda Cc, Messina Gd a Department of International Medicine Medical Oncology, ‘City of Udine Hospital’, Udine, Italy; b Psychologist–Psychotherapist of Educational Health, Opera Sacra Famiglia, Pordenone, Italy; c Department of Obstetrics & Gynaecology, University of Messina, Messina, Italy; dDepartment of Oncological Radiotherapy, University of Messina, Messina, Italy A diagnosis of breast cancer causes in women a great vulnerability with presence of psycho-sexual problems. METHODS: Subject to informed agreement, the impact of breast cancer diagnosis on relational and sexual–emotional life has evaluated on 200 women from 2000–2004 and in follow-up March 2006. 47% were in menopause, 53% were in post-menopause. Each of them was

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given anonymous survey of 36 questions with multiple choice answers, to investigate about their relational and emotional–sexual life before and after the cancer. The survey was handed back by the entire sample. The awareness about the diagnosis produced a greater intensity in the relationship with the family of origin, especially with children (100%) and with the mother (32%), going decreasing in 34.5% of cases. Likewise, the way to face other people has changed (67%); while there is a decreasing interest in one’s body care (60%). Similarly, there are significant alterations in interests and hobbies (83%). As far as the life as a couple is concerned, if for 23% of women the relationship with the partner got better/became stronger, for 37.5% there were some variations in terms of less time given (5.5%), communication (6%) and physical–emotional closeness with the partner. The greatest impact in the couple points out a significant awkwardness in showing one’s own body (44%), affecting sexuality with a considerable drop of desire and sexual fantasies (decreased or ceased 91% of cases); likewise, there is uneasiness in seizing the partner’s desire (71%). CONCLUSIONS: These data can be read with reference to past emotional experiences of different nature (anxiety, depression, shame, anger whose effects should be investigated also in the partner) the woman lives, independently on how old she is when she is told the diagnosis of cancer. This confirms how the cancer diagnosis and treatments produce a sense of final change in the patient’s feminine image and function, affecting every part of her relational and emotional life.

436 A Journey Through the Care: The Laughing Body Buda Pa, Ruggeri Ea, Sanguigno Gb, Ravaioli Ac a Istituto Oncologico Romagnolo, Rimini, Italy; b Clown One Italia, Milano, Italy; cDipartimento di Oncologia Ospedale Infermi, Rimini, Italy ‘ISTITUTO ONCOLOGICO ROMAGNOLO} IOR’ is a volunteer association interested in research, prevention, information and assistance for oncological patients in critical disease situations by: supporting domiciliary or hospital assistance activities and palliative cares; organizing courses for aiding volunteers. The ‘A JOURNEY THROUGH THE CARE: THE LAUGHING BODY’ project bore to enrich further the decennial IOR experience as in volunteers’ formation (reception, attention and support for

Copyright # 2006 John Wiley & Sons, Ltd.

oncological patients in critical or terminal disease situations) as in sensitization campaigns about volunteer engagement and social solidarity. We developed this project also with the help of Ginevra Sanguigno: she’s a clown of Patch Adams’ group, she gave birth to ‘Clown One Italia’ organization, and she made us try the importance of humour, physical contact and smiling in helping relationships. Clown, in suffering situations, doesn’t cure, but helps in recovery process, listens, inspires trust. First work shops, realized in 2005, made us check our new work methodology: we created more serene and significant relations with ourselves and other people through the use of imagination, joke and physical communication to find the clown hidden within us and to strengthen communicative and relational abilities. We will present a DVD about these work-shops.

437 No Adverse Effects of Adjuvant Chemotherapy on Hippocampal Volume in Japanese Breast Cancer Survivors Yoshikawa Ea, Matsuoka Yb, Masatoshi Ic, Akechi Td, Uchitomi Yc a Psycho-Oncology Shizuoka Cancer Center, Suntogun, Japan; bAdult Mental Health Division National Institute of Mental Health, National Center of Kodaira, Japan; cPsycho-Oncology Research Center for Innovative Oncology, National Kashiwa Japan; dPsychiatry the Depa Nagoya City, University Medical School, Nagya, Japan PURPOSE: Impaired cognitive function, including memory function, has been recognized as a possible adverse effect of adjuvant chemotherapy in breast cancer patients. However, the pathophysiology of this phenomenon remains unknown. The hippocampus is one of the brain regions which plays a critical role in memory. The purpose of the present study was to investigate the adverse effects of adjuvant chemotherapy on the hippocampus in Japanese breast cancer. METHODS: The subjects were 75 female cancer survivors who had undergone breast cancer surgery 3 or more years earlier. The hippocampal volumes of the cancer survivors with (n ¼ 44) and without (n ¼ 31) adjuvant chemotherapy, were measured by MRI. The Wechsler Memory Scale}Revised (WMS}R) a memory function scale was used to measure memory function. RESULTS: There were no significant differences in hippocampal

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volume or additionally in memory function between the two groups. CONCLUSION: It might be suggested that there are no adverse effects of adjuvant chemotherapy on the hippocampus. Brain regions other than the hippocampus, such as the prefrontal cortex might be involved in memory impairment after adjuvant chemotherapy.

438 A Randomized, Controlled Trial of Physician Postures when Breaking Bad News to Cancer Patients Bruera Ea, Palmer JLa, Pace Ea, Strasser Fb, Bennett MIc a Pallliative Care and Rehabilitation Medicine, UT M.D. Anderson Cancer Center, Houston, USA; b Kantonsspital St. Gallen St., Gallen, Switzerland; c Palliative Medicine St. Gemma’s Hospice, Leeds, UK PURPOSE: To establish cancer patients’ preference for physician posture when physicians break bad news. METHODS: Participants were randomized to watch 1 of 2 videos of a physician breaking bad news to a cancer patient. Videos consisted of 2 sequences and were identical in content and length. In video A, the physician was standing in 1st sequence, then sitting in 2nd sequence. In video B, sequence was reversed. Primary outcome measures were blinded preference for video sequence (1st or 2nd) and ratings of overall impression and compassion for physician in each sequence. We also asked patients for their ideal preference for physician posture, and assessed other relevant physician attributes and behaviours. RESULTS: In 168 patients, ratings of overall impression and compassion were significantly higher for sitting physician compared to standing physician (p50.0001). The majority of patients chose sitting physician posture in blinded and ideal selection. A minority of patients preferred standing physician in blinded (8.4%) and ideal selection (17.3%). A significant period effect was confirmed; patients rated physician in second sequence as more compassionate than first physician regardless of posture. Significantly more females than males chose sitting as ideal physician posture (p ¼ 0:025). Other physician attributes and behaviours were generally rated as of equal or more importance than posture. CONCLUSION: Cancer patients, especially females, prefer physicians to sit when breaking bad news and rate

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physicians who adopt this posture as more compassionate. Sitting posture alone is unlikely to compensate for poor verbal and aural communication skills and lack of other respectful gestures during a consultation.

439 Psychological Distress in Women with Early Stage Breast Cancer Bulotiene G, Veseliunas J, Ostapenko V Institute of Oncology, Vilnius University, Vilnius, Lithuania PURPOSE: To assess the psychological distress of the women with early stage breast cancer in the period of 9 months after the surgery and examine the influence of social support on women’s distress. METHODS: 117 early stage breast cancer patients were included into the longitudinal study between January 2004 and December 2005. Patients’ psychological distress was assessed using HADS. The patients were questioned prior to surgery then one week and 9 months post surgery. In addition patients completed the Functional Assessment of Cancer Therapy Scale (FACT}G) one week and 9 months post surgery. RESULTS: It was estimated that borderline and clinically significant values of anxiety and depression were more constantly observed prior to surgery (HADS-A: 42%; HADS-D: 19%, p50.05). A week after the surgery showed a decline of anxiety and depression (HADS-A: 28%; HADS-D: 10%, p50.05). The rate of anxiety grew up to 29% and of depression to 12% in the period of 9 months after the surgery. The results on FACT}G social/ family well-being subscale correlated negatively with anxiety (r ¼ 0:15) and depression (r ¼ 0:34) one week post surgery and also with anxiety (r ¼ 0:29) and depression (r ¼ 0:23) nine months post surgery. CONCLUSIONS: Findings revealed that psychological distress among early stage breast cancer patients decreased a week after the surgery but increased slightly 9 months post surgery. The results suggest that higher distress is associated with little social support.

440 Impact of Interferon Maintenance Therapy on Multiple Myeloma Patients’ Quality of Life, Progression-Free Survival and Overall Survival

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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One Year Post High-dose Chemotherapy and Autologous Blood Stem Cell Transplantation Bumeder Ia, Tyroller Mb, Fischer Nc, Busch Rd, Frick Eb a Medical Clinic Klinikum Innenstadt, LudwigMaximilians University, Munich, Germany; bDepartment of Psychosomatics and Psychotherapy, Clinic of Psychiatry Klinikum Innenstadt LudwigMaximilians University, Munich, Germany; c1st Medical Clinic Municipal Clinic Mu¨nchen-Schwabing, Munich, Munich, Germany; dInstitute for Medical Statistics and Epidemiology, Klinikum Rechts der Isar, Technical University, Munich, Germany PURPOSE: This study aims to determine the effects of interferon therapy as maintenance in multiple myeloma patients post high-dose chemotherapy and autologous blood stem cell transplantation (ABSCT). METHODS: Data of 88 continuously accrued patients (52 male, 36 female, mean age 57.7 years) with multiple myeloma were analysed before and one year post ABSCT. 42 had received interferon as a maintenance therapy, 46 had not. Quality of life was measured by EORTC QLC-Q30 supplemented by a lymphoma specific module and Profile of Mood States (POMS) questionnaires. Kaplan–Meier analyses for overall survival and progression-free survival were carried out. RESULTS: Interferon maintenance therapy was correlated with worse cognitive functioning (p ¼ 0:039; Cohen’s d ¼ 0:47), more weight loss (p ¼ 0:012; Cohen’s d ¼ 0:54) on EORTC and better physical functioning (p ¼ 0:08; Cohen’s d ¼ 0:37) as well as less depression (p ¼ 0:092; Cohen’s d ¼ 0:35) on POMS. There was no correlation between global health score, fatigue or other physical symptoms and interferon. The interferon group showed significant longer overall and progression-free survival (90.6 vs 50.2 months p ¼ 0:003; 53.7 vs 26.2 months p ¼ 0:000) at one year post ABSCT. CONCLUSIONS: In this nonrandomized study interferon maintenance therapy has a negative influence on cognitive functioning and weight, but did not result in other physical problems, depression or fatigue. At one year post transplant a significant advantage in both overall and progression-free survival for the interferon patients seems possible. These results should be kept in mind when counselling patients. ACKNOWLEDGEMENTS: This study was supported in part by a grant of the Deutsche Jose Carreras Leuka¨mie-Stiftung e.V.

Copyright # 2006 John Wiley & Sons, Ltd.

441 Silence and Cancer: Why Do Families and Patients Fail to Communicate? Zhang AYa, Siminoff LAb a FPB School of Nursing Case, Western Reserve University, Cleveland, OH, USA; bDepartment of Bioethics, School of Medicine, Case Western Reserve University, Cleveland, OH, USA PURPOSE: To examine the phenomenon of avoidance of family communication about cancer and identify psychological factors that contribute to this phenomenon. METHODS: 37 patients with stage III or IV lung cancer and 40 family caregivers (24 primary and 16 secondary caregivers) from 26 families were interviewed. The open-ended telephone interviews were audiotaped and transcribed verbatim. NUDIST computer software was used to perform content analysis. RESULTS: Two-thirds of the families (65%) experienced communication problems. The avoidance of family communication was associated with several underlying thought processes: (1) fears that discussing cancer-related issues will provoke psychological distress; (2) desires for ‘mutual protection’}both patients and caregivers try to protect each other from being exposed to a harmful situation (words or action); and (3) beliefs that positive thinking leads to tumor reduction and negative thinking results in tumor growth, therefore thinking or talking about cancer and its detrimental consequence must be avoided. Family communication was further hindered by the increasing difficulty of issues inherent to late-stage cancer: treatment side effects, persistent smoking, and death and dying. CONCLUSIONS: The findings shed light on cognitive patterns}beliefs and attitudes}that contribute to the avoidance of family communication about cancer. These beliefs or attitudes stemmed from patients’ and family caregivers’ experience with cancer. They have adverse effects on patient care, for example, increased stress and delayed recognition of needed care for cancer patients. Thus, the study findings call for a further investigation of the family communication about cancer.

442 Exploring the Unmet Needs of Informal Caregivers: A Health Care Professional View Buscemi Va, Cortı´ Va, Viladrich MCb, Font Ac

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Psicologia Oncolo`gica Asociacio´ Espanyola Contra el Ca`ncer, Barcelona, Spain; bPsicobiologia i Metodologia de les Cie`ncies de la Salut Universitat Auto`noma de Barcelona, Barcelona, Spain; cPsicologia Ba`sica Universitat Auto`noma de Barcelona, Barcelona, Spain PURPOSE: This preliminary study explored the professionals’ perceptions of informal caregivers’ unmet needs of terminally ill cancer patients, and the reasons why these needs remain unsatisfied. METHODS: A questionnaire of 55 physical, psychological, and social unmet needs of informal caregivers was created for the purpose of this study. The questionnaire was sent by email to professionals working in the palliative care setting in Catalonia (Spain). Data on needs were obtained on this questionnaire, and an open question was used to elicit data on the reasons why these needs are generally unmet. RESULTS: Results (33) indicate a significant diversity in the professionals’ perceptions. The most important unmet needs are: ‘knowing how to manage the patient’s physical symptoms’ (19.6%), ‘having an easy and rapid access to professionals like psychologists or physiotherapists’ (9.7%), and ‘knowing how to cope with negative emotions’ (9.7%). Regarding all reasons (50) why the professionals think these needs are unmet, 24 (48%) reflected a ‘lack of’ (particularly time and specific human resources). The professionals also considered the lack of death culture (5), and on the whole the lack of psychological preparation and formation of the caregivers (13). CONCLUSIONS: The results are in accordance with the caregivers’ unmet needs found in the literature. However, it would be interesting to compare them with the views of the informal caregivers using the same questionnaire. Moreover opinions about why these needs are unmet may guide the public health care system to adapt to the palliative situation.

443 Physician–Patient Conversations about Internet Cancer Information Bylund CL, Gueguen JA Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, USA PURPOSE: Internet cancer information is frequently searched by cancer patients and caregivers; however, we know little about the impact of those searches on physician–patient commu-

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nication. This study explores cancer patients’ and caregivers’ experiences discussing internet cancer information with a doctor. METHODS: Thirtynine patients and forty caregivers participating in an NCCN-sponsored online forum completed a 15-item survey regarding conversations with physicians about internet cancer information. Eightyseven percent of the patients were Caucasian, 61 percent were between the ages of 45–65, and 67 percent were female. RESULTS: Of those who had looked for cancer information on the internet, 33% reported always speaking to the doctor about this information, and 46% responded sometimes. When asked about the most recent conversation they had with the doctor about internet information, most respondents reported not bringing a copy of the internet information to the visit, but explicitly stating that the information being discussed was from the internet. Fifty-seven percent of respondents were somewhat or very satisfied with this conversation, with 19% responding that they wished they could change the way the doctor responded. Eighteen percent of respondents said that this conversation had an impact on their choice of doctor or where to seek treatment. Other qualitative themes emerged from open-ended questions and will be presented. CONCLUSIONS: The way in which a doctor communicates with patients and caregivers about internet health information has the potential to affect patient outcomes, including satisfaction and the decisions that patients make about treatment.

444 Psychopathological Conditions and Quality of Life in Patients with Lymphoma, a Transversal Study Cabral AS, Carvalho A, Domingues V, Santos M, Santos Z Psychiatry Coimbra University Hospital, Coimbra, Portugal PURPOSE: Lymphoma is frequently associated with psychological distress and psychiatric disorders and has major implications in patient’s quality of life. In fact, oncology is being asked to increasingly look beyond treatment to the care and quality of life of patients. The authors intended to analyse the quality of life and psychopathological condition among patients under chemotherapy treatment for lymphoma and the correlations between those two variables. METHODS: This study included 50 patients

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currently in chemotherapy treatment in the Oncology Day Unit of the Coimbra University Hospitals, who were assessed through a brief demographic questionnaire, the Brief Symptom Inventory (BSI) and the Medical Outcomes Study-Short Form (SF-36). RESULTS AND CONCLUSIONS: The authors made a reflection about their results and mention some conditions.

445 The Bad News Communication in Oncology: How to Make the Alliance with the Old Patient and Caregivers? Preliminary Results of a Descriptive Inquiry Calandra Ga, Di Nunzio Ca, Bettinardi Ob, Malingher Aa, Moroni CFa, Vallisa Da a Division of Medical Oncology and Psychology in Oncology, ‘Guglielmo da Saliceto’ Hospital, Piacenza, Italy; bDivision of Psychology, San Giacomo Privat Hospital, Ponte dell’olio, Piacenza, Italy PURPOSE: Old patients over seventies with cancer in more Italian oncology units represent 20–40% of patient having treatments; though the complexity of their evaluation, most of all for what concerns the communication of the diagnosis, they are still nowadays a matter of deepening and surveying. Aims to comprehend the will of the old patients to be informed or not about the diagnosis of cancer and to identify whether the family could be a problem in the process of communication of the diagnosis of cancer. METHODS: 1. Semi-structured interviews about subjective perception of disease and about need or not of information. 2. Multidimensional evaluation (MMSE, ADL, IADL, GDS). RESULTS: The results shows that 106 subjects (53 patients and 53 caregivers) with mean age, respectively, of 74 and 52 years old, who acceded to the oncology unit of the Piacenza Hospital in 2005, 66% of the patients and 76.6% of the relatives thought about a possible tumour disease. 57.4% of the relatives did not think that the patients were conscious of the entity of the disease. Finally, 74% of the patients wanted to be informed about the diagnosis while 53.2% of the relatives asked not to tell anything to the patient. CONCLUSION: Results we found, underline that old patients too will to be accurately informed about their clinical conditions, but the family, with positive and protective intentions, could be an obstacle to the relationship between physician and the patient itself,

Copyright # 2006 John Wiley & Sons, Ltd.

often influencing the communicative exchange doctor–patient.

446 Restarting Activities after Cancer: Influence on Medical, Psychological and Social Variables in Patients With Solid Neoplasia Calandra Ga, Di Nunzio Ca, Bettinardi Ob, Berte´ Ra, Bidin La, Rodino` Ca a Division of Medical Oncology and Psychology in Oncology, ‘Guglielmo da Saliceto’ Hospital} Piacenza, Italy; bDivision of Psychology, San Giacomo Privat Hospital, Ponte dell’olio, Piacenza, Italy PURPOSE: In neoplastic patients early identification of anxious-depressive symptomatology and psychological distress encourages better communication and trust both in received treatments and in doctor–patient relationship. With reference to patients with an early diagnosis of neoplasia, it is fundamental monitoring variables interfering with their reintegration and social reinstatement. METHODS: 43 patients (aged 18–60) all under chemotherapeutic treatment, had been inspected twice. The first time after 10–90 days from the diagnosis and three months later for the second time. Patients with psychiatric paths and in advanced or terminal stage of cancer were dropped. A semi-structural interview about patients’ personal, social and working situation was given compiling the progressive A–D report (STAI-X1 and Depression Questionnaire-Cognitive Behavioural Assessment 2.0) distress -PDI. RESULTS: 59% of the patients showed anxiousdepressive symptoms, in the 13% worsening of the symptoms occurred while 34% kept his scores high. We found that the distress condition emerged during the last week of treatment can be an indicator of patients’ last three months psychological condition. Social-cultural, social protective and social contact factors were not found to be psychologically supporting or protective. Patients reporting the highest scores in the D scale were those referring the lowest motor-functional autonomy. CONCLUSION: This study points out the need of periodical evaluation of patients’ psychological state for any supporting treatment. In particular, according to the distress and the social contact required, patients’ working activity could be both relevant and critical. Open answers monitoring of patients’ emotional state and subjectively perceived needs is advisable as well.

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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447 Psychological Point of Listen: Exploratory Survey on the Needs of the Onco-haematological Patients Hospital Admittance. Preliminary Data Calandra Ga, Dallanegra La, Monfredo Mb, Vallisa Da, Mordenti Pa, Capanna La a Division of Medical Oncology and Psychology in Oncology, ‘Guglielmo da Saliceto’ Hospital, Piacenza, Italy; bDivision of Psychology, San Giacomo Privat Hospital, Ponte dell’Olio, Piacenza, Italy PURPOSE: Detection of onco-haematological patient’s needs with the aim of paying more attention to psychological distress throughout a empathic listening. METHODS: It has been activated, during the period of hospital staying, a psychological point of listen with the intention to facilitate the emotion expression by the patients and to explore the unexpressed feelings that are behind the words. To complete the seed-structured interview it has been proposed to the patients the Needs Evaluation Questionnaire (NEQ) at the beginning of the shelter. RESULTS: we have evaluated 100 patients, 51 women, 49 men, with a medium age of 64 years (range 23–88 years), 53% with hematologic disease and 47% with cancer. A preliminary analysis shows a linear correlation between the demand for a greater control of physical symptoms and the need of a greater information on the own diagnosis and prognosis (active attitude with regard to the cure process). The psychological aid, is requested from 25% of the patients. It is correlated with the need to face the disease when the patient feels alone without any help from his relatives. 38% of patients express major concern about prognosis, about psychosocial and familiar effect. CONCLUSIONS: Our data suggest that psychological intervention can help the patient along his specific distress. Finally, in the future it will be useful to utilize more specific measures for the evaluation of the self-perception of isolation and loss.

448 Evaluation of Emotional and Cognitive Neurotoxicity in Course of Chemotherapy for Cancer: Preliminary Data from a Multicenter Study Caldera P, Berra C, Amodeo L, Malabaila A, Torta R Psycho-Oncology Unit, University of Turin, Turin, Italy

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PURPOSE: While chemotherapies; neurotoxic effects on peripheral nervous system are well known, only few trials studied the effects on central nervous system (CNS). No prospective studies on cognitive and emotional side effects on cancer survivors, are available; this prospective study assesses the chemotherapies neurotoxic effects on CNS. METHODS: This is a multicenter, prospective study, involving not depressed patients (MADRS510) under neurotoxic chemotherapies (taxanes, vinca alchaloids, platinum derivates), which are tested before the beginning of antiblastic therapies (T0), and after 6 (T3), 12 (T4), 24 (T5) months with a battery of neuropsychological tests evaluating different cognitive domains, and neurophysiological instruments (EEG and cognitive evoked potentials). At T0, T1 (1 month), T2 (3 months), T3, T4, and T5 patients are tested for anxiety, depression, QoL, and pain. Seric BDNF and Serotonine receptor allele are also determined. RESULTS: This study is designed to recruit 200 patients. These preliminary data are obtained by the first 10 patients enrolled, now evaluated at T3. At baseline, patients showed no significant differences from the normal population in terms of cognitive ability. After 6 months of chemotherapies, we found a significant (p50.05) deterioration in patients performing, particularly in Attention/Concentration (p50.001), WorkingMemory (p50.05), Mental-Flexibility (p50.05), while Speed of Information Processing worsened, but not significantly. During the first 6 months, QoL worsens, with increased anxiety levels. CONCLUSIONS: These preliminary data suggest that neurotoxic effects of chemotherapies also involve CNS. These results should be confirmed by a larger sample.

449 Depressive Symptoms and Cognitive Limitations in Brain Tumor Survivors Calvio LCa, Feuerstein Ma,b, Hansen JAa,c, Johnson LGa, Ronquillo JGa a Medical and Clinical Psychology, Uniformed Services, University of the Health Sciences, Bethesda, MD 20814, USA; bDepartment of Preventative Medicine and Biometrics, Georgetown, University Medical Center, Washington, DC 20007, USA; c Department of Psychology, American University, Washington, DC 20016, USA BACKGROUND: Brain tumour survivors often experience cognitive changes (i.e. difficulty con-

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centrating, and aphasia). Depression, sleep difficulties and cognitive limitations can persist long after the cancer treatment. Depression worsens learning and memory. Sleep deprivation negatively impacts leaning, memory and emotions. Exercise has been shown to positively impact mood and sleep quality of cancer survivors. The interaction among these variables on cognitive function in brain tumour survivors is not well documented. The purpose of this study was to assess the relationship among distress (depressive and anxiety symptoms, emotional distress), health behaviours (i.e. aerobic exercise, sleep, and diet) and cognitive limitations in malignant brain tumour survivors, while controlling for demographic and treatment-related factors. METHODS/ DATA ANALYSIS: Malignant brain tumour survivors (n ¼ 131), ages 20 through 70, were recruited from brain tumour organizations in the US completed a comprehensive on-line survey. The survey collected information on demographics, medical status, emotional distress, fatigue, health behaviours (i.e. aerobic exercise, sleep, diet), and cognitive limitations. A multivariable regression was conducted. RESULTS: The survivors were on average 4.8 (3.9) years post diagnosis. Depressive symptoms (beta ¼ 1:24; p ¼ 0:001), anti-seizure medication (beta ¼ 4:43; p ¼ 0:048) and radiotherapy (beta ¼ 5:04; p ¼ 0:046) were significant predictors of cognitive limitations. The model accounted for 34% of the variation in cognitive limitations. Aerobic exercise (beta ¼ 2:43; p ¼ 0:06) and healthy diet (beta ¼ 5:82; p ¼ 0:08) approached significance. DISCUSSION: Depression was the only modifiable factor that was significantly associated with cognitive function. The input of aerobic exercise and healthy diet while marginal may also contribute to improved outcomes.

450 LaComm: A French Medical Communication Analysis Software Razavi Da, Durieux JFb, Moucheux Ab, Farvacques Cb, Camara Fa a Unite de Recherche en Psychosomatique et en Psycho-oncologie Universite´ Libre de Bruxelles, Bruxelles, Belgium; bC.A.M, Groupe de Recherche et de Formation (ASBL) C.A.M, Bruxelles, Belgium There is an increasing awareness that effective communication skills in health care are needed to

Copyright # 2006 John Wiley & Sons, Ltd.

achieve desired health outcomes. Consequently, there has been a growing demand for effective methods to evaluate communication training programs. To answer this problem, a software has been developed: Logiciel d’Analyse de la Communication me´dicale (LaComm). The aim of this program is to analyse the verbal communication between health care professionals and their patients. This software not only performs a content analysis but also identifies communication skills used by professionals as well as their effects on patients and relatives utterances. To analyse utterances, LaComm works on written audiotaped interviews and use two methods. First, the heuristic method allowing the formalization of language’s forms and functions: assessment, support, information, etc. Second, the semantic analysis method using numerous data bases allowing the recognition of words, their semantic category and their number.

451 The Effect of Mirtazapine on Depression, Anxiety Symptoms and Quality of Life in Cancer Patients Cankurtaran ES, Ozalp E, Soygur H, Turhan L Psychiatry Clinic, Ankara Oncology Research and Education Hospital, Ankara, Turkey PURPOSE: Psychiatric disorders could frequently accompany cancer so could have negative impact on quality of life in cancer patients. Adjustment disorders, depression are the most seen psychiatric disorders in the cancer patients (1). This study aims to research the effectiveness of mirtazapine on depression, anxiety symptoms and quality of life of cancer patients. METHODS: Twenty patients with cancer attending to Ankara Oncology Research and Training Hospital, diagnosed with any of those; major depressive disorder, anxiety disorder or adjustment disorder, were included in the study. All patients diagnosed with different cancer types were interviewed by 3 visits. The patients were asked to complete Hospital Anxiety-Depression Scale (HADS) and Quality of Life scale of European Organization for Research and Treatment of cancer (EORTC QLQ-C30) at each visit. RESULTS: There were statistically significant difference between 3 visits for the mean total (p ¼ 0:03), anxiety (p ¼ 0:03) and depression (p ¼ 0:002) scores of HADS. There were difference only for emotional functioning (p ¼ 0:03), cognitive functioning (p ¼ 0:00), sleep disturbance (p ¼ 0:00) and nausea/vomiting (p ¼ 0:03) sub-

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scales of EORTC QLQ-C30 between 3 visits. There was no significant difference for other subscales. CONCLUSION: This study shows that mirtazapine resolves anxiety, depression symptoms and has positive impact on quality of life of cancer patients especially for emotional functioning, cognitive functioning, sleep disturbance and nausea/vomiting.

452 Emotional Adjustment to Newly Diagnosed Cancer: How Do Beliefs About Illness, Self and World Contribute? Carboon Ia, Anderson VAa, Pollard Ab, Szer Jc, Seymour JFb a Psychology University of Melbourne, Melbourne, Australia; bHaematology & Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; cClinical Haematology & Medical Oncology, Royal Melbourne Hospital, Melbourne, Australia PURPOSE: It has long been accepted that cognition plays a key role in mediating emotional responses to stressful life events. To elucidate the role of specific cognitions in adjustment to a recent cancer diagnosis, this study explored relationships between personal beliefs and emotional outcomes. We measured people’s beliefs about the causes of, and control over, their cancer as well as core beliefs abut self and the world. We hypothesised that emotional adjustment would be associated with cancer-specific beliefs and that core beliefs would also be implicated in this process. METHODS: Eighty-six adults undergoing primary treatment for a hematologic cancer participated an average of 36 days post-diagnosis. Self-report measures were used to assess: (a) cancer-specific beliefs (causal attribution and locus of control), (b) core beliefs about world and self and, (c) depression, anxiety and positive emotion. Regression analyses were used to assess the contribution of beliefs to emotional adjustment. RESULTS: Depression was predicted by the attribution that negative emotional states caused one’s cancer while anxiety was related to attributing poor medical care as a cancer cause. Lower personal control over illness beliefs predicted higher anxiety. World beliefs did not predict any emotional outcomes. Higher endorsement of the self belief, luck, predicted lower depression and higher positive emotion. CONCLUSIONS: The findings provide evidence that beliefs about personal luck

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and cancer causality and control are implicated in emotional adjustment to a new diagnosis of cancer. The clinical implications will be illustrated using interview data from participants.

453 Exploring Meaning and Emotional Wellbeing: A Longitudinal Study of the Assumptive World in the Wake of a Cancer Diagnosis Carboon Ia, Anderson VAa, Pollard Ab, Szer Jc, Seymour JFb a Psychology University of Melbourne, Melbourne, Australia; bHaematology & Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; cClinical Haematology & Medical Oncology, Royal Melbourne Hospital, Melbourne, Australia PURPOSE: The assumptive world hypothesis postulates that traumatic events such as cancer can challenge or shatter previously held beliefs about the world and self and restructuring these beliefs may be integral to successful adjustment. This longitudinal study examined cancer patients’ assumptive world}a model of eight beliefs about the world and self. We explored whether particular configurations of assumptions were related to emotional wellbeing and if assumption change was implicated in long-term adjustment. METHODS: Fifty-five adults with a newly diagnosed hematologic cancer completed measures including the World Assumptions Scale (WAS) on three occasions over the year following diagnosis. We used cluster analytic techniques to classify participants according to differences in their assumptive world beliefs. ANOVAs were used to conduct post hoc explorations of group differences in long-term emotional wellbeing and other factors of interest. RESULTS: Three groups with distinct configurations of world assumptions were identified. These groups varied according to emotional wellbeing at follow-up. Group 1 had high justice and controllability assumptions and greater traumatic stress symptoms. Group 2 had low self-control beliefs and higher depression and anxiety. Group 3 had stronger assumptions of benevolence, self-worth and luck with lower depression and more positive emotion. None of the beliefs changed significantly over time. CONCLUSIONS: The findings of differential emotional adjustment between the groups suggest an important role for assumptive world beliefs in coping with cancer. The implications for

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targeting psychotherapeutic interventions will be discussed.

454 Psychological Support in CGO Zaccherini M, Maruelli A, Zanna I, Miccinesi G, Nencini G Oncological Preventing and Studying Centre, Oncology Rehabilitation, Florence, Italy At the C.S.P.O. in Florence an out-patients’ department has been founded since the 01/01/ 2002 in order to offer a support psychological consultancy which integrates the CGO service for cancer breast. This department receives women with a risk defined as high, middle or low. The service offers an individual support through a psychological assessment with tests. This research includes 210 subjects who came to the CGO from 01/01/2002 to 31/01/2005. They were offered a psychological assessment through: 1. HADS; 2. MMPI-2. A psychological interview is offered to people who have values higher than 65 in the MMPI basis scales and/or higher than 8 in the HADS scales (A,D), either in the basal assessment or in the following after 6/8 months. RESULTS: CGO total consultancies ¼ 394: Total psychological assessments ¼ 210=394 ¼ 53:3%: Among 210 subjects with assessment: 158 (75.2%) HIGH RISK 43 (20.5%) MIDDLE RISK 6 (2.9%) LOW RISK 3 (1.4%) NON-DEFINITED RISK 42/210 (20%) made the genetic test and among these: 8 (19.1%) POSITIVE 4 (9.5%) NEGATIVE 4 (9.5%) NON-INFORMATIVE 26 (61.9%) are waiting for result. In the basal assessment: 39/210 values D > 8 68/210 values A > 8 86/210 come to the following assessment: 21/86 values D > 8 30/86 values A > 8 66/86 values 58 in D and A after 3 counselling interviews 21/86 made at least 8 counselling meetings 147/210 compile the MMPI: 19/147 values D > 65 15/147 values Pt, in axis with D, > 65 11/147 values > 65 in D and Pt. CONCLUSIONS: The screening of need support could be observed in the subjects who were subjected to a CGO had been functional.

455 Coping Strategies and Depression Symptomatology in Parents of Children Diagnosed with Cancer Zabalza MA Psicooncologia, Asociacio´n Espan˜ola Contra Cancer, Santiago de Compostela, Spain

Copyright # 2006 John Wiley & Sons, Ltd.

OBJECTIVE: In this work the strategies mainly used by a group of parents to cope to their children onco-hematological diseases are evaluated. Also the intensity of depression symptomatology is analysed. METHOD: A sample of 41 parents of children with several onco-hematological diseases is selected. Methods used in the evaluation were the interview, the COPE (Carver, Scheier, Weintraub, 1989) and Beck Depression Inventory (BDI; Beck, 1967). RESULTS: The results of this study allow us to observe that a series of coping strategies mainly used by parents exists: active coping, planning, suppression of competing activities, restraint coping and acceptance. About these strategies we can say that they are potentially becoming of the coping process parents should make. The rest of the evaluated strategies are hardly used by parents, some of these strategies are potentially positive for the situation they have to cope and some others are negative. BDI results show that 40% of parents do not present depressive symptomatology, 37.5% present low depressive symptomatology, 7.3% medium and 15% serious. CONCLUSIONS: The information from this study allows us to conclude that the majority of parents with children having onco-hematological diseases place themselves in positions that show that they actively face up to disease. This coping process is tinged with the characteristic nature of the disease and its medical evolution. The majority of parents that have participated in this work do not present depressive symptomatology that could be dysfunctional for their facing up to children disease process.

456 Relationship between Psychosocial Factors and Survival Rate after Hematopoietic Stem Cell Transplantation Yoshiuchi K, Kikuchi H, Sakamoto N, Fukuo W, Akabayashi A Department of Psychosomatic Medicine, The University of Tokyo, Tokyo, Japan PURPOSE: Hematopoietic stem cell transplantation (HSCT) is an alternative to conventional treatment for adults who have hematological malignant diseases. Some previous studies have reported that survival rate after HSCT is associated with psychosocial factors. However, there has been no report on the association between psychosocial factors and survival rate after HSCT

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in Japan. Therefore, the aim of this study was to investigate prospectively the association between psychosocial factors and survival rate after HSC in Japan. METHODS: The subjects were 95 male patients and 53 female patients (38:2 þ= 11:7 years) with hematologic malignancy. The duration after HSCT ranged from 14 days to 3302 days (median 694 days). Psychosocial factors consisted of mood states, coping skills, self-esteem, and social support. We used the Cox proportional hazards regression model for univariate and multivariate analysis controlling for age, sex, and matching of HLA. RESULTS: With the multivariate Cox proportional hazards regression model, the self-controlling coping skill was associated with survival rate (R.R. 0.88, p ¼ 0:04), which means the self-controlling coping skill is favourable for survival. Anger–Hostility mood states tended to have a positive association with the survival rate (R.R. 1.05, p ¼ 0:08), which means anger–hostility mood is not favourable for survival. CONCLUSION: Psychosocial factors may influence survival rate after HSCT in Japanese patients with hematologic malignancy.

457 Online Computerized Screening for Distress, Pain and Fatigue in Newly Diagnosed Cancer Patients: Program Description and Preliminary Results Carlson LEa,b, Bultz BDa,b, Clifford Sb, Hilliard Fc, Welter Mb a Oncology University of Calgary, Calgary, Canada; bPsychosocial Resources, Tom Baker Cancer Centre, Calgary, Canada; cFrank Hilliard Co., Grand Forks, Canada High levels of distress, pain and fatigue have been documented in cancer patients across all stages of the cancer trajectory. Many groups advocate routine psychosocial screening as part of usual clinical practice, but few centres have adopted this model. We have developed such a program for use with new cancer patients in Calgary, Canada. The screening protocol is based on published recommendations using validated measures including the Distress Thermometer (DT), Problem Checklist (PCL), and 10 anxiety and depression questions from the Psychological Scan for Cancer (PSSCAN). Other data collected includes demographics (age, gender, income, education, ethnicity) and cancer-related variables. Triage to appropriate services follows an established algorithm specific to our treatment centre. A wireless

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online web-based computer program for use with tablet PCs and a stylus touch screen has been developed and pilot tested with groups of patients. New patients will be randomly assigned to one of four versions of the screening protocol, and subsequently contacted three months later for follow-up assessment of distress and awareness and use of Psychosocial Resources. The program is known to patients and marketed as the Personal Well-Being Checklist. The first phase of the screening program has been implemented with all new patients attending lung clinic. We will present the content of the program, demonstrate the online interactive assessment and present preliminary feasibility and outcome data. ACKNOWLEDGEMENTS: Funded by the Public Health Agency of Canada-Canadian Strategy for Cancer Control, The Alberta Cancer BoardTom Baker Cancer Centre, Enbridge Inc., KARO.

458 Pilot Crossover Study of Reiki for Treating Fatigue in Cancer Patients Tsang Ka, Carlson La,b, Olson Kc a Psychosocial Oncology, Tom Baker Cancer Centre, Calgary, Canada; bOncology University of Calgary, Calgary, Canada; cNursing University of Alberta, Edmonton, Canada PURPOSE: Fatigue is an extremely common side effect during cancer treatment and recovery. Limited research has investigated complementary and alternative medicine strategies that may reduce cancer related fatigue. This research examined the effects of Reiki, a type of touch therapy, on fatigue and overall quality of life in cancer outpatients completed active medical interventions. METHODS: The study used a counterbalanced crossover pilot design with participants receiving either: (1) Reiki for seven sessions, with a one-week washout period between sessions five and six, followed two weeks later by five sessions of rest as a control condition, or; (2) the opposite (rest, then Reiki). Participants completed fatigue and QL questionnaires before and after all sessions of Reiki and rest, and a visual analogue scale assessing daily fatigue (tiredness) before and after each session. RESULTS: In 16 participants, fatigue decreased over the course of all seven treatments within the Reiki condition ðp ¼ 0:05Þ; but not more than in the rest control condition. On daily fatigue, a cumulative decrease in tiredness was observed in Reiki compared to the

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control condition. In addition, Reiki significantly enhanced overall quality of life ðp50:01Þ; more than the control resting condition ðp50:05Þ: CONCLUSIONS: Future research should further investigate the impact of Reiki on fatigue in cancer patients using larger sample sizes and control conditions such as sham Reiki that control for expectancy, social contact and touch. ACKNOWLEDGEMENTS: Funded by a CIHR New Investigator Research Allowance and an Alberta Heritage Foundation for Medical Research Establishment Grant.

tion of patient depression ðp ¼ 0:058Þ: The buffering effect of communication approached significance for the relation between caregiver anxiety and perception of patient anxiety ðp ¼ 0:09Þ: CONCLUSIONS: Caregivers who perceive patients to have high distress experience less distress when they can communicate about difficult topics with patients. Interventions such as CHESS that teach patients and caregivers how to discuss such topics may promote caregiver adjustment. ACKNOWLEDGEMENTS: Supported by National Cancer Institute, 1 P50 CA095817-01A1.

459 Communication Buffers the Relationship between Caregiver Distress and Their Perceptions of Patient Distress in Advanced Lung Cancer Carmack Taylor CLa, Bernard-DuBenske LLb, Gustafson DHb, Cleary JFc, McTavish FMb a Behavioral Science, The University of Texas, M.D. Anderson Cancer Center, Houston, USA; b Center of Excellence in Cancer Communication, University of Wisconsin, Madison, USA; cUniversity of Wisconsin Comprehensive Cancer Center, Madison, USA PURPOSE: Psychological distress may limit cancer caregivers’ abilities to provide support. Because caregiver and patient distress may be related, one person’s distress may exacerbate the other’s. Identifying moderators of this relationship may suggest who will benefit from interventions. Dyads communicating about stressors may experience less distress; however, social constraints in discussing important topics can perpetuate distress. METHODS: Data are from baseline measures of 123 caregivers of advanced lung cancer patients participating in a study evaluating Comprehensive Health Enhancement Support System (CHESS). RESULTS: Caregivers were predominately spouses (65.9%), white (93.5%), and female (67.5%); average age was 56.2. POMS data indicated caregivers’ depression and anxiety were above the mean compared to a published normative sample (8 and 13 SDs, respectively). Caregiver depression and perception of patient depression (r ¼ 0:40; p50:01) and caregiver anxiety and perception of patient anxiety (r ¼ 0:33; p50:01) were significantly correlated. Linear regression analyses controlling for caregiver age and gender indicated that caregiver perception of communication with the patient buffered the relation between caregiver depression and percep-

Copyright # 2006 John Wiley & Sons, Ltd.

460 The Form of Health Carotenuto M, Persiani M Rome, Italy Illness does not exist without a program. Behind it lies a definite intentionality, which needs a specific causality inside the unconscious psychical activity of the subject to take form. Psychical activity is the ground action which formalizes every human phenomenology, therefore it has the capability to change biological co-ordinates and to alter them on a molecular basis. Ontopsychology got ready a rational method in order to know psychical activity in its first actuality and to achieve the cure, if the patient agrees. It doesn’t replace medicine, which intervenes on the somatic effects, it rather acts upon the psychical causality which, modifying the DNA, carries the symptom into effect. To investigate psychosomatic disease means to inquire into the ground-cause of illness. Ontopsychology by psychosomatic disease means: an exclusively somatic phenomenon with an exclusively psychical causality. In the medical and immunological sphere it is demonstrated that the state of stress is the etiological ambient of the disease setting up, neoplastic diseases included, but isn’t clear what it is and how it acts. Ontopsychology means stress as giving answer to an exigency with a satisfaction not suiting that need at the requested level. It’s a persistent psychical action in vain as to the possible existential self realisation. So Ontopsychology have found how the disease is planned and have based its scientific theorises on successful and documented clinical praxis. Nowadays a scientific Psycho-oncology experimentation is on and the first results will be expounded with the present report.

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A Response to Cancer Patient Information Needs: the SOR SAVOIR PATIENT Guide on Psychological Aspects of Cancer Leichtnam-Dugarin La, Carretier Ja, Machavoine JLb, Brusco Sa, Delavigne Va a SOR SAVOIR PATIENT, French Federation of Comprehensive Cancer Centre, Paris, France; b Psycho-Oncology Centre Franc¸ois Baclesse, Caen, France

Psychological Impact of Genetic Counselling for Hereditary Colorectal Cancer Caruso Aa, Vigna Ca, Bongiorno La, Casale Vb, Stigliano Vb a Department for Formation and Prevention in Psycho-Oncology Regina Elena Cancer Institute, Rome, Italy; bDepartment of Gastroenterology Regina Elena Cancer Institute, Rome, Italy

PURPOSE: This project aimed to involve patients in the development of cancer patient information to meet their needs for better information about psychological aspects of the disease, and facilitate communication on that topic in the physician– patient encounter. METHODS: The information provided stems from clinical practice guidelines of the FNCLCC and the 20 French cancer centres (‘Standards, Options & Recommendations’) and national recommendations on the topic. It was elaborated by multidisciplinary working groups involving specialists, the French Society of Psycho-oncology and institutions. A first draft is written in plain language by methodologists, a linguist, psychologists, nurses and oncology experts. Then the draft produced is adapted to the needs expressed by patients using qualitative. The final document is reviewed nationally by experts and patients. RESULTS: 27 patients and former patients were involved. Questionnaires identified information needs and explored the content, the language level, the form, etc. Expressed information needs centred on topics like emotions felt, possibility of self or mutual help and support during and after cancer. Informations on the psychological impact of cancer help patients better understand their emotions, accept treatments and side effects, find resources and support to meet their needs and facilitate communication with health professionals. CONCLUSION: Cancer patients expressed great information needs on all aspects of living with cancer. Patient involvement in the development of a patient guide is an essential criterion to produce easily understood information and satisfy specific information needs. Written information is a supplement to verbal information in the clinical setting. The SOR SAVOIR PATIENT guide can be used for patient education sessions. Its impact on patients’ outcomes and physician–patient relationships remains to be assessed.

Copyright # 2006 John Wiley & Sons, Ltd.

PURPOSE: Assessment of psychological variables of individuals who approach genetic counselling for colorectal cancers in order to: survey psychosocial impact of genetic counseling and surveillance program; survey possible correlation between psychosocial characteristics and development of disease; modulate the intervention of multidisciplinary team on consultants needs. METHODS: Psychological assessment is performed: family history collection and eligibility communication (T0); blood-withdrawal (T1); communication test outcome (T2). Assessment follows surveillance program. Instruments: Minnesota Multiphasic Personality Inventory (MMPI2) performed annually; Family Adaptation and Cohesion Evaluation Scale (FACES-III); Hospital Anxiety and Depression Scale (HADs); Genetic Risk Perception (GRP). RESULTS: Data are preliminary and refers at T0. 14/16 cancer affected; 7/16 male; mean age 46. MMPI-2. Sample shows normal profile. FACES-III. Cohesion (real 39.73 an ideal 40.07) is significantly different than adaptation (real 31.73 and ideal 34.47) p50:002: HADs. Mean score of anxiety is significantly different than depression (8.25/5.69, p50:01), female level of anxiety is different than male level (9.56/6.57 p50:01). GRP. Level of risk perception of being carrier mutation: high 12%, mean 44%, low 19%. I don’t know 25%. CONCLUSION: These families have higher levels of cohesion than adaptation; anxiety levels are higher than depression and females are more anxious than males. Its interesting to notice that, although all subjects are eligible for genetic test and most of all are colorectal cancer affected, only 12% perceives high risk of being carrier mutation.

463 ‘PSICONCOGEN’: The Italian Society of PsychoOncology (SIPO) Committee on Psychological Aspects related to Oncogenetic Counseling Caruso Aa, Razzaboni Eb,c

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a

Attivita` di prevenzione e formazione in Psiconcologia, Istituto Regina Elena, Rome; bCattedra di Medica, Universita` di Bologna}Policlinico Sant’Orsola-Malpighi, Rome; cCentro per lo studio dei tumori familiari della mammella e/o dell’ovaio, Cattedra di Oncologia Medica II, Universita` di Modena e Reggio Emilia, Rome Identification of gene mutations that confer susceptibility to certain types of cancers has led to an increase in demand for oncogenetic counseling (OGC) about individual cancer risks. OGC aims to communicate information regarding personal cancer risk and to help consultant making informed and autonomous choices regarding options for risk management, principally cancer surveillance and predictive genetic testing. Given the complexities in communicating genetic risk, psychological aspects of OGC are a matter of growing interest. Literature on this topic has increased in the last ten years. Even if both national and international guidelines for genetic counseling has focused the attention on these aspects, little is known about how the psychological intervention should be done. Thirteen Italian psychologists belonging to different institutions (Aviano, Bari, Bologna, Carpi, Forl"ı, Genova, Modena, Milano, Napoli, Ravenna, Roma, Torino) have established a specific committee to study the psychological aspects related to OGC (PSICONCOGEN), with specific attention to Italian situation. This committee received the endorsement from the SIPO. Goals of PSICONCOGEN committee are: to evaluate how psychologist are involved in OGC in Italy; to elaborate specific guideline for psychological intervention on OGC; to promote conferences on OGC; to elaborate multicentric studies on psychological aspect of OGC. Members have met together three times. During these meeting, they have decided to realise an explorative research on OGC models applied in Italy. This research will enable members to: outline a map of Italian centres where OGC is conducted, find out psychological intervention models in Italy, contribute to elaborate psychological intervention guidelines. Maria Antonietta Annunziata, Dania Barbieri, Cristina Bellati, Claudia Borreani, Caterina Cordello, Anna Costantini, Nadia Crotti, Tatiana Danese, Laura Gangeri, Elena Meggiolaro, Samantha Serpentini, Miriam Strada, Cristina Vigna.

464 Quality of Life in Women with Breast Cancer

Copyright # 2006 John Wiley & Sons, Ltd.

Carvalho A, Domingues V, Cabral AS, Santos Z Department of Psychiatry, Coimbra University Hospital, Coimbra, Portugal BACKGROUND: Most women experience at least some psychosocial distress during the course of their breast cancer diagnosis and treatment. The level of distress varies from woman to woman and, within an individual, over the course of diagnosis and treatment. Cancer-related distress can be expected to dissipate with time for the majority of individuals diagnosed with cancer. For others, however, such distress may interfere substantially with comfort, quality of life, and the ability to make appropriate treatment decisions and adhere to treatment. AIMS AND METHODS: The aim of the present study was to analyse the psychological condition and the quality of life among women in treatment for breast cancer and how those variables are related. The authors studied 50 women currently in chemotherapy treatment in the Oncology Day Unit of the Coimbra University Hospital, using a brief demographic questionnaire, the Brief Symptom Inventory (BSI) and the Medical Outcomes Study-Short Form (SF-36). CONCLUSIONS: The authors made a reflection about their results, and have concluded that women studied showed good psychological adjustment and quality of life.

465 Sleep and Surgery in Cancer Patients Casault La,b, Simard Sa,b, Savard Ja,b a Laval University Cancer Research Center, L’hoˆtelDieu de Que´bec, Que´bec, Canada; bSchool of Psychology, Laval University, Que´bec, Canada Insomnia affects between 30 and 50% of cancer patients. Surgery is among the factors that may contribute to the triggering of insomnia in cancer patients, although this hypothesis has yet to be investigated in a prospective study. PURPOSE: This study, conducted on 130 cancer patients, aimed at assessing the effect of surgery on sleep quality. METHODS: The participants were met during their preoperative examinations and they were asked to complete a socio-demographic questionnaire and the Insomnia Severity Index (ISI). Approximately 1 month after the surgery, the participants were contacted by telephone in order to complete the ISI for a second time. RESULTS: Results of a T-test for matched samples showed a significant difference between

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the two times of measurement on the total ISI score (pre-versus post-surgery), tð102Þ ¼ 2:21; p5 0:05: Specifically, the mean ISI score was significantly greater at the preoperative phase (M ¼ 6:22; ET ¼ 5:12) compared to after the surgery (M ¼ 5:16; ET ¼ 4:94). Moreover, 22.3% of the participants who had a clinical ISI score (i.e. score 8) prior to the surgery, did no longer meet this criterion in the post-operative phase. CONCLUSIONS: Contrary to our expectations, this study showed a reduction in the severity of sleep difficulties following surgery. Although additional research is necessary, this study suggests that insomnia may be more strongly associated with the stress associated with the surgery, a problem that may fade away after the procedure has been completed.

the indicators of central areas of our work: costbenefit relation as regards new company-minded hospital targets, dynamics between health staffs, communication and relationship doctor-patient, life quality and psychological wellbeing of oncological patients. CONCLUSION: The presence of our staff in the oncological department permits operators to linger over and cross some areas of professional identity, usually not taken care, but expressed in acting and cause of a background of anxiety, depression, frustration. A holistic and global taking care of patients has given a better equilibrium and psycho-physical well-being, an attenuation of anxious-depressive symptoms, a better life quality.

466 ‘Psichiatria di Collegamento’: Models and Operating Praxis Carreca A, Cina` G, Novembre MR, Prestifilippo C, Sabatino C Dipartimento Salute Mentale ASL 6- U.O. Psichiatria di Consultazione e Collegamento, Palermo, Italy

A Needs Assessment of Male Partners of Newly Diagnosed Women with Breast Cancer Cheng Ta, Jackman Ma, McQuestion Mb, Fitch Mc a Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, Toronto, Canada; b Nursing, Princess Margaret Hospital, Toronto, Canada; cPsychosocial & Behavioural Research Unit, Toronto-Sunnybrook Regional Cancer Centre, Toronto, Canada

INTRODUCTION: Our contribution wants to explain the activity carried on for more than ten years in psycho-oncology by the Sicilian ‘Psichiatria di Collegamento’ constituted by a multidisciplinary staff, connected with ASL 6 of Palermo. The purpose is a specific and multidisciplinary support toward health operators and patients of many oncologic department in Palermo, throughout a particular attention not technical, but mostly for human and empathetic aspect. The objectives are: Continuative taking care of patients of various oncological departments that present psychiatric/psychological emergencies; Sensitising the operators towards a psychological listening (holding of diseases expressed or not by operator exposed to stressful events); Connection with family doctor, domiciliary (house) assistance in collaboration with voluntary services, outpatients’ activity (pharmacological and psychotherapeutic); Psychological and pedagogic operation with patients’ families. METHODS: The instruments used were: for patients, psychotherapeutic (individual or group), psychopharmacological, psychosocial supports; for operators: Workshop, Balint or support group. RESULTS: In this contribution, we limit ourselves to notice

BACKGROUND: The diagnosis of breast cancer has a devastating impact on the patient and her family, in particular her male partner. It creates a ripple effect that changes the family’s basic identity and heralds the host of other challenges that follow. As the psychological reactions and traumatiztion of women with breast cancer are increasingly well documented in the literature, more interest is being paid to the experiences and needs of their male partners. Husbandly support and empathy play a key part in the emotional adaptation and recovery of the woman. But as the ‘co-sufferer’ (Northouse and Peters-Golden, 1993), these partners are in a unique position of needing support as well as providing it. Because the needs of male partners are not well understood, they are often overlooked by the health care profession. PURPOSE: The aim of this qualitative exploratory study is to develop an understanding of the experiences of male partners of women newly diagnosed with breast cancer. METHOD: 33 male partners participated in semi-structured telephone interviews. Interviews occurred 6 months post breast surgery in order for the men to have time to move beyond the crisis of the situation of their partner’s diagnosis and start of

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treatment and be able to reflect on their experience. RESULTS: An inducive strategy is being used to analysis the data. The findings of this evaluation will be presented. CONCLUSION: The findings of this evaluation will be presented.

468 Neoplasia and Psychotheic Image Chikota Oa, Ceccarelli Fb, Palumbo Gc a Psychosomatics Catarinense Psychosomatic Association and European Association of Ontopsychology, Santa Catarina, Brasil; bSurgery General Hospital, Latina, Italy; cPsychology European Association Ontopsychology, Roma, Italy PURPOSE: Even though the field of medicine has developed tremendously; the wide variety of cancer is still among chronic and life threatening disease today. Therefore, the specialists constantly research and try every possible way to find psychological social and behavioural variables that influence cancer prevention; risk and survival. In this paper, the authors will focus on subject interior image working at psychological level. Specifically, the psychotheic image that make it possible to manage and intervening on emotional distress related with cancer and biological and cellular interactions will be discussed. METHODS: The psychosocial interview according to the ontopsychological approach; focused on the presence or absence of ruminating images/ideas of introverted hostility and impact of psychic intentionality variables are illustrated with clinical cases examples. RESULTS: The analysis of the results has shown that, 1. The introverted hostility in people with cancer was high in both male and female patients, although very exemplary socially but bringing inside a latent revenge, image/idea and ruminating on it: 2. The lack of functional coping strategies in front of a strongly frustrating situation. CONCLUSIONS: The results from this study highlight the importance of taking into account subject ruminating ideas/psychotheic image of revenge. Furthermore, teaching the subject how to change his/her ideas/thought from negative to positive image and thought can be used as a form of preventive ways to increase patient quality of life and decrease cancer further development through its different steps. ACKNOWLEDGEMENTS: The authors thank the Chair of Ontopsychology of the Faculty of Psychology, State University of Saint Petersburg for scientific support.

Copyright # 2006 John Wiley & Sons, Ltd.

469 Depression 15 Months after Surgery in a Nationwide Cohort Study of 3400 Danish Women Treated for Loco-regional Invasive Breast Cancer. The Influence of Histopathology, Treatment, Demographics, Health Status, Health-related Behaviors, and Psychosocial Factors at Baseline Christensen Sa, Zachariae Ra, Jensen ABa, Væth Mb, Mller Sc a Psychooncology, Aarhus University Hospital, Aarhus, Denmark; bBiostatistics, Aarhus University, Aarhus, Denmark; cDanish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark PURPOSE: Identifying predictors of depression 15 months after surgery for breast cancer. METHODS: Eligible patients (n ¼ 4968; 21–70 yrs.) were treated for loco-regional breast cancer between 2001 and 2004. A questionnaire including Beck’s Depression Inventory (BDI-II) was mailed out 3–4 months (baseline) and 15–16 months post-surgery (Follow-up). Response rates were 68.1% ðn ¼ 338 1Þ (baseline) and 91.4%, n ¼ 3091 (follow-up). RESULTS: BDI scores were lower at follow-up (M ¼ 7:57; SD ¼ 7:48) than baseline (M ¼ 8:86; SD ¼ 7:47) ðp50:0005Þ: 239 women were moderately severely depressed at follow-up. The final model of a hierarchical logistic regression entering: (1) disease- and treatment variables, (2) demographics, (3) health behaviors, and (4) a number of psychosocial variables, including alexithymia, hostility, cancer-related distress (IES), and depression at baseline, showed that depression at followup was predicted by cancer-related distress (IES) (OR ¼ 1:015; p ¼ 0:029). Reduced risk of depression was associated with being older (OR ¼ 0:963; p ¼ 0:009), better physical functioning (OR ¼ 0:988; p ¼ 0:024), and never having smoked (OR ¼ 0:525; p ¼ 0:007) or being a former smoker (OR ¼ 0:585; p ¼ 0:027). Generally histopathological and treatment related variables did not predict depression. Allocation to radiotherapy was marginally significant in the final model (OR ¼ 1:55; p ¼ 0:057). CONCLUSIONS: Increased risk of depression was independently predicted by smoking status, physical function, and cancer-related distress.

470 Differences in Pain Perception between Patients With and Without Cancer. Role of Anxiety and Depression

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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Ciaramella A, Lucente F, Paroli M, Poli P Unita` di Terapia Del dolore e Cure Palliative, Dipartimento di Oncologia, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy BACKGROUND: Recent reviews suggest that the prevalence of pain in advanced cancer is about 70% (Bruera and Portenoy, 2003). PURPOSE: To investigate the influence of the presence of depression and anxiety on the perception of clinical pain in patients with and without cancer. METHODS: Consecutive and eligible patients (April–December 2005) were recruited in the Pain Therapy Unit of Pisa. All patients were investigated through: (a) an electronic demographic, collected file (b) an Italian multidimensional questionnaire for pain, Quid (De Benedittis et al., 1987) (c) a self-report questionnaire for Anxiety and Depression, HADS (Zigmond and Snaith, 1983). RESULTS: Three hundred and one patients with chronic pain (129 with cancer and 172 without cancer) were recruited. Patients with various site of cancer and pain were recorded. Chronic pain patients with cancer had more Affective (PRIrcA), Evaluative (PRIrcE) and less intensity of pain (VAS) (p ¼ 0:002; p50:0001; p ¼ 0:042; respectively) than chronic pain patients without cancer. Significant positive correlation coefficient was found from the total score of Depression and Anxiety of HADS and Sensorial, Affective, Evaluative and intensity of pain. The differences of Affective, Evaluative dimension and intensity of pain between the two groups were independent of the presence of Anxiety and Depression (ANCOVA Analysis). Sex and age have not influence on the different perception of pain between the two groups. CONCLUSIONS: Although Anxiety and Depression increase all dimensions of pain, the differences in pain perception between the two groups was found to be independent.

471 How to Better the Quality of life in Women in Oncology: Results Experienced with Art Therapy Cini Ra, Ciuffardi Ga, Biancalani Fb, Velicogna Fb a La Finestra, Florence, Italy; bMetis, Florence, Italy INTRODUCTION: Since one year, the voluntary association ‘La Finestra’ collaborates with the rehabilitation structure Villa delle Rose in Florence, organizing Art Therapy courses for

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Oncology patients. This study examines the efficacy of the use of Art Therapy, based on music and the use of images acquired with colour and creations, to better the Psychosocial adapting to the illness and thus reducing the feeling of isolation favouring communication regarding the patient’s state of health. SUBJECTS AND METHODS: A group of 21 Women suffering from Cancer was selected and issued with the Functional Living Index-Cancer (FLI), a questionnaire related to how the Tumour and relative therapy alters social functions. The experiment adopted, as a design, to issue the FLIC both at the beginning (pre-test) and at the end (post-test) of a 10 week period during which the Therapy activity was carried out. RESULTS: Analysis of the data demonstrated a significant variation ðp ¼ 0:01Þ in the quality of life perceived by the group at the end of the Art Therapy, with positive effects, in particular, regarding self-confidence for the future and satisfaction expressed regarding domestic and occupation activity. CONCLUSIONS: The results of the study portray that participation in Art Therapy courses can contribute to better the Psychosocial aspects of the illness and relative therapy and thus the life quality of the patient. Also the test carried out demonstrates the effectiveness of the FLIC in the Italian clinical context.

472 Study to Evaluate the Effectiveness of Art Therapy to Reduce Distress in Oncology Patients Ciuffardi Ga, Cini Ra, Focardi Fb, Fioretto Lb, Velicogna Fc a La Finestra, Florence, Italy; bS.M. Annunziata Hospital (Oncology Section), Florence, Italy; c Metis, Florence, Italy INTRODUCTION: In the DH Oncology section of the S.M Annunziata Hospital in Florence (ASL 10), a study was carried out to determine the effectiveness of Art Therapy aimed at improving life quality in patients suffering from Neoplastic pathologies. This study provided confrontation between one group which had chosen to follow Music Therapy with Video activity as proposed by the Voluntary Association ‘La Finestra’ and a second verification group (balanced by sex, age and cure interval) which was not exposed to the Therapy. SUBJECTS AND METHODS: Within a 5 month interval (February–July 2005) 56 patients received the Symptom Distress Scale (SDS) self-evaluation questionnaire, which, in

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the past, proved to be a valid method to quantify experimental conditions relative to short periods and thus portray changes in variables such as, humour, pain and psychophysical conditions. RESULTS: Analysis of data produced demonstrates that the application of Art Therapy associates a significant reduction in the value of perceived distress ðp ¼ 0:01Þ and, in particular, in those variables related to the Psychological area: In fact, patients, exposed to the Therapy, declare minor tiredness and openly look and feel better. CONCLUSIONS: Results obtained confirm the Psychometric property of the SDS questionnaire (alpha Cronbach ¼ 0:78; four individual factors) and demonstrate that specific Art Therapy application can be useful in the reduction of sense of tiredness and suffering linked to physical symptoms in Oncology.

473 The Study on the Psychotherapy and the Psychological Rehabilitation of Malignant Tumor Ciyao H Traditional Chinese Medicine Ningbo No. 2 Hospital, Ningbo, China PURPOSE: The purpose of this study is to evaluate the effects of psychological factors in the progress, metastasis, prognosis and outcome of malignant tumor. METHODS: Analyze the observation of emotion and personality in most of the patients with malignant tumor. RESULTS: Under the guidance of ‘Biology-Emotion-Society’ clinical treatment mode and TCM theory, medical staff can use rational emotion psychotherapy, positive reinforcement procedures, catharsis treatment, nonverbal treatment, TCM seven emotions theory and traditional Chinese and western medicine treatment which will help patients allay negative emotion, increase confidence on treatment to improve the quality of life. CONCLUSIONS: When patients receive comprehensive treatment, medical staff must think highly and analysis the reasons of negative emotion in patients, can try to use ‘Biology-Emotion-Society’ clinical treatment mode and TCM theory.

b

Familial Cancer Centre, Peter MacCallum Cancer Institute, Victoria, Australia PURPOSE: The Cancer Council Victoria (TCCV) in conjunction with the Peter MacCallum Familial Cancer Centre has developed the Cancer Gene Support Program (CGSP) for people who are known to carry a gene mutation increasing their risk for the development of cancer. Program development included the support of and collaboration with Victoria’s Familial Cancer Centres (FCC). AIM: Previous research has identified unmet needs around support in this group. The CGSP will provide innovative, telephone-based peer support in an attempt to meet these needs. METHOD: The CGSP is based on TCCV’s successful Cancer Connect (CC) Program where people are matched with a trained volunteer who can share their cancer experience. The CGSP will train people with BRCA 1/2, HNPCC or FAP mutations, who have an increased risk for cancer although not had a cancer diagnosis, to provide telephone peer support. RESULTS: To date a committee of Genetic Counsellors and TCCV staff has developed the CGSP. Recruitment for potential volunteers occurred via the FCC and 12 people have been interviewed and accepted into the program. Further recruitment of HNPCC and FAP mutation volunteers is also planned. Program evaluation will be based on CC methods and research in the form of a RCT is being considered. CONCLUSION: The CGSP will meet the support needs of people already identified with a genetic mutation. In addition it will also provide invaluable groundwork in terms of cancer control and knowledge about support options for people with genetic mutations.

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Cancer Connect}Telephone Peer Support. Evaluating Shared Experiences Coffin JMa, Sutherland Gb, White Va, Raco Ga, Livingston Ta a Cancer Information and Support Service, The Cancer Council Victoria, Carlton, Victoria, Australia; bFamilial Cancer Centre, Peter MacCallum Cancer Institute, Victoria, Australia

The Cancer Gene Support Program}Providing Peer Support for People with Genetic Mutations Coffin JMa, Young MAb, Akkerman Da a Cancer Information and Support Service, The Cancer Council Victoria, Carlton, Victoria, Australia;

PURPOSE: Cancer Connect (CC) is a telephonebased peer support program where patients receive one-on-one support from a cancer survivor, matched according to numerous variables. Cancer patients’ experience and satisfaction with

Copyright # 2006 John Wiley & Sons, Ltd.

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the CC program will be discussed. METHOD: Fifty cancer patients who contacted the Helpline and agreed to be involved in the CC program were recruited into the study. Patients participated in two telephone questionnaires, one at baseline and one 3 months after the initial call. Participants for this report are patients who reported contact with a CC volunteer at baseline ðn ¼ 36Þ and at followup ðn ¼ 41Þ: RESULTS: At baseline, 94% of patients reported that it was ‘easy’ or ‘very easy’ to talk to a CC volunteer and over 80% reported that they felt better after the telephone conversation. Most people (78%) reported that the contact with the volunteer was very helpful. At three month follow up, 93% of patients reported that contact with the volunteer affected their situation. Participants reported the program had a positive impact, they felt better informed, encouraged, confident, and empowered. 81% of patients agree that their volunteer made them feel that they weren’t alone. All participants commented they would recommend the service to others. CONCLUSION: Results suggest receiving information and support from someone who has had a similar diagnosis can positively affect cancer patients’ experience. Words used by patients to describe their situation, such as feeling reassured and encouraged, show the potential positive impact of peer support.

476 Supporting the Supporters. Attending to Volunteers of a Telephone Peer Support Program Coffin JM, Akkerman D, Hoey L, Raco G Cancer Information and Support Service, The Cancer Council Victoria Carlton, Victoria, Australia PURPOSE: Cancer Connect (CC) is a telephone peer support program where callers to The Cancer Council Victoria’s (TCCV) Cancer Helpline are matched with a trained volunteer who can share their experiences. Supporting these volunteers is integral to the program’s ongoing success. METHODS: Following recruitment, volunteers attend 3-day intensive training. Annual training maintains their accreditation and media and public speaking sessions are offered for those wishing to be program ambassadors. Detailed contact forms are submitted after every telephone call and reviewed by the program coordinator. Volunteers are strongly encouraged to debrief their calls and consider their self-care needs by taking ‘time out’ from the program. Program

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evaluation (questionnaire format) explored volunteer satisfaction. RESULTS: CC Volunteers are conscientious and motivated, demonstrated by their training attendance, ambassador roles and submission of contact forms. They utilise debriefing opportunities and value contact with/from the program coordinator. All available volunteers (119) received a questionnaire about the program and their role. It yielded a response rate of 75%. Ninety-five per cent of volunteers were satisfied with matches ‘all’ or ‘lots of the time’. Satisfaction with being a CC volunteer was high (76%) and 90% reported that they were ‘satisfied’ or ‘very satisfied’ with the level of support they received from TCCV. CONCLUSION: CC volunteers are supported in multiple ways and report that they are satisfied with their experiences of the program. Their satisfaction is indicated by their responses, their length of service, ongoing enthusiasm and commitment to the program.

477 Patient Education in Cancer: Effects on Illness Perceptions, Emotions and Support Hoey L, Sutherland G, Coffin JM, Hegarty S Cancer Information and Support Service, The Cancer Council Victoria Carlton, Victoria, Australia PURPOSE: The Living with Cancer Education Program (LWCEP) enables patients and family/ friends to learn about cancer within a supportive group environment. We examined how the program influences participant perceptions of illness, emotions and feelings of support. METHODS: The LWCEP is free, conducted by trained facilitators and consists of two-hour sessions weekly for between 4 and 8 weeks. Participants complete pre- and post-program questionnaires assessing their understanding of cancer, feelings of support and emotional functioning. Participants were 705 patients and 354 family/friends. RESULTS: The majority of attendees were female (72% patients, 66% family/friends). Patients reported an average time since diagnosis of 19 months. Paired t-tests examined change over time in illness perceptions and emotions. Both cancer patients and family/ friends reported their understanding of cancer and treatment improved over time. They felt more positive, in control, supported and able to cope. Participants also indicated they felt better able to communicate with health professionals and were less worried and stressed at the end of the program comparison to pre-program responses.

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CONCLUSION: These findings suggest the LWCEP may assist cancer patients cope with their diagnosis. The results also indicate the potential benefit of providing information and support to the family/friends of people with cancer. Although it is possible that improvements in perceptions of emotional functioning and support may have occurred over time without participation in the program, the results most likely reflect the positive impact of education and support to the experience of cancer.

478 Participant Reflections. Providing a Peer Led Communication Skills Program For Cancer Clinicians Coffin JM, Jefford M, Tilkeridis J, Sutherland G, White V Cancer Information and Support Service, The Cancer Council Victoria Carlton, Victoria, Australia PURPOSE: The Victorian Cancer Clinicians Communication Program (VCCCP) establishes a service delivery model here cancer clinicians attend half-day communication skills workshops. The workshops are co-facilitated by an oncology clinician and clinical psychologist who attended facilitator training. Participants’ experiences of the workshops were examined. METHOD: Participants completed a post-workshop evaluation form. Questions assessed satisfaction with: the workshop; the role-plays; the facilitators; and characteristics of the workshop (e.g., location). RESULTS: Thirty one clinicians participated and 64% were female. Ages ranged from 27 to 65 years. Preliminary analyses indicated the workshop was rated very highly: 97% were very satisfied or satisfied with the information delivered and 94% were satisfied with the practical skills presented. Only 10% did not think the workshop increased their understanding of the evidence base for communication skills. All participants agreed that the role-plays provided an opportunity to practice new skills and the vast majority (96%) felt safe and comfortable when role-playing. Most strongly agreed that the facilitators created a safe environment for practicing skills (69%) and encouraged everyone to be involved (76%). Those in larger groups (>7) reported that group size hindered involvement. Physical characteristics (i.e. comfort of training room) received the poorest ratings. CONCLUSIONS: This pilot program has been received favourably by clinicians and

Copyright # 2006 John Wiley & Sons, Ltd.

provided them with opportunities to learn and practice new skills. Overall, the results of the VCCCP pilot program have provided enough clinical evidence for continuation of VCCCP as a core program of The Cancer Council Victoria.

479 Early Breast Cancer Detection Practices, Health Beliefs and Cancer Worries in Jewish and Arab Women Cohen M, Azaiza F School of Social Work, Haifa University, Haifa, 31905, Israel PURPOSE: 1. To study differences in practices of breast examinations (BE) for the early detection of breast cancer among Arab and Jewish women. 2. To characterize demographic, cognitive, and emotional factors related to Arab and Jewish women’s BE practices. METHODS: 489 Jewish women and 440 Arab women, ages 20–60, and randomly sampled from the female population of Israel, answered a telephone questionnaire related to BE practices, health beliefs, and breast cancer worries. RESULTS: Arab women performed fewer BE practices, received fewer recommendations from physicians for mammography screening, perceived fewer benefits, reported lower confidence and more barriers to self BE, but higher benefits together with more barriers to mammography and more barriers to clinical BE. They perceived a higher severity of breast cancer, but a similar susceptibility to breast cancer and the same level of cancer worries as Jewish women. Logistic regression revealed that age, ethnicity (Arab/Jewish), and barriers significantly predicted BE practices. Physician’s recommendation predicted ever having mammography, higher perception of susceptibility predicted taking clinical examinations, while self BE was also predicted by confidence in its performance and by cancer worries. CONCLUSIONS: Health communication should be made more accessible to Arab women to increase performance of BE practices. Special efforts should be invested in elevating physicians’ awareness of their crucial role in this.

480 The Contribution of Attachment Styles Among Breast Cancer Mothers, to the Distress and Well Being of their Adolescent Daughters Cohen Ia, Berant Ea, Mikulincer Ma, Hubert Ab

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a

Psychology, Bar Ilan University, Ramat, Gan, Israel; bOncology, Sharrett Institute of Oncology, Hadassah, Jerusalem, Israel

Nursing, University of Shizuoka, Shizuoka, Japan; c Health Science, Tokyo Gakugei University, Tokyo, Japan

PURPOSE: To examine the contribution of attachment style from mothers diagnosed with breast cancer to levels of mental distress of their adolescent daughters. While previous research shows that adolescent daughters are especially vulnerable to the effect of the parent disease, few studies have attempted to explain the individual differences. We assume that the attachment style of the mothers could explain the levels of distress of their daughters. METHOD: An experimental group of 52 women diagnosed with breast cancer stage 1–3, and their adolescent daughters, and a control group of 21 healthy women and their adolescent daughters were recruited for this study. Demographic date were gathered, and the Attachment Scale (ECR) and Mental Health Inventory were administered. RESULTS: Two multiple linear regressions were conducted separately in each study group. Dependent variables were daughter’s distress and well-being, and mother’s attachment style: with attachment avoidance style as the independent variables. In the experimental group, the mothers’ attachment style accounted for 16.1% of the daughters’ distress and 12.3% of their well-being. In the control group, mothers’ attachment style was not a significant contributors to daughters’ distress (1.3%) nor to their wellbeing (2%). Only the anxiety attachment style of mothers diagnosed with breast cancer was found to be significantly correlated negatively with their daughters’ distress (r ¼ 0:35; p ¼ 0:01), and significantly positively with their daughters’ wellbeing (r ¼ 0:33; p50:05). CLINICAL IMPLICATIONS: The attachment style of mothers diagnosed with breast cancer and its effect on adolescent daughters should be considered relevant in the psycho-oncology setting. ACKNOWLEDGEMENTS: This study was supported by The Israel Cancer Association.

PURPOSE: This study was conducted to implement a supportive–expressive group facilitator training program for nurses, and to evaluate its effects. METHODS: This 2-day (19-hour) education program addressed the purpose of the support groups, the role of the facilitators, the problems that could arise in the groups and how to respond to such problems, and so forth. The participants were all nurses, with a mean age of 36.2 years, and a mean cancer nursing experience of 8.5 years. The effects of the program were evaluated regarding the changes in concern and self-efficacy in the face of difficult situations in supportive groups before and after participation. The rating scale consists of 16 items on a 5-point scale regarding concern and self-efficacy, namely, Concern on the Group Scale and Self-efficacy on the Group Scale. A paired t-test was used for analysis. RESULTS: After participation in the program, a significant change in concern was observed in 4 items and the total score. Concern was significantly decreased in the items ‘there is a member who talks at length’ and ‘there is a member who doesn’t talk at all.’ A significant change in self-efficacy was observed in 7 items and the total score. Self-efficacy was significantly elevated in the items ‘there is a member who complains about medical staff,’ and ‘the topics in the group lack depth.’ CONCLUSION: I was shown that this program alleviates concern and elevates self-efficacy in some of the difficult situations faced by nurses who facilitate support groups for patients with cancer.

481 An Evaluation of a Support Group Facilitator Training Program for Nurses Part 1}Changes in Concern and Self-efficacy in the Face of Difficult Situations Yoshida Ma, Asakura Tb, Morita Ma, Okuhra Hc, Endo Ka a School of Nursing, The Japanese Red Cross College of Nursing, Tokyo, Japan; bSchool of

Copyright # 2006 John Wiley & Sons, Ltd.

482 An Audit to Assess the Impact of Education About Sexuality on Medical Assessments in a Specialist Palliative Care Service Colleran MCa, McQuillan RJa, Bharacha Sb a Palliative Care, St. Francis Hospice, Dublin, Ireland; bUniversity of Minnesota Medical School, Minneapolis, MN, USA INTRODUCTION: Sexuality is integral to a person’s sense of self and to their sexual relationships. The limited studies available indicate that patients with advanced cancer wish to discuss the impact of cancer on their sexuality and sexual function. However, patients would prefer if health

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care professionals initiated the discussion. PURPOSE: The aim of this audit was to assess the impact of education about the importance of sexuality on medical assessments in a specialist palliative care service. METHODS: A retrospective review of all medical assessments of patients either in homecare or the inpatient unit in January 2006 was preformed. Education on sexuality in palliative care was provided. Possible phrases to initiate the discussion of the impact of cancer on sexuality were proposed. A prospective assessment of all new patients was preformed for a one month period from March. To continue the audit cycle, the results were reviewed by the medical team. RESULTS: 47 medical assessments were carried out in January and 46 in March in homecare and 23 and 22 respectively in the inpatient unit. Sexuality was addressed in 6 patients in January and 32 patients in March. Sexuality was considered in 9 patients but not assessed for clinical reasons. CONCLUSIONS: Education can improve the incorporation of the impact of cancer on sexuality in medical assessments in palliative care. It is planned to continue the inclusion of sexuality in medical assessments. Further developments will include assessing the appropriate timing of such discussions.

RESULTS: Patients’ and partners’ GHQ-28 scores were correlated with each other, as were ODCF scores (respectively, r ¼ 0:53; p ¼ 0:005; and r ¼ 0:47; p ¼ 0:016). Neither patients’ nor partners’ psychosocial distress were associated with patients’ gender, age, educational level, cancer stage, time elapsed since diagnosis, and ODCF scores of each member of the couple. Couples were subsequently divided in four classes according to the median-split ODCF scores of each partner (limited–limited, limited–open, open– limited and open–open communication). After controlling for gender, patients’ as well as partners’ GHQ-28 scores were found lower in couples with concordant communication skills (open, or else limited, in both members) compared with discordant couples (open communication for one member and limited for the other): p ¼ 0:038 and 0.052, respectively, for patients’ and partners’ GHQ-28. CONCLUSION: These results encourage to take into account communication skills in couples affected by cancer and to respect them or, on the contrary, to propose an appropriate support, according to the concordant or discordant pattern of communication characterizing each couple.

484 483 Psychosocial Distress and Communication About Cancer Within Couples, When One of the Members is Treated for Cancer Consoli SMa, Pelicier Nb, Paradis Mc, Andrieu Jd, Jian Re a C-L Psychiatry, European Georges Pompidou Hospital, AP-HP, Paris-5 University of Medicine, Paris, France; bMedical Oncology and Haematology, La Source Hospital, Orleans, France; c 3rd sector of adult psychiatry, Sainte Anne Hospital, Paris, France; dHepato-Gastro-Enterology European, Georges Pompidou Hospital, Paris, France; eOncology European, Georges Pompidou Hospital, Paris, France PURPOSE: To explore the levels of psychosocial distress, communication skills, as well the association between both groups of variables, within couples comprising one partner treated for cancer. METHODS: 30 couples (19 male and 11 female patients) completed the general health questionnaire (GHQ-28) and the Openness to Discuss Cancer in the nuclear Family (ODCF); a version of the latter was adapted for the partners.

Copyright # 2006 John Wiley & Sons, Ltd.

Qualitative Study to Explore Cancer Clinicians’ Perceptions of Their Role in Providing Emotional and Psychological Support for Cancer Patients Coombes La, Tolosa Ia, Horne David, Jde La, Medley Ab a Cancer Centre, University Hospital Birmingham, Birmingham, UK; bPsychology Brain Injury Rehabilitation Trust, Birmingham, UK PURPOSE: This qualitative study focuses on cancer clinicians’ views of their role and experience in providing emotional and psychological support for cancer patients. Specifically to explore what they see as their role, how they discuss emotional and psychological concerns with patients, and when and how they decide to refer patients (or family members) for specialist psychological support. METHOD: Semi-structured interviews were conducted with 5 participants (health professionals) with at least two years’ experience working in oncology. Data was analysed using grounded theory methodology. RESULTS: Clinicians expressed differing views of their role in talking to patients about the emotional and psychological impact of cancer.

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Some were comfortable eliciting these concerns; others did not see this as part of their role. Views were influenced by their attitudes about the importance of psychosocial issues and good communication skills in patient adjustment to cancer, and their own coping strategies. Other relevant factors were lack of privacy and time to elicit concerns, and fear of unleashing strong emotions in patients. Health professionals perceived patients’ fears, and a socio-cultural stigma of mental illness and psychological/psychiatric services. This influenced both explanations of the cancer psychology service and their tendency to refer patients. CONCLUSIONS: Clinicians acknowledged an emotional impact of working in oncology and responded to patients either by encouraging disclosure of emotional concerns; or blocking disclosure. Both may be appropriate responses and depend on various factors, e.g. patient readiness to disclose, the availability of time and privacy for discussion and clinician confidence.

485 The Curie Institute Ethics Project: An Innovation in the Field of the Hospital Ethics Copel LM , Mino JC , Zucker JM , Bellanger AM Supportive Care Institut Curie, Paris, France PURPOSE: In France there are two models of ‘structures d’e´thique’ in hospitals. First, in the area of research, there are ‘committees’ comprising university doctors, medical researchers and experts. They have a normative role and opine on research protocols. Secondly, in the area of patient care, there are ‘think tanks’ of practising professionals. They discuss the day-to-day matters and institutional considerations in an open and reflective way. However, neither of these groups handle specific patient cases as their purpose is not to decide but to discuss. The Curie Institute is a comprehensive cancer centre encompassing both research and daily patient care. We have sought to develop a third type of ‘structures d’e´thique’ which is a mix of the research and discussion group models. METHOD: A small experienced multidisciplinary workgroup was formed which reviewed available studies and research data and elaborated recommendations for the implementation of an innovative project in this field. RESULTS: The Project aims to help doctors and the administrators in their daily decisions whilst still leaving the actual decision making

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power with such professionals. The Project performs three purposes: (1) to provide every professional with tools for practical analysis, (2) to assist hospital administrators in making decisions on institutional questions, (3) to provide support in the making of decisions in cases of particular clinical difficulty. The working philosophy, architecture and specific means upon which the Project is based will be described in detail in the presentation.

486 Longitudinal Cognitive Follow-up in Low-Grade Glioma Patients Correa DDa, Shi Wb, Thaler HTb, Cheung AMa, DeAngelis LMa a Neurology MSKCC, New York, USA; bEpidemiology and Biostatistics MSKCC, New York, USA PURPOSE: In low-grade glioma (LGG) patients, the tumour itself and treatment with conformal radiation therapy (RT) and chemotherapy can disrupt cognitive function. The few published studies examining the contribution of disease and treatment effects to cognitive outcome revealed conflicting results. In this study, we performed longitudinal cognitive follow-up in a subgroup of patients who received RT, chemotherapy, or no treatment. METHODS: Twenty-five of 40 LGG patients underwent three cognitive evaluations at approximately 6-month intervals; 9 patients received RT  chemotherapy and 16 had no treatment prior to enrolment. RESULTS: Patients showed no overall cognitive impairment (i.e. defined as scores 4 1.5 standard deviations below normative values); however, at the initial evaluation treated patients had z-scores 1 standard deviation below normative values on tests of working memory, psychomotor speed, and cognitive flexibility. Repeated measures analyses of variance showed a significant variation over time ðp ¼ 0:03Þ in nonverbal delayed recall scores. Treated patients’ performance improved at the second evaluation to a level comparable to untreated patients; both declined slightly by the third evaluation. Patients who dropped out of the study after the baseline or 6-month evaluation due to disease progression ðn ¼ 8Þ or loss to follow-up ðn ¼ 7Þ obtained lower baseline nonverbal memory test scores than patients who completed the study ðn ¼ 25Þ: CONCLUSIONS: Treatment with RT  chemotherapy contributed to mild

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cognitive difficulties in LGG patients. Recall of nonverbal information may be a more sensitive measure to detect longitudinal cognitive change in this population.

487 Young Adults and Cancer: ‘The Forgotten Age’ Unique Challenges and Unique Options Corsini La, Ammerman DJb a Social Work, The Ottawa Hospital Regional Cancer Centre, Ottawa, Canada; bClinical Epidemiology Program, The Ottawa Health Research Institute, Ottawa, Canada PURPOSE: Cancer is generally a disease of older adults. In 2005, only 5% of newly diagnosed cancer patients at TOHRCC were between 18 and 35 years of age. The purpose of this study was to determine whether young adults with cancer face unique challenges regarding relationships, selfimage, fertility, education, career, and/or finances and if so, whether these needs are being met by current psychosocial services at TOHRCC such as Connexions 18–35, an age-specific face-to-face support group currently being offered to this patient population. METHODS: All newly diagnosed cancer patients between the ages of 18 and 35 registered at TOHRCC in the years 2004 and 2005 were identified through a computer-generated list. A short survey consisting of 12 questions and an information sheet describing the available age-specific services were mailed to 210 young adult cancer patients identified. A minimum 60% response rate ðN ¼ 126Þ is expected. RESULTS: Data collection is ongoing and will be presented. Based on preliminary results, it is expected that younger cancer patients have unique needs that may warrant the implementation of innovative psychosocial interventions. For example, young adult cancer patients may prefer to receive pertinent services electronically via the Internet. CONCLUSIONS: It is expected that young adults with cancer may have unique age-specific needs not currently being met by the services available to them at TOHRCC. Survey results will be present and may offer future directions for the development and implementation of age-specific psychosocial services.

488 ‘What about my kids?’ A Guide for Parents Living with Breast Cancer Corsini L

Copyright # 2006 John Wiley & Sons, Ltd.

Social Work, The Ottawa Hospital Regional Cancer Centre, Ottawa, Canada PURPOSE: ‘What about my kids?’ is often the second question parents ask upon learning that they have breast cancer. The first question mostly asked is: ‘Will I live or die from my illness?’ Few resources exist to help parents manage the demands of parenting while they deal with their illness and treatment. This book covers the entire course of illness from diagnosis, treatment, survivorship, recurrence, advancing illness, death and bereavement. Throughout it offers information, coping strategies and resources for parents with breast cancer. Specific chapters are also devoted to topics of genetics, finances, and legal issues as they relate to parenting concerns. METHODS: The idea for this book came from a monthly workshop for parents with cancer led by this writer in Ottawa. A guide book was needed and funding was obtained from the Canadian Breast Cancer Foundation and other sources to produce one. A series of focus groups reviewed English and French drafts of the book and participants were recruited from this project’s community partners. RESULTS: From the focus groups, personal tips and quotes were included in the book. The result is a practical and reliable resource of information and guidance for parents living with breast cancer in English and French. CONCLUSION: This poster will offer the opportunity to learn about this new resource. Highlights will be presented at the poster site and will include samples from the book: common children’s questions, and practical parenting matters related to cancer. English and French resources will also be included.

489 Problems with Performing Practical Household }and Work-related Duties Predict Future Depression in Cancer Patients Mehlsen MYa, Jensen ABb, Zachariae Ra a Psychooncology, Aarhus University Hospital, Aarhus, Denmark; bOncology, Aarhus University Hospital, Aarhus, Denmark AIM: Unresolved psychosocial problems may lead to significant distress and development of clinical depression. Our aim was to examine whether psychosocial problems predicted future depression in cancer patients. METHODS: At baseline, a total of 515 patients (34% men, 66% women) 18–90 yrs of age (mean: 59 yrs) from an oncology

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department were included. Baseline measures included distress (HADS), and self-reported financial and work-related problems, practical problems in the household, worries of spouse and children, and perceived problems in relation to the oncology department. At 8-month followup (FU), 374 patients (73%) completed the Beck Depression Inventory (BDI). RESULTS: At follow-up, 26% of the patients scored above the cutoff for clinical depression (BDI>13). More women (29%) than men (18%) showed indications of depression (chi-square ¼ 5:18; p50:05), while there were no differences in age or educational level between depressed and non-depressed patients. Logistic regression showed that fewer work-related problems (OR:0.79; p50.05) and more practical problems in the household (OR:1.15; p50.005) predicted depression eight months later, when controlling for baseline distress (OR:1.18; p50.001) and gender, age, marital status, and job status (ns). CONCLUSION: The results showed that the cancer patients’ experience of their ability to handle their household and work-related duties were independent predictors of depression 8 months later. The results indicate that psychosocial interventions for cancer patients should include focus on the practical problems of daily life.

490 Psychological Distress in Oncology Patients During Chemotherapy Treatment: Does Family Structure Affects? Cortes-Funes F, Narvaez A, Abian L, Garcia Valverde A Psycho-oncology Unit, Hospital 12 de octubre, Madrid, Spain In Spain oncology patients are usually helped by their family all over the illness period. The family is the basic social support and in some cases it even takes care of many medical issues. This way of coping with the illness turns the family into an important objective in investigations and in psychological interventions. In order to verify the relationship between some family variables and the psychological adjustment of both patient and family members, we measure the family structure (using the fire–family relationship index) and psychological distress (using he had}hospital anxiety and depression). Our sample includes 130 patients suffering various types of cancer who were receiving chemotherapy at least three months

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after diagnosis. Following the statistical analysis we can divide families of patients into different groups, depending in the psychological distress the patient suffers and the family structure. According to this study our work should be focused on taking care of the family variables (cohesion, expressiveness and conflict) while treating the distress symptoms (anxiety and depression).

491 Oncology Inpatient Mood Status Analysis Cortes-Funes Fa, Garcia Valverde Aa, Abian La, Narvaez Aa, Gongora Bb a Psycho-oncology Unit, Hospital 12 de Octubre, Madrid, Spain; bA.E.C.C., Hospita Torrecardenas, Almeria, Spain Hospitalization is a key stressing factor for patients, moreover it frequently affects their mood, specially the first occurrence. In our unit, patients stay for a short period of time (3–7 days) generally to be treated for the acute symptomatology caused by their illness and chemotherapy. Several variables related to the illness were considered in our study: reason for the admission, illness stage and presence of metastasis. Frequently these variables affect the psychological adjustment of a patient to the hospitalization. Therefore, we need to use adequate instruments to measure the distress (anxiety and depression) a patient feels during his stay at the hospital. We analyze the results achieved with the hospital anxiety and depression scale (HAD) and the visual analogue scale in a sample of 100 oncology patients during the time they were at the hospital. We regress the sociodemographic and the medical variables on anxiety and depression scores.

492 Burnout Syndrome in Oncology Staff in Barcelona: Interpersonal Relationship Problems and Intervention Suggestions Corti-Barbera Va, Buscemi Va, Font Ab a Psycho-oncology Asociacion Espan˜ola contra el Cancer, Barcelona, Spain; bPsicologia Basica Universitat Autonoma de Barcelona, Barcelona, Spain PURPOSE: To estimate burnout in professionals working with cancer patients and to explore their difficulties in daily work relationships with colleagues and also their suggestions to improve. METHODS: A semistructured questionnaire was sent to 200 professionals working in multi-

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disciplinary oncology units. Data were obtained on this questionnaire by the use of the Maslach Burnout Inventory, questions to obtain demographic characteristics and to measure difficulties in dealing with colleagues, and finally possible suggestions or solutions to improve. RESULTS: In the first phase, 30 professionals gave back the questionnaire (30% oncologists, 43.3% nurses, 3.3% social workers, 16.6% psychologists, and 6.6% secretaries). The preliminary results show burnout potential problems in many professionals. The most important difficulties with colleagues are: lack of communication, feeling of loneliness, different priorities in patient’s care, lack of coordination between physicians and the others, and acceptance of others’ critics. Few solutions are proposed, but having more time for group sessions and contact with colleagues is the most highlighted. CONCLUSIONS: Multidisciplinary work in oncology units facilitates decision-making in problem solutions, improves quality of cancer patients’ care and reduces burnout risk because of the sense of ‘working together’ but, on the other hand, team work can also be a source of interpersonal conflicts. The results show useful information to design preventive burnout intervention programs and let us learn something more about the reality of the daily work in these multidisciplinary groups.

493 Psychiatric Evaluation of Cancer Patients: A Retrospective Study of Four Years of Experience Costa A, Mota M, Sousa V, Fonseca S, Grangeia R Department of Psychiatry, Hospital Sa˜o Joa˜o, Porto, Portugal The authors describe socio-demographic and clinical data in a sample of 100 patients with cancer, evaluated by a psychiatry team (Psychooncology consultation). This is an ongoing study and the authors are planning to enlarge sample size. The preliminary results put on evidence a predomination of women, married, with low education level; retirement seems to be associated with old age and not with the disease. Cancer diagnosis was, in most cases, made more than a year before. The request of psychiatric evaluation, made by other medical colleagues, was mostly replied in between 15 and 60 days. The majority of patients had breast, haematological or colon cancer and have been submitted to chemotherapy, as well as surgery; a large group of patients has

Copyright # 2006 John Wiley & Sons, Ltd.

also done radiotherapy. In the breast cancer group, only few made reconstruction surgery. Most cancers were stabilized or in remission. A quite considerable number of patients had past psychiatric history. The authors also evaluated other parameters such as: personal experience with cancer and emotional distress during the previous year before the diagnosis. This study pretends to better characterize the population of patients evaluated in this specific kind of psychiatric consultation and to conclude about pertinent correlations collected from the data.

494 Use of Psychotropic Drugs in Psycho-oncology Consultation Costa A, Mota M, Sousa V, Fonseca S, Grangeia R Department of Psychiatry, Hospital Sa˜o Joa˜o, Porto, Portugal The aim of this study is to evaluate the use of psychotropic drugs in Psycho-oncology consultation. The authors collected retrospective data on this subject, gathered from the clinical data of 100 patients, and present the preliminary results. This is an ongoing study and the authors are planning to enlarge sample size. Most patients were evaluated more than a year after cancer diagnosis. The majority of patients were medicated with this kind of medicine during the year that preceded psychiatric evaluation, mostly with sedatives and hypnotics. These were maintained, in most cases, and associated with antidepressants. In a quite significant number of cases, doses of benzodiazepine were reduced. It is the authors’ opinion that this condition may result from an inadequate previous evaluation of patients’ symptoms, excluding anxiety disorders from the depressive disturbance, which is the principal pathology presented by this patients, mainly adjustment disorders and major depression. Only few patients were medicated with antipsychotic, and this is consonant with the diagnoses obtained. Some of the patients are taking antidepressants at the time of the consultation, but shown only partial improvement. This fact enforces the importance of psychotherapeutic intervention. Psychiatric support should be proposed as soon as the patients shows psychological disturbance, rather than after unsuccessful procedures. It will save time, avoid the worsening of symptoms and adjust the patient’s perception of medical support.

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495 Sexuality and Cancer Costa A, Grangeia R Department of Psychiatry, Hosptal Sa˜o Joa˜o, Porto, Portugal Sexuality is nowadays considered one of the main subjects, when talking about quality of life. The previous negligence of this matter in the clinical evaluation of patients suffering from cancer gives now place to a new era of concern and care for this important health issue. Cancer and its treatments are responsible for a huge number of sexual dysfunctions, which must be diagnosed and treated. The authors reviewed the epidemiology of sexual dysfunctions in specific groups of cancer patients and relate them with: age, personality, previous sexual dysfunctions, direct effects of the oncological disease, psychological impact of cancer on sexuality (individual and couple relationship), adverse reactions to treatments, psychiatric co-morbidity (depression, anxiety), use of alcohol, tobacco and other substances, general health status. After recognizing the sexual problem, one must initiate the therapeutic process, and by that different kinds of treatment approaches are briefly exposed, such as: P-LI-SS-IT method, psychotherapies (individual and couple), and sexual therapeutic techniques. These ones, reduced to the most basic exercises such as: learning to kiss and touch in a pleasant way for the patient and its partner, developing methods to increase intimacy, erotic massage of sensitive focus, masturbation techniques, Kegel’s exercises, exploring different sexual positions and practises (decentralizing coital relation) and promoting the creation and communication of sexual fantasies. Attending to the high incidence of depression and anxiety among cancer patients, the adverse effects on sexuality of the most used antidepressants, as well as its appropriate use, are also reported.

496 The Light at the End of the Tunnel: End-of-life Psychological Approach Costa A, Grangeia R Department of Psychiatry, Hospital Sa˜o Joa˜o, Porto, Portugal ‘The art of living well and dying well is one’ (Epicurus). In this era of ‘death without soul’ in the Intensive Care Unit, the authors pretend to signal the need for specific psychological

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approaches that must always join the medical procedures of palliative care, in order to provide subjective quality of life to these patients. The art of communication is unquestionable, mainly in this fragile period, in which the patient prepares himself for the end of his life, and communication traps must be avoided and its techniques must be optimized, in order to promote the treatment compliance, the patient’s correct perception of the disease, coping, satisfaction and health outcomes. The authors also mention the doctors’ attitudes requested by patients, which, most of times, do not necessarily correspond to the doctor’s perception of their patients’ needs. There are main subjects that end-of-life patients need to discuss with the therapeutic team, such as: symptom control, personal dignity, religious beliefs, ‘saying goodbye’. Sometimes they are not, by themselves, able to focus their worries and by that, there should be guidelines for conducting this process. The authors briefly expose some of the more accepted and well known guidelines and give their own perception of its results, based on their own clinical experience, focusing on the fact that these techniques must take into account cultural level and beliefs and by that should be considered as an extremely important complement of clinical global impression.

497 Journey, Dialogue and Interaction: ‘The Interplay of Australian Oncology Social Work and its Contribution’ Cotroneo Aa, Araullo Rb, Nicholl Kc a Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, Sydney Australia; bCancer Services}Northern Sydney/Central Coast Area Health Royal North Shore Hospital, St Leonards, Sydney, Australia; cSocial Work Department Prince of Wales Hospital, Randwick, Sydney, Australia Journey, Dialogue and Interaction: ‘The interplay of Australian Oncology Social Work and its contribution’. This poster proposes to represent one view of the contribution of Australian Oncology Social Work in comprehensive cancer care. Cancer is only one part of the patient’s dialogue. Social Work elicit a broader narrative, beyond that which focuses on the patient’s diagnosis. Within the social work–patient relationship, the patient is supported in their efforts to identify and address those life issues which they

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deem to be of greatest import. The skill of the Social Worker to elicit a broader dialogue provides us and multidisciplinary stakeholders with a privileged opportunity to potentially share the patient’s (life narrative). This interplay of dialogue and interaction should ideally occur within a context of trust and reciprocity. The dialogue and interaction of the social worker and patient takes place across various domains of psychosocial care. These include scientific societies, health care agencies and tertiary institutions, together with affiliated organisations, which exist within and across said domains. A core skill in Social Work Practice (which is underpinned by the value of starting where the patient is at) is the appropriate disclosure of relevant and meaningful information. The goal being to provide excellence in care that best enhances their quality of life and facilitates adjustment along the cancer continuum. The contribution of Oncology Social Work in Australia is one of bridging the link between the patients (and their significant others) with the multidisciplinary stakeholders via appropriate, timely and well-developed dialogue and interaction.

(ps50.01) indicated that survivors’ average weekly minutes of moderate/strenuous exercise decreased from pre-diagnosis ðM ¼ 92:5 minutesÞ to post-treatment ðM ¼ 41:6 minutesÞ and then increased in the longer-term post-treatment period ðM ¼ 100:1 minutesÞ: Only a quarter (27.4%) of lung cancer survivors met national guidelines for regular weekly exercise. Lower rates of meeting exercise guidelines were found among individuals with lower levels of education and those with poorer lung diffusing capacity (ps50.05). CONCLUSIONS: Treatment for lung cancer adversely affects engagement in regular exercise. Few lung cancer survivors engage in regular exercise. Future research is warranted to examine the role of exercise in ameliorating post-treatment symptoms and quality of life impairments among lung cancer survivors.

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Alternative medicine must be distinguished from complementary therapies by examining the promoted purpose of the method in order to clarify this dissimilar collection of therapeutic techniques. Alternative cancer therapies are products and treatments recommended for use instead of mainstream cancer care and can be a vast collection of disparate, unrelated regimens and products that claim to cure cancer and thus may harm the patient both directly and indirectly. Complementary therapies, in contrast, serve a complementary role in conjunction with conventional medicine and their aim is to improve quality of life and symptom control. They are often used as part of wellness and health maintenance programmes and many regimens are part of preventative medicine and supportive care. Complementary therapies tend to be non-invasive, inexpensive and widely helpful. However, frequently when reference is made to ‘alternative’ approaches, the therapy under discussion is ‘complementary’ and this adds confusion in terms of perception and understanding. This paper aims to describe and identify the differences between alternative and complementary therapies as used by people diagnosed with cancer in an Irish setting. While some patients request information from their cancer team in

Exercise Patterns in Lung Cancer Survivors Coups EJa, Ostroff JSb, Steingart RMc, Feinstein MBc, Wilson Dc a Division of Population Science, Fox Chase Cancer Center, Philadelphia, USA; bPsychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, USA; cMedicine, Memorial Sloan-Kettering Cancer Center, New York, USA PURPOSE: Despite the potential benefits of regular exercise, no previous research has examined lung cancer survivors’ patterns of exercise across the cancer trajectory. We addressed this research gap and also examined the demographic and medical characteristics of lung cancer survivors who do not engage in regular exercise. METHODS: 73 individuals (M age ¼ 67:4 years, 62% female) who were from 1 to 5 years posttreatment (M ¼ 3:3 years) for stage I non-small cell lung cancer completed a one-time telephone survey of their pre-diagnosis, short-term posttreatment, and current levels of exercise. Medical characteristics were determined via chart review. RESULTS: The results of a repeated-measures ANOVA (Wilks’ lambda ¼ 0:81; Fð2; 71Þ ¼ 8:30; p50.001) and follow-up pairwise comparisons

Copyright # 2006 John Wiley & Sons, Ltd.

499 CAM Or CAT? Medicine or Therapy? Is There a Difference? Courtney U ARC Cancer Support Centre, ARC House, Dublin, Ireland

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relation to the usage of alternative or complementary therapies, other patients refuse to admit their usage of CAM any of their hospital multidisciplinary team. This paper explores the efficacy of current alternative and complementary therapies in Ireland and the accreditation methods for therapists within the Irish health and legal systems. This is currently an area of great controversy in Ireland with registration and annual continuing professional development of complementary therapists.

500 Coping Through Knowing}A Psycho-Educative Programme for Men with Prostate Cancers Courtney U ARC Cancer Support Centre, ARC House, Dublin, Ireland OBJECTIVE: Men are usually diagnosed with prostate cancer in an out-patient setting and consequently their feelings of vulnerability may not be exhibited during this decreased time spent in a hospital setting. Psychosocial oncology focuses on how the physical manifestations of cancer impact upon the cognitive, behavioural, social and spiritual components of the lives of patients with cancer, with interventions aimed at alleviating the emotional and social impact of cancer on patients and their families. METHOD: Many men actively try to find a way to cope with the feelings of loss of control by seeking extensive information as rapidly as possible. Correct and adequate information is essential to helping everyone affected by a diagnosis of cancer and the development of coping skills. Studies suggest that patients who receive good information are more satisfied with their care and demonstrate lowered levels of anxiety and depression and the role of support groups has been well documented in cancer literature. Psycho-educative group support helps people who have similar problems to act as role models to one another, especially in the use of adaptive coping responses. This programme explores the physical, psychological and social aspects of prostate cancers in an Irish context. RESULTS: This paper describes results of perceived benefits of nine psycho-educative support programmes for men with prostate cancer. The limitations of the programme are described and the discussion addresses the need for further patient education in centres throughout Ireland.

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501 Women Talk, Listen and Learn: Results of a Study of Psycho-educative Groups for Women with Gynaecological Cancers Courtney U ARC Cancer Support Centre, ARC House, Dublin, Ireland Patients react to a cancer diagnosis with a variety of emotions including shock, anger, guilt, denial, anxiety and depression. Psychosocial oncology focuses on how the physical manifestations of cancer impact upon the cognitive, behavioural, social and spiritual components of the lives of patients with cancer. Psychosocial interventions aim to alleviate the emotional and social impact of cancer on patients and their families. Information is a basic form of support. Correct and adequate information is essential to helping patient and family adapt to a diagnosis of cancer and develop coping skill. Studies suggest that patients who receive good information are more satisfied with their care and demonstrate lowered levels of anxiety and depression. The role of support groups has been well documented in cancer support. Psycho-educative group support helps people who have similar problems to act as role models to one another, especially in the use of adaptive coping responses. This paper describes the perceived benefits of seven psycho-educative support programmes for women diagnosed with gynaecological cancers. The programme is divided into four main areas dealing with the physical, psychological and social aspects of gynaecological cancers in an Irish context. The limitations of the programme are described and the discussion addresses the need for further patient education in centres throughout Ireland.

502 Impact of Social Support, Anxiety and Coping on Survival after Breast Cancer: A Ten Year Followup Study Cousson-Ge´lie Fa, Bruchon-Schweitzer Ma, Dilhuydy JMb, Jutand MAc a Department of Psychology, University of Bordeaux, Bordeaux, France; bRadiothe´rapie Institut Bergonie´, Bordeaux, France; cPublic Health ISPED, Bordeaux, France PURPOSE: Over the past decades, studies have examined a wide range of psychological predictors of survival. Consensus is lacking with regard to

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anxiety and coping strategies. The general lack of agreement could be due to the fact that most of the studies were not drawn form a clear theoretical model. We therefore decided to study the link between anxiety, social support, coping strategies and duration of survival with an integrative model. The model is based upon Lazarus and Folkman’s transactional stress model. METHOD: 75 women with primary breast cancer were enrolled. Before the confirmation of diagnosis, trait anxiety and sociodemographic variables were measured. Three weeks after diagnosis, social support, coping strategies and state anxiety were evaluated. The criterion was the number of days of survival measured 10 years after the diagnosis. RESULTS: In Cox proportional hazards models adjusting for severity of disease and age, high social support (hazard ratio 1.04 [95% CI 1.01– 1.07]) and low state anxiety (hazard ratio 0.97 [95% CI 0.94–0.99]) predicted an increased risk of death from breast cancer. A significant increased risk of death in women with low scores on the Body Image Questionnaire appeared only with the univariate model. CONCLUSION: These findings are consistent with the hypothesis that difficulties in expressing negative emotion could be associated with a poor outcome.

requiring an immobilization cast for treatment of a head and neck or brain malignancy. Exclusions: Unable to comprehend written or spoken English. Age less than 18 years. Incapable of informed consent (too ill or brain impaired). At baseline [prior to planning appointment] patients complete the following instruments: BSI18; Panic module of Patient Health Questionnaire; Anxiety sensitivity Index; Eysenck neuroticism scale: and locally derived measures of claustrophobia and trauma. On day one, treatment mid course and on the second last day of treatment the radiation therapists repeat the BSI 18. Each session is prospectively timed and a log sheet kept of patient level of anxiety, distress and disruption due to patient anxiety as rated by the radiation therapists. RESULTS: The study is in the recruitment phase with 30 patients accrued at May 2006. Results will be analysed in terms of levels of anxiety and distress. Relationships between baseline scores and subsequent disruption to treatment will be explored using logistic regression. CONCLUSIONS: The value of the above tools as screening instruments to detect patients in need of proactive psychosocial intervention will be determined.

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The Benefits of Physical Activity for Men with Prostate Cancer Culos-Reed SNa,b,c, Robinson JWb,c, Lau Hc, Keats MRa, Kline Gd a Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; bDepartment of Psychosocial Resources, Tom Baker Cancer Centre, Calgary, Alberta, Canada; cDepartment of Oncology, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada; dFaculty of Medicine, University of Calgary, Calgary, Alberta, Canada

A Multidisciplinary Pilot Study to Screen for Anxiety and Distress in Cancer Patients When a Head Immobilization Device is Used for Radiotherapy Treatment Cross LJa, Clover KAb,d, Adams CAb,d, Utram SCc,e, Ponman LKc,e a Oncology Social Work, Mater Hospital, Newcastle, NSW, Australia; bPsycho-Oncology, Mater Hospital, Newcastle, NSW, Australia; cRadiation Oncology, Mater Hospital, Newcastle, NSW, Australia; dCentre for Mental Health Studies, University of Newcastle, Newcastle, NSW, Australia; eMedical Radiation Science, University of Newcastle, Newcastle, NSW, Australia PURPOSE: This is a multidisciplinary pilot study to determine levels and predictors of anxiety and distress experienced by patients undergoing radiotherapy using an immobilisation device. It should lead to an increased ability to identify patients at risk of experiencing anxiety or distress undertaking radiotherapy. METHODS: Prospective design: Sample: 100 consecutive new patients of the NMMH radiation oncology outpatient services

Copyright # 2006 John Wiley & Sons, Ltd.

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BACKGROUND: Adaptive health behaviours, such as regular physical activity (PA), may serve an important role in mitigating many of the adverse late effects of the cancer experience and ultimately improve quality of life (QOL). PURPOSE: The ongoing RCT investigates the benefits of PA for prostate cancer survivors. METHODS: Participants were randomly assigned to the intervention ðn ¼ 53Þ or control ðn ¼ 47Þ: A theorybased PA intervention, with weekly group booster sessions, was administered over a 16-week period. Participants completed fitness and QOL measures pre ðn ¼ 100Þ and post-intervention ðn ¼ 57Þ: RESULTS: The sample (age range 46–86 years)

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was primarily married (89%) and retired (57%). Participants attended 63.5% of the weekly group booster sessions. There was a significant group  time interaction (p50.005) for PA levels, with PA increasing for cases vs controls as measured by the GLTEQ. Group differences on fatigue, girth measurements, and fitness indices also all significantly improved over time for the cases vs controls (all p’s50.05). However, there were only trends towards significance for the QOL indices, as measured by the EORTC and the PCI. Loss to post-testing (50%) for the controls may have contributed to the lack of significant findings. CONCLUSIONS: While these preliminary findings support the use of PA for prostate cancer survivors, a means of promoting adherence for the controls to the assessments must be considered in future RCT research. ACKNOWLEDGEMENTS: Funding provided by AHFMR-Health Research Fund.

505 Cancer Unplugged Curran MSa,b a Nursing Department, Towson University, Towson, MD, USA; bVolunteer for Non-Profit Organization, Ulman Cancer Fund for Young Adults Affected by Cancer Baltimore, MD, USA PURPOSE: The purpose of the program was to provide education and support to young adults affected by cancer. This program supported the mission of the Ulman Cancer Fund for Young Adults (UCF). The program was developed to provide a venue for discussing issues related to cancer that were ‘real, uncensored, and informative’. METHOD: Steps to planning and implementing the program: (1) Identify themes that emerged as psychosocial issues for young adults affected by cancer. (2) Seek professionals and survivors as speakers for the series to be held on six Saturdays afternoons in the community. (3) Identify and secure resources within the UCF organization and the community to support the promotion and implementation of the program. (4) Promote the program throughout the community by disseminating information on the program via local media and online announcements with affiliated organizations and treatment centers within the community. RESULTS: The program was implemented on 1/28/06, 2/4/06, 2/18/06, 2/25/06, 3/4/06 and 3/11/06. The participants were young adult survivors and their family and

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friends. The program promoted an environment that was ‘real, uncensored, and informative’, through the use of small groups and informal discussion. CONCLUSIONS: Young adult cancer survivors were able to establish linkages with community support networks. More than half of the cancer survivor participants have maintained contact with the UCF and are currently engaged in activities which provide ongoing support and education. ACKNOWLEDGEMENTS: Ulman Cancer Fund: Brock Yetso & Esther Ehrmann.

506 Multidimensional Assessment of Elderly Patient: Quantitative and Qualitative Research D’Accordi S, Morgana F, Vigorelli SM, Capovilla ED Oncologia Medica Istituto Oncologico Veneto I.R.C.C.S Ospedale Busonera, Padova, Italia PURPOSE: To evaluate life quality of 44 elderly cancer patients through a Multidimensional Geriatric Assessment (MGA). The sample included 23 female and 21 male, aged 65–95, submitted to their first visit in the Medical Oncology Department, during the period from September to December 2004. METHOD: Used tools: Activity of Daily Living (ADL), Instrumental Activity of Daily Living (IADL) and Geriatric Depression Scale (GDS), as reported in MGA. We considered results of statistical analysis performed using loglinear models of two-way contingency tables. General and multiple analysis models were applied. RESULTS: From cross-tabulation of variables we obtained: long-lived persons (>85) are more dependent in both ADL and IADL function ðz ¼ 2:429; p ¼ 0:0075Þ; elderly patients with serious depression (GDS score) were also significantly dependent in ADL function ðz ¼ 2:334; p ¼ 0:0099Þ: CONCLUSIONS: The results fortunately demonstrate that only a minority of the sample shows a depression a different degrees of disability, so it is important to underline the need for the hospital to take care of them. Psycho-oncologist’s role consists in promoting an integrated approach with a specialist psychological intervention aiming to consider the depressive disease.

507 Elderly Cancer Patient: Comparison Between Treatment and Maintaining of Quality of Life

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D’Accordi S, Morgana F, Vigorelli SM, Capovilla ED Oncologia Medica Istituto Oncologico Veneto I.R.C.C.S Ospedale Busonera, Padova, Italia PURPOSE: To get a good balancing between patient’s life quality and type of treatment. The peculiarity of this approach is the integration of different roles: doctor, psycho-oncologist, nurse and volunteer. This was achieved by a multidimensional assessment of a sample of 190 elderly cancer patients (125 female–65 male), aged 70–92 carried out at the Medical Oncology Department in the period from April 2004 to January 2006. METHOD: Used tools: semi-structured welcome interview and Multidimensional Geriatric Assessment (MGA). RESULTS: Considering all the aspects investigated by MGA, it had been possible to identify three categories of elderly and the most adequate treatment for each one: The three categories were: (1) FIT (28%). (2) TRUE ELDERLY (36%). (3) FRAIL (28%). The difference of treatment between the first (FIT) and the third one (FRAIL) was mainly due to the chemotherapy: prescribed to 22% of the first group vs 11% of the third group. DISCUSSION: MGA’s tool is a clinical method which gets into an interpersonal relationship. This implies, for its use, a psycho-oncological training in communicativerelational terms for doctors and nurses and in medical-nursing terms for psychologists. Only by means of a multidisciplinary integrated teamwork, it is possible to assess an elderly patient respecting his QOL.

508 Gender and Cancer: A Psychosocial Analysis Dany La,b, Dudoit Ea,c, Favre Ra a Service d’Oncologie Me´dicale CHU de la Timone, Marseille, France; bLaboratoire de Psychologie Sociale Universite´ de Provence, Aix-en-Provence, France; cCentre PsyCLE Universite´ de Provence, Aix-en-Provence, France This study examines the impact of gender schema on the participation of psychosocial cares in the context of cancer illness. Two different analyses were conducted in the context of the oncology department of a university Hospital. First we examined quantitatively the modalities of participation to different psychosocial cares (psychooncologists and specialised nurse interventions) during two months. Second we conducted 55

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interviews on the care experience with patients and nurses of the oncology department. We used Interpretative Phenomenological Analysis (Smith, 1995) and Alceste1 textual analysis software (Reinert, 1999) to analyse interviews. Analyses of psychosocial care activities demonstrate a more important participation of female patients. Length and average number of interventions are significantly higher for them. Furthermore, female patients initiate more frequently these cares than men (50.9% vs 35.7%; p ¼ 0:01). Data from interviews indicate different conceptions of care participation. Some conceptions of virility (strong, silent type: restricted experience and expression of emotions) and collective identity elements are used by men to explain their choices and needs. Two models of participation emerge from discourses: a ‘contribution model’ (more feminine) and a ‘disposal model’ (more masculine). These findings provide evidence for an association between social dimensions of identity and experience of illness and care. The gender schemas constitute a keyfactor to understand models of participation in the context of oncology psychosocial care. Furthermore, gender analysis of the experience of care in the cancer context is a useful way for psycho-oncologists to provide roadmap for intervention.

509 Coping with Adjuvant Chemotherapy: The Experience of Toxicity and Psychological Distress in Women Undergoing Treatment for Early Breast Cancer Davenport SCa, Byrne DGa, Stuart-Harris Rb a School of Psychology, Australian National University, Canberra, Australia; bMedical Oncology Unit, The Canberra Hospital, Canberra, Australia PURPOSE: The diagnosis and treatment of early breast cancer (EBC) involves multiple unique and traumatic challenges to patients’ wellbeing. An important one of which is adjuvant chemotherapy as it elicits significant side effects and psychological distress that may require considerable medical and psychosocial assistance. While the mediating role of coping on wellbeing has been investigated following diagnosis, its role in response to adjuvant chemotherapy is unknown. Two coping styles, monitoring (information seeking) and blunting (information avoidance), have been associated with increased and decreased levels of side effects and psychological distress, respectively, in

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patients undergoing stressful medical treatments. The present study aimed to determine whether the use of monitoring and blunting coping affected the levels of side effects and psychological distress experienced before, during, and following adjuvant chemotherapy treatment in EBC patients. METHODS: 52 female EBC patients (mean age 53) completed self-report questionnaires assessing use of monitoring and blunting coping styles and levels of side effects and distress experienced before, during and following adjuvant chemotherapy. Information concerning diagnosis, health status, and treatment administered were collected from medical files. RESULTS: Preliminary results indicate those employing a monitoring coping style report greater overall toxicity and distress before and throughout chemotherapy. There were no significant associations between blunting and toxicity or distress. CONCLUSIONS: Monitoring is clearly important in understanding the experience of EBC patients undergoing adjuvant chemotherapy and deserves further investigation to ensure its contribution to enhanced medical and psychosocial outcomes. ACKNOWLEDGEMENTS: Thanks must go to the Australian Capital Territory Cancer Council for their support.

510 A Unique and Integrated Model of Psychological Support and Counselling Working Locally for People Affected by Cancer Day J, Gillespie G, Delfont S Oncology, FORCE Cancer Support Centre, Exeter, England PURPOSE: Research shows that many patients and carers experience anxiety and depression as a result of a cancer diagnosis, and recent Government guidelines (NICE) have emphasised the need for adequate psychological support. Our aim was to set up an integrated service of psychological support and counselling for anyone affected by cancer: patient, carer, relative or friend, many of whom attend a local Foundation Trust hospital in Exeter, Devon, which has around 2000 newly diagnosed patients each year. METHOD: FORCE, a local cancer charity, provides funding for three Oncology Support Specialists who are also experienced counsellors. They offer a free and readily accessible support and counselling service for patients, carers, family or friends, both in hospital wards and departments, and in a purpose

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built Support Centre in the hospital grounds. Bereavement follow-up is also offered. Referrals are received from healthcare professionals in the hospital and the community, and people can also self refer. Criteria for referral include inability to cope, unresolved concerns, and mild anxiety and depression. RESULTS: In the past year we have seen 424 Patients 153 Carers, 138 relatives or friends. Response time is usually a few days to a week, and patient or carer can return at any time during disease or treatment. CONCLUSION: This model of support has proved highly effective, and provides the patient and carer with psychological support which is seen an integral part of treatment. Acknowledgement of funding to FORCE Cancer Charity.

511 Cognitive Function Among Women with Breast Cancer in Relation to Adjuvant Therapy in Denmark Debess JE, Ernst B, Ewertz M Department of Oncology, Aalborg Hospital, Aarhus University, Aalborg, Denmark The primary aim of the study is to examine cognitive function in women who receive adjuvant therapy for early breast cancer. BACKGROUND: Today around eighty percent of women with early breast cancer (BC) receive adjuvant treatment such as chemotherapy, radiotherapy and anti-hormonal therapy. Recently, some studies have shown that chemotherapy and/or Tamoxifen can affect cognitive functions especially verbal learning, concentration, and memory function. DESIGN: The study is designed as a longitudinal cohort study. PARTICIPANTS: The study population will include approximately 120 women under the age of sixty who had surgery for primary BC in North Jutland County during the period 1st May 2004 to 30th June 2006. In addition, a reference group of 224 healthy age matched women are included in the study. MEASURES: Data on self reported cognitive function are collected by questionnaires including socioeconomic data, side effects to chemotherapy, Quality of Life (EORTC QLQ C30), Self-efficacy (GPS-E), Stress, Anxiety, and Depression (POMS) and Coping with Cancer (MAC). In addition, neuropsychological tests (Danish Adult Reading Test, Visual Verbal Learning Test, Concept Shifting Test, Letter Digit Coding Test and Stroop Colour Word Test) are performed at baseline,

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after six and twelve months. Preliminary data on Self-efficacy at baseline will be presented from 88 breast cancer patients compared with 224 healthy controls without cancer.

512 The Development of a Psychosocial and Family Support Service for Breast Cancer Women: The ‘Mimosa Project’ De Feudis RL, Ancona A Sezione di Senologia P. O. ‘S. Paolo’ Ausl Ba/4, Bari, Italy As a consequence of the improvement in early diagnosis and more advanced treatment options, women with breast cancer now have better expectations of life free from the illness. This implies the urgency of restoring these women to the fullness of their personal, family and social life. Given these premises, a psychosocial and family support service named ‘Mimosa Project’ has been designed and implemented at the ‘S. Paolo’ Hospital of Bari (Italy). PURPOSE: The aim of this presentation is to illustrate the development of the program, structured in order to address three main areas the psychosocial needs of breast cancer women and their families, the health-care teams involved in diagnosing and treatment process, the administrative and sociocultural context. METHOD: Methodology of patient identification for psychosocial care, clinical, research, educational services and of interdisciplinary team collaboration is described, based on the integration of a systemic-relational approach with the medical context. RESULTS: Strengths and limitations of the ‘Mimosa Project’ are discussed; challenges for future developments highlighted. CONCLUSIONS: Psychosocial interventions for cancer patients are today considered an unavoidable activity of modern oncology practice. The ‘Mimosa Project’, with its added emphasis on interdisciplinary and family support serves the function of containing tensions, facilitating the integration of the individual traumatic experience through the creation of a trust-building, relational healthcare context, avoiding fragmentation and dispersion of healthcare resources. AKNOWLEDGMENTS: The authors wish to thank all their patients and co-workers, from whom they learned the courage to strive and hope in humanness.

Copyright # 2006 John Wiley & Sons, Ltd.

513 The Consequences of Previous Experiences of Cancer in Their Families for Women Coping with Breast Cancer De Feudis Ra, Cotroneo Mb, Taversa Mc a C.S.M. 1 ‘S.Paolo’ Ausl Bari 4, Bari, Italy; bSchool of Nursing and School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; cSenologia ‘S.Paolo’ AUSL, Bari 4, Bari, Italy Caring about more than one person simultaneously is the basic ethic of family life and the foundation of responsibility for consequences which is intrinsic to the Contextual approach to psychotherapy. Such approach (one of the major systemic family therapy theories, originally developed by Ivan Boszormenyi-Nagy and coll.) individuates four dimensions of relational reality, among which ‘relational ethics’ is the simultaneous consideration of the needs, interests and obligations of all relating partners in a dialogue of fair give and take. This paper will address the issue of how the ‘legacy’ of previous experiences of cancer within the family affect coping with breast cancer. PURPOSE: The aim is to identify constructive relational patterns that can be activated to facilitate recovery. METHODS: On the basis of Contextual Theory, a semi-structured interview and a Psychological and Contextual Evaluation Sheet have been developed in order to evaluate the impact of breast cancer and to record information from family history. Data have been collected comparing two groups of breast cancer women: with and without previous experiences of cancer in their families. RESULTS: Results indicate that gaining constructive ‘entitlement’ through caring for others may be a major leverage in facilitating constructive mechanisms of coping with breast cancer. CONCLUSIONS: The application of Contextual Theory suggest that addressing family ‘relational ethics’ is relevant for the understanding of the motivational system of the woman coping with breast cancer. If the legacy cannot be avoided, it is possible to change the options for building trust for the future.

514 Cancer Screening Behaviour of People Taking Place in Genetic Counselling for Hereditary Nonpolyposis Colorectal Cancer (HNPCC) Deges Ga, Elbert Ib, Keller Mb, Alberti Lc, Hasenbring Ma

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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Department of Medical Psychology, Ruhr-University-Bochum, Bochum, Germany; bDepartment of Surgery, University of Heidelberg, Heidelberg, Germany; cClinical Institute of Psychosomatic Medicine, Heinrich-Heine-University, Du¨sseldorf, Germany PURPOSE: Cancer Screening Behaviour is one of the most important preventive tasks of the health system. If Colon cancer is hereditary, prevention is the only way to identify and treat the disease at an early stage. The present prospective longitudinal and cross-sectional study is part of the multicenter study ‘Psychosocial factors during genetic counselling and diagnostic by families with suspicion of HNPCC’. We aimed to define the actual uptake of preventive behaviour of 252 consulters of interdisciplinary genetic counselling for HNPCC and to identify psychosocial factors, predictive for an increasing or decreasing preventive behaviour. METHODS: Cross-sectional survey and logistic regression analysis. Consulters, who came to genetic counselling for HNPCC at the participating centers between 2003 and 2006 and agreed to take part in a psychological study, were asked to complete a comprehensive questionnaire. RESULTS: 71% had a coloscopy screening once in life. 44% had a gastroscopy, 64% a sonography. From the female participants 96% once in life had been to a gynaecological screening, 80% declared to take part at least yearly. 28% were afraid of the coloscopy, 33% of the gastroscopy, only 4% of the sonography and 6% (female) of the gynaecological screening. Furthermore, 40% were afraid of the results of the coloscopy followed by 26% (gastroscopy), 22% gynaecological screening and 20% (sonography). Results of the logistic regression will be presented later. CONCLUSION: Results suggest, that fear of ‘result of the examination’ might be a barrier for regular screening behaviour. The study was supported by ‘Deutsche Krebshilfe’.

515 Do Single and Partnered Women with Gynecologic Cancer Differ in Types and Intensities of Illness and Treatment Related Psychosocial Concerns? A Pilot Study de Groot JMa,b, Mah Kc,d, Fyles Ae, Winton Sc, Devins GMc,d a Psychosocial Resources, Tom Baker Cancer Centre, Calgary, Canada; bPsychiatry, University of Calgary, Calgary, Canada; cPsychosocial

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Resources and Palliative Care, Princess Margaret Hospital, Toronto, Canada; dPsychiatry, University Health Network, Toronto, Canada; eGynecologic Oncology, Princess Margaret Hospital, Toronto, Canada OBJECTIVE: Relationship status and psychosocial context are important to sexuality, a life domain often affected by gynecologic cancer. Thus, we compared the psychosocial and psychosexual concerns of single and partnered women with gynecologic cancer, to assist in he development of subsequent psychosocial interventions. METHOD: Women with gynecologic cancer attending gynecologic oncology clinics in a major cancer center completed the 72 item self-report Cancer Concerns Questionnaire and additional psychosocial questionnaires. RESULTS: Among 49 women (68% response rate), with ovarian ðn ¼ 31Þ; endometrial ðn ¼ 12Þ and cervical ðn ¼ 6Þ who participated in the study, 27 were in treatment and 22 were on average 16.7 months post-treatment. Overall, psychosocial concerns did not differ between women with early (stage 1–2a) and advanced (2b–4) cancer. Whereas after controlling for recent non-cancer related stressful life events, single ðn ¼ 13Þ and partnered women ðn ¼ 36Þ reported prognosis as their highest concern, but single women (26% of the sample) reported that treatment side effects and communication with the treatment team was of greater salience to them than partnered women. The latter group had greater sexuality and partner relationship concerns. Differences in the intensities of psychosocial concerns between single and partnered women were present although they reported similar illness and treatment-related lifestyle disruption to relationships and personal development, intimacy and instrumental life domains. CONCLUSION: Further research attention is required to assess for differences in psychosocial and psychosexual concerns among single and partnered women with gynecologic cancer, and thus inform subsequent psychosocial interventions.

516 Bereavement in Oncology and General Practice Medicine De la Calle Prieto MAa, Meseguer Hernandez Cb a Enfermeria Centro de Salud Portazgo, Madrid, Spain; bPsico-Oncolog"ıa Instituto Madrileno de Oncolog"ıa (IMO), Madrid, Spain

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PURPOSE: Analyse bereavement experience in two samples of people, those who had cared for and lost a family member due to cancer, and those whose family member had died of other diseases. Identify the fundamental variables that describe bereavement experience both short and long term. Compare the variables identified in our study with classic variables in bereavement literature. METHODS: Qualitative analysis of the narratives of thirty relatives in bereavement. Discourses were obtained through semistructured interviews in the Palliative Care Unit of the Oncology Department of Hospital General Universitario Gregorio Maran˜o´n and the Health Centre Portazgo, Area 1 of Madrid, Spain. Each interview was recorded and then transcripted. Each transcription was analyzed twice by two independent analysts. The common construct resultants identified by both analysts, with a 80% agreement, are presented here. RESULTS: From the analysis of the interviews, the common construct obtained were: Bereaved historical biography; The dead person’s illness history; Personal experience previous to death; Early experience of bereavement; Long term bereavement experience; Help and support received. Each one of the previous constructs resultant is also divided into other construct. We present the type of bereavement experienced by bereaved relatives that is different depending on the cause of death and the type of attachment bonds. The long term bereavement experience, average ten years is also presented.

517 Communication Skills Training and Psychosocial Supervision for Oncology Physicians Dellson Pa, Berglo¨f Ba, Mattsson Eb, Hellbom Ma a Section of Psycho-Oncology, Department of Oncology, University Hospital of Lund, Sweden; b Department of Surgery, University Hospital of Lund, Sweden PURPOSE: To provide communication skills training and psychosocial supervision to resident physicians. The project has been running for three years 2002–2005. METHODS: Resident physicians participated in 40 hours of communication skills training. The curriculum included theoretical orientation in psycho-oncology, practical training using role-playing of the participants’ own problematic clinical encounters, and video-recordings of actual clinical interviews. Participants were then offered monthly group psychosocial supervision.

Copyright # 2006 John Wiley & Sons, Ltd.

Another group of oncologists underwent basic training in psychotherapy, in order to meet future needs for training and supervision. RESULTS: Three communication skills courses took place. Seventeen physicians participated. All expressed that they were very satisfied with the course. Having finished the course, 10 physicians joined three groups of supervision. The participants all stated that the supervision was helpful. They stressed the importance of the supervisor being familiar with cancer care, and that the groups include physicians only. Eight physicians underwent training in basic psychodynamic psychotherapy for three years, including theoretical sessions, psychotherapeutic practice with a cancer patient or a relative, and clinical seminars on cancer patients. CONCLUSIONS: This project has provided a pedagogical model for communication skills training, combining theory, practice and continuous supervision to get long lasting skills of communication. The evaluations have all been favourable. This is a way of meeting the needs of modern physicians to communicate well and to reflect upon themselves and their work. The course and supervision is now being offered to resident physicians on a regular basis. ACKNOWLEDGEMENTS: The Swedish Cancer Foundation.

518 Psychosocial Impact in Caregivers of Adult Cancer Patient Annunziata MAa, Da Re Sa, Tammaro Aa, Bidoli Eb, Del Ben Gc a Psychology Unit, Centro di Riferimento Oncologico, Aviano, Italy; bEpidemiology Unit, Centro di Riferimento Oncologico, Aviano, Italy; cDirector, Centro di Riferimento Oncologico, Aviano, Italy PURPOSE: Assessment of the psychosocial impact in caregivers of adult cancer patients. METHODS: From April 2004 to December 2005 81 caregivers of cancer patients afferent to our Institute were interviewed by means of a self report questionnaire}the IMPACT-on-Family Scales of Stein and Riessman}that measures the impact of chronic disease on the family. The scale is composed by 24 items and inquires four dimensions of impact: Financial Burden (FB); Familial/Social impact (FS); Personal Strain (PS); Mastery (COPE). Caregivers of patients with a disease history of at least two years, at the second/ third phase of treatment, not affected by other

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pathologies independent of the cancer (HIV, physical or mental handicaps) were evaluated. RESULTS: The study sample consisted of 60.5% males, and 71% of patients spouses. The caregivers’ mean age was 54.9 years ðM ¼ 55:7; F ¼ 53:5Þ: 69.1% had an education of 58 years; 34.6% were retired and 74% were resident in the Triveneto area. The total impact of assistance is 51.92 ðDS ¼ 12:0Þ; M ¼ 51:08 ðDS ¼ 10:54Þ; F ¼ 53:21 ðDS ¼ 14:02Þ; p ¼ 0:46: In particular: FB: M ¼ 8:12 ðDS ¼ 3:39Þ; F ¼ 7:25 ðDS ¼ 3:0Þ; p ¼ 0:15; FS: M ¼ 19:73 ðDS ¼ 5:78Þ; F ¼ 21:34 ðDS ¼ 7:71Þ, p ¼ 0:14; PS: M ¼ 15:06 ðDS ¼ 3:78 Þ; F ¼ 15:93 ðDS ¼ 4:36Þ, p ¼ 0:99; COPE: M ¼ 8:16 ðDS ¼ 2:53Þ; F ¼ 8:68 ðDS ¼ 2:94Þ, p ¼ 0:99: Time since diagnosis was not significantly correlated to the dimensions measured by the IMPACT. CONCLUSIONS: Our sample is composed mostly by males. No statistically significant differences were found among genders on the psychosocial impact measure.

reflected a general positive evaluation. However there were also some negative evaluations as well as differences in the subjective representation of the examined relationship. CONCLUSIONS: This work evaluated the representation of the patient/ staff relationship inside medical structures during the various phases of the treatment. The results collectable through the use of the proposed ScReTS questionnaire about the differences in this representation between patients and medical staff can give helpful information for the improvement of the medical service in Oncology.

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Analysis of Fatigue in Women Cancer Survivors Fatigue may be characterised as a multi-dimensional phenomenon that develops over time, diminishing energy and mental capacity of cancer patients. Survivors of women’s cancer frequently suffer from chronic fatigue. Although most cancer patients experience fatigue as a major obstacle to maintaining normal daily activities and quality of life, little is known about what factors underlie it and indeed how common this condition is. Consequently, it is seldom assessed and treated in clinical practice. The aim is to provide insight into the aetiology and clinical course of cancerrelated fatigue. OBJECTIVES: (1) Determine the incidence of fatigue, and its impact on quality of life, in women cancer survivors versus the control population by using the Piper fatigue scale. (2) Evaluate cytokines in the pathogenesis of fatigue. (3) Establish whether cancer and cancer treatment can alter quantitative measures of cellular immunity and subsequently lead to side effects such as fatigue. RESULTS: The current study indicates this patient population is significantly fatigued when compared with the control group. There was some variation in cytokine levels between fatigued and non-fatigued participants. Implications for patient care. The results of this study are currently being used in the development of protocols pertaining to the assessment and management of patient care. It is also anticipated that this study will lead to a greater understanding of the

The ScReTs: A Questionnaire on the Subjective Relationship Between Medical Staff and Patients in Psycho-Oncology De Marco IF, Veglia F, Bara BG Center for Cognitive Science and Department of Psychology, University of Turin, Turin, Italy PURPOSE: We present the ScReTS: a new questionnaire in psycho-oncology. The ScReTS is split in two complementary parts, one for patients and one for medical staff; each part is composed of three scales of 5 items each: Therapeutic communication: clarity of the information and indications given to the patients by the medical staff. Care: quality of the medical treatment and, in particular, the issue of handling possible side effects during the cycle of the therapy. Quality of life: the patient’s perceived comfort during the time spent inside the hospital and the his/her own reported wellbeing after the diagnosis and during the treatment. METHODS: 150 patients recruited in two hospitals in Turin. The ScReTS was presented to patients and medical staff. The medical staff was solely informed about the collective results, and patients were informed that their own single result was classified even to the medical staff. RESULTS: Most of the participants’ judgments about the relationship with the medical staff and with patients respectively, according to the ScReTS,

Copyright # 2006 John Wiley & Sons, Ltd.

520 Analysis of Fatigue in Women Cancer Survivors Gooney Ma, McGrath Db, Denieffe Sc a Department of Nursing, Waterford Institute of Technology, Waterford, Ireland; bDepartment of Nursing, Queens University Belfast, Belfast, Ireland; cDepartment of Nursing, Waterford Institute of Technology, Waterford, Ireland

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fundamental processes, which underlie cancerrelated fatigue and may direct the development of clinical interventions for maintaining health in women who have suffered and survived cancer.

521 Learning English at the Ward De Nittis Ga, Klikovac Tb a Inlingua Galindo, Belgrade; bInstitute for Oncology and Radiology, Belgrade The idea is to offer an educational program of English to the children, who are treated in the pediatric oncology Ward. The project began thanks to the co-operation with the private school of foreign languages Inlingua Galindo (Belgrade). It aims at giving the possibility of spending the time in the most interesting, creative and constructive way to the children, who are on cure in the pediatric oncology Ward because they are getting the treatment. Pilot, i.e. a testing phase program has been lasting for 8 months. The lessons are held twice a week and they are assigned to younger (from 4 to 8 years old) and older children (from 8 to 16 years old). The attendance at the lessons is not compulsory and the decision is primarily made by the children and their parents. The younger children decide on their attendance at the English lessons with their parents. The older children are already independent enough to decide by themselves if they feel well or are able to attend the lessons. The work with the younger children is based on learning through games and through the use of interesting material with subjects which can be interesting and adapted for kids (pictures, pictures books, computer games for learning English, books for children, etc.). The fundamental principle of work is that only English language is used with the children. During the work with the younger children we have noticed that those who have the illness localized to the CNS have as well a bad concentration, attention and memory. For such reason they quickly get demoralized and they give up learning. It is very hard to motivate them to keep on working.

522 Mental Health Services in an Oncology Setting: an Indian Perspective Deodhar JKa, Goswami SSb, Kakade ACc a Psychiatric Unit, Tata Memorial Hospital, Mumbai, India; bClinical Psychology Department, Tata

Copyright # 2006 John Wiley & Sons, Ltd.

Memorial Hospital, Mumbai, India; cStatistician, Tata Memorial Hospital, Mumbai, India PURPOSE: An almost 50% prevalence of psychiatric disorders is seen in cancer patients, according to most studies in developed countries in the area of mental health service provision. Amongst studies done in developing countries, settings and methodologies differ. The purpose of this study is to examine the referral patterns, patient characteristics, psychiatric diagnoses and types of interventions used, as well as evaluate comparisons between males and females and inpatients and patients, in a pure oncology tertiary care centre in India, as a baseline measure for service provision and further development. METHODS: A retrospective analysis, of all new referrals, inpatient and outpatient, to the psychiatric unit of an oncology tertiary care hospital, over a 12 month period was carried out. A proforma was designed to note demographic variables, referral methods, psychiatric diagnoses (by clinical interview and using International Classification of Diseases version 10) and management. Relevant statistical analysis was done using Statistical Package for Social Sciences version 14 for descriptive statistics and within group comparisons. RESULTS: About 63% of all patients referred were males and outpatients. Approximately 50% patients had a psychiatric diagnosis, mainly Organic Mental Disorder and Adjustment Disorder (about 19% each). Psychological interventions were used most commonly (63.1%). There were statistically significant differences in psychiatric diagnoses between male and females, being higher in females than males ðp ¼ 0:001Þ and in inpatients than outpatients (p50.001). CONCLUSION: Mental health service provision and development, as well as research are significant aspects of patient care in oncology settings in developing countries, in view of high psychiatric morbidity in cancer patients. ACKNOWLEDGEMENTS: Dr K. Dinshaw, Dr Narayan.

523 Emotional Adjustment and Bereavement in Palliative Care Nurses Desbiens JF, Fillion L Faculty of Nursing, Laval University, Que´bec, Canada BACKGROUND: Recent standards in Canada recommend adoption of strategies to reduce work

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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stress for palliative care workers. Notably, repeated exposure to grief and bereavement has been identified as an emotional stressor in palliative care nursing. Surprisingly, however, it is in accompanying the dying that nurses find meaning in their work. To further explore the relationship between bereavement and emotional adjustment in palliative care nurses, the consideration of coping strategies is proposed. PURPOSE & METHODS: The main objective of this correlation study was to describe the association between coping strategies (cognitive, emotional, behavioural and disengagement strategies; revised version of the COPE), emotional outcomes (Vigor and Distress; POMS) and Spiritual Quality of Life (FACT-sp). A sample of 120 nurses providing palliative care in acute-care hospitals and the community in Quebec were included. RESULTS: Controlling for several socio-demographic variables, the final regression model includes positive reinterpretation, turning to religion, and disengagement strategies as predictors, and explains 20% of the total variance of Spiritual Quality of Life ðF ¼ 9; 143; p ¼ 0:00Þ: Positive reinterpretation and turning to religion, two cognitive coping strategies, were the best predictors accounting for 17% of variance of Spiritual Quality of Life. Finally, disengagement strategies were positively related with emotional distress. CONCLUSION: These findings are consistent with recent studies, and highlight the need of developing nurses’ and other palliative caregivers’ abilities to use cognitive strategies, which could contribute to enhance their quality of life, and in turn, improve quality of palliative care.

524 Implementation and Evaluation of Dignity Therapy in Denmark: Experiences and Cultural Challenges Jul Houmann La, Rydahl Sa, Chochinov HMb, Kristjanson Lc, Groenvold Ma a Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen, Denmark; bDepartment of Psychiatry, University of Manitoba, Manitoba, Canada; cResearch and Development, Curtin University of Technology, Perth, Australia Dignity Therapy (DT) is a brief, psychotherapeutic bedside intervention supporting palliative care patients. This novel approach, developed by Professor Chochinov et al., invites the patient to reflect on important aspects of their life, relationships, and things they would want known or

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remembered. These recorded conversations serve as the basis for a personal document, which the patient can bequeath to family and/or friends. We investigate the feasibility and effect of implementing DT in the Danish culture. PURPOSE: To describe early lessons and results of the Danish DT study. METHOD: Since September 2005 patients have been recruited from three sites: a department of palliative medicine, a hospice, and a department of oncology. RESULTS: Target recruitment goals have been reached, with 31 patients enrolled over a 9-month period. Of these, 20 patients provided pre and post evaluations (with the remainder either not yet finished, having died or otherwise dropped out of the study). Some cultural specific issues have arisen in relation to the DT interview guide. For, some patients reported discomfort in naming aspects of their life that made them feel proud, and some struggled with the notion of ‘giving instructions’ to their relatives. Of those providing complete evaluations, all (100%) have been either satisfied or very satisfied with DT. 80% thought DT had helped them. 95% thought DT would help their family. 63% reported that it heightened their sense of dignity. CONCLUSION: To date, DT appears to be a feasible and positively received intervention for critically ill patients in Denmark.

525 Assessment of Patients’ Satisfaction with Cosmetic Results, Impact on Body Image and Sexuality After Mastectomy and Immediate Plastic Surgery With or Without Nipple Sparing Didier Fa, Petit JYb, Bedolis Ra, Radice Dc, Luini Ad a Psycho-Oncology Unit, European Institute of Oncology, Milan, Italy; bDivision of Plastic and Reconstruction Surgery, European Institute of Oncology, Milan, Italy; cDivision of Biostatistics, European Institute of Oncology, Milan, Italy; d Division of Senology, European Institute of Oncology, Milan, Italy INTRODUCTION: At Milan’s European Institute of Oncology, women with invasive breast cancer (CI) or Carcinoma in situ (DCIS) undergoing mastectomy were offered to spare the nipple (NAC) by performing intra-operative radiation therapy. The psychological impact of breast loss with or without nipple preservation was assessed. The aim of the study was to determine whether NAC sparing in mastectomy is important or not in

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body image perception, sexuality, fear of recurrence and patients’ satisfaction with cosmetic results. METHODS: Women with mastectomy, NAC sparing, immediate breast reconstruction (IBR) and women with mastectomy, IBR and nipple tattoo, were evaluated from September 2004, one year after surgery. We assessed the psychological distress, quality of life and Body Image. We used a new questionnaire, developed by the Psycho-Oncology Unit, tailored at assessing patients’ satisfaction with cosmetic results, satisfaction with NAC preserving surgery results, its impact on sexuality. We collected socio-demographic data, post-surgery oncology treatments, complications. RESULTS: 132/254 patients with NAC sparing, 96/135 patients with nipple tattoo completed the questionnaires. Preliminary results showed significant difference between groups regarding the feeling of mutilation ðp ¼ 0:0308Þ: The majority of women who had their nipple preserved expressed the feeling that the new technique helped them feel less mutilated (81%). Results indicated a high level of satisfaction with NAC preservation (86%). CONCLUSION: The new technique showed an positive impact on patients’ satisfaction with cosmetic results however preliminary results showed an important problem regarding the sexuality after the disease and its treatments.

526 Relaxation Techniques: Rebirthing, Autogenic Training and Guided Imagery to Reduce Stress in Cancer Patients During and After Treatment Didier F Psycho-Oncology Unit, European Institute of Oncology, Milan, Italy Cancer is one of the most stressful event that an individual can live through. Patients must deal with the trauma of a life-threatening diagnosis and an inevitable existential crisis is encountered by the individuals. Cognitive–behavioural interventions help patients to cope with the diagnosis and treatment of cancer. They have been shown to be effective in reducing emotional distress and controlling physical symptoms in cancer patients. They are readily accepted by patients thanks to the brief period of time of these interventions and because of the emphasis that is placed on increasing the patient’s sense of personal control and self-efficacy. Relaxation therapy is part of the cognitive–behavioural interventions and is used

Copyright # 2006 John Wiley & Sons, Ltd.

extensively with patients who have cancer. The systematic use of positive thought and imagery when patients are in a relaxed frame of mind help to cope with stress. The aim of this presentation is to illustrate two of these relaxation techniques that are used in the Psychooncology Unit of the European Institute of Oncology during and after chemotherapy treatment to enhance physical and emotional well-being; the Autogenic-Training (Schultz) and the Re-birthing, a technique that uses breathing as a means of relaxing and harmonizing the body–mind system (J Leonard and P Laut). There is the need to integrate a physical approach to the verbal psychological setting with a complementary approach based on relaxation techniques. These relaxation techniques complement counselling, and help patients deal with the traumatic experience and help them feel alive.

527 Examining the Impact of an Informational Intervention on Knowledge and HPV Screening Intentions Di Dio Pa,b,c, Rosberger Za,b,c, Fraid AKa, Morison EJPc a Psychology, McGill University, Montreal, Canada; b Psychosocial Oncology/Department of Oncology, McGill University, Montreal, Canada; cPsychology Division in Department of Psychiatry, SMBDJewish General Hospital, Montreal, Canada Human Papillomaviruses are the most common of the sexually transmitted infections and the main cause of cervical cancer. Incorporating HPV testing in cervical cancer screening may help to correctly identify more women with precancerous lesions than Pap testing alone. However, women’s lack of knowledge of HPV and its link to cervical cancer may pose a significant barrier to obtaining HPV testing, thereby limiting the effectiveness of HPV testing in primary screening. PURPOSE: The present research investigated the impact of an informational intervention on women’s knowledge of HPV testing and their intentions to attend HPV screening in the future. METHOD: Ninety-six Canadian university women completed self-report questionnaires about their knowledge and intentions regarding HPV testing and were subsequently assigned to one of four experimental conditions. Baseline measures of knowledge and intentions were obtained using a web-based questionnaire. Participants attended an informational

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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session in which they received either a Long or Short Experimental pamphlet about HPV testing for cervical cancer, or a Long or Short Control pamphlet about cancer prevention. RESULTS: Both long and short informational interventions significantly improved women’s knowledge of HPV and cervical cancer screening more than control conditions. In addition, knowledge gained following the intervention predicted intentions to obtain HPV testing in the future. These findings suggest that when women have all the relevant information, they are more receptive to HPV testing. CONCLUSION: Future research should examine the applicability of these pamphlets in health care settings in reducing anxiety and predicting screening adherence. ACKNOWLEDGEMENTS: This research was supported by an operating grant (#MOP-74685) from the Canadian Institutes of Health Research held by Zeev Rosberger, the Principal Investigator and two postdoctoral fellowships held by the first author from the Social Sciences and Humanities Research Council of Canada and the Psychosocial Oncology Research Training grant funded by the Canadian Institutes of Health Research}Institute of Cancer Research and the National Cancer Institute of Canada.

528 Resource-focused Psychotherapy for Cancer Patients Diegelmann C, Isermann M Research and Education, ID Institut fu¨r Innovative Gesundheitskonzepte, Kassel, Germany PURPOSE: Many cancer patients seek psychotherapy to work on their fears, symptoms and problems but are unable to do so because they are overwhelmed by stress. Neurobiology research demonstrates that it is important to help patients reduce their stress level before focusing on other concerns. METHODS: A 4-step-model of resource-focused psychooncological psychotherapy based on neurobiological research, considering concepts from Traumatherapy and Positive Psychology, is presented. Every step provides special tools of interventions giving therapists an orientation for the individual psychotherpeutic process. The important first step of the model is the stabilization phase. RESULTS: A resource-focused therapeutic strategy can help balance the patient’s distress immediately. Therapeutic experience shows the importance of using this approach

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for stabilization. This strategy helps manage typical critical situations which are often associated with cancer, like fear of relapse, anxiety, fear of dying, side-effects of chemotherapy and reduced quality of life. This approach is helpful during all treatment phases (diagnosis, surgery, aftercare and also palliative-care). Cancer patients are educated to understand the relevance of first reducing distress by means of special interventions in order to enhance their functioning, coping abilities and decision making. CONCLUSIONS: In the psychotherapeutic treatment of cancer patients it is important that concepts including results from Neurobiology, Positive Psychology and Traumatherapy be integrated and that classical therapeutic methods be adapted. Specific resource-focused interventions are especially important to reduce distress.

529 Do Seizures and Antiepileptic Drugs (AEDs) Affect Quality of Life in Patients with Epilepsy Related to Brain Tumours? Dinapoli La, Maschio Ma, Zaraba Aa, Giannarelli Db, Jandolo Ba a Epilepsy Outpatient’s Center}Department of Neuroscience and Cervical-Facial Pathology, National Institute for Cancer, ‘Regina Elena’, Rome, Italy; bBiostatistical Unit, National Institute for Cancer, ‘Regina Elena’, Rome, Italy PURPOSE: Patients with epilepsy related to brain tumours have to cope with the diagnosis of a malignant disease and with seizures that can worsen quality of life (QoL) by introducing psychological distress. Aim of this study is to investigate how the perception of QoL could be affected by epilepsy and by AEDs in these patients. METHODS: We included 26 patients with brain tumours and epilepsy (15 female, 11 male, mean age 47.7) who came to our Centre for first control. We changed therapy in eleven patients because of side effects of previous AED, whereas eleven remained stable. The patients completed two tests: Quality of Life in Epilepsy Questionnaire (Qolie-31-P) ad EORTC QLQ-C30. At the second control (about three months after) all patients were in therapy with Oxcarbazepine or Topiramate in monotherapy and with Levetiracetam in add-on. Twenty-two patients answered the tests the second time and four dropped out. During the follow up 16 patients were seizure free and 6 had unmodified seizures. Seven patients

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were in chemotherapy and six were undergoing radiotherapy. RESULTS: Only at Qolie-31-P we observed that patients who modified AEDs were less disturbed by the distress related to the energy/ fatigue (p50.05) whereas stable patients were less worried about the possibility o seizures (p50.03) at the time of second testing. In patients who modified AED we saw a trend who showed that after three months of new antiepileptic therapy they were less worried about seizures. CONCLUSIONS: These preliminary data show that seizures control and a good choice of AEDs seem to reduce distress in these patients.

530 We Have No Sex Dinkevich I, Fyodorov A Oncology Unit, The Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel PURPOSE: It’s not forbidden but unacceptable that a nurse talks with patients about their sexual life, especially in oncology units. Basic needs and holistic treatments have been discussed for many years but usually the topic of sexual life has not been talked over. METHODS: In the framework of the annual inter-unit projects competition of the Tel-Aviv Medical Center, the project ‘An approach toward sexual life of a patient as the part of holistic treatment’ started in the oncology unit. An activity group including 5 nurses was organized. The group prepared the questionnaire and checked the attitudes and knowledge of the nursing staff about sex and sexuality in common and as part of the patient holistic treatment in oncology. Then the group invited a specialist in the subject of human sexual life to the weekly meeting. The group made a short movie about oncology treatments and problems it caused to the sexual life of patients, and guided staff in their attitude to the topic. RESULTS: It was found that the staff had very little knowledge of sexuality in common, had no course of human sexual life in their learning programs and never or very rarely talked with patients about the subject even when patient initiated discussion. The full analysis of the questionnaires specified almost similar results. CONCLUSIONS: As a result of the study, significant improvement in the knowledge level and the attitudes toward the respect of sexual life of oncology patients as a part of holistic treatment was found.

Copyright # 2006 John Wiley & Sons, Ltd.

531 Delirium in the Neoplastic Patient: Data on Eight Years of Psychiatric Consultation Activity Disavoia A, Ferrari S, Forghieri M, Rigatelli M Section of Psychiatry, Neuroscience Department, University of Modena and Reggio Emilia, Modena, Italy INTRODUCTION AND PURPOSE: Delirium is a psychiatric syndrome due to medical causes, affecting 10–30% of patients in the general hospital, where it is the most frequent reason for psychiatric referral. Its incidence reaches 80% in some high-risk categories of patients, among which neoplastic ones. A few further risk factors have been identified for delirium in neoplastic patients, such as: old age, male gender, postsurgery, infections, multiple drug-therapy, highdosage opioids and metabolic encephalopathy. The present study aimed at identifying and describing a population of patients with a cancer–delirium comorbidity among the patients referred for psychiatric consultations to the Consultation-Liaison Psychiatry and Psychosomatics Service of Modena General Hospital in a eight-year period (1996–August 2004). METHODS: Socio-demographic and clinical features (before and after psychiatric consultation) of neoplastic-delirious patients were compared to those of all the other delirious patients in the same period. RESULTS: 61 are the neoplastic patients referred for psychiatric consultation and diagnosed with delirium, accounting for the 18.2% of total delirious patients. Non-neoplastic, delirious patients were instead 267 (81.8%). Significant differences were found as to gender, being male sex more frequent among neoplastic patients (75 vs 54%) and as to prescription of psychotropic drugs, being this less frequent among neoplastic patients (61 vs 75%). CONCLUSIONS: Cancer–psychiatric comorbidity, particularly in delirium, should herald an alert for both physician and psychiatrist, with the aim to develop adequate screening procedures at the moment of admission, to better control for risk factors and to allow an early recognition and management of symptoms.

532 Life End Information Forum}Physicians (LEIF} artsen): Improvement of Communication Skills in End-of-life Issues Among Physicians

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Distelmans Wa, Destrooper Pb, Bauwens Sa a Oncology, Palliative Care AZ VUB, Brussels, Belgium; bLEIF Wemmel, Belgium INTRODUCTION: In Belgium, the law on euthanasia has been implemented since September 2002. It is officially confirmed that 80% of the euthanized patients suffered from terminal cancer. However, a lot of physicians still lack communication skills when confronted with end-of-life issues of cancer patients. PURPOSE: A platform was founded with more than 200 physicians in Flanders (the Flemish speaking part of Belgium; 60% of the Belgian population). They are trained in ethical decision making and palliative care for cancer patients. The physicians are called ‘LEIF}artsen’ (Life End Information Forum} physicians). They are meant to advise and support their colleagues in difficult end-of-life issues. METHODS: Recently, a questionnaire was sent to all LEIF-physicians to get an interim report on their activities. CONCLUSIONS: The LEIFartsen-platform in Flanders may be the reason of the higher willingness for officially registering euthanasia-cases by the Flemish physicians (more than 80%) in contrast (less than 20%) with their Walloon colleagues (Wallonia: French speaking part of Belgium and containing 40% of the Belgians). Other conclusions will be reported. ACKNOWLEDGEMENTS: The LEIF project is granted by the Federal Belgian government, Recht op Waardig Sterven and the Vlaamse Liga tegen Kanker.

533 Shared Decision-Making as a Measure for the Improvement of Physician–Patient Interaction with Breast Cancer Patients Ditz S, Bauer L, Mu¨ller B Gynaecology and Obstetrics, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany PURPOSE: In recent times, various models of patient involvement in decision-making for upcoming treatment measures have been developed. The model of ‘shared decision-making’ (SDM) is settled in a middle position between two extremes in which the decision is made more or less either from the physician (‘paternalistic’) or from the patient alone (‘informed choice’). How can the decisional competence of oncological patients be improved so that they are optimally involved in

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the treatment process? METHODS: The communication model of ‘shared decision making’ (SDM) was investigated with linguistic methods. Authentic dialogues from the daily clinical routine with breast cancer patients were submitted to a qualitative discourse analysis (transcribed cassette recordings). RESULTS: In the analysis of the transcripts, we were able to establish that many elements of communicative cooperation, the central tool of SDM, are contained in successfully conducted discussions. Nonetheless, the concept of shared decision-making (SDM) can’t be considered to be sufficiently clarified, specially in its implementation in practice. CONCLUSION: The concept of shared decision-making can improve compliance and enable a mutual decision process. This is progress that optimizes for both parties the communication and the common taking of action. For the practice of decision-making, variants and mixed-forms are to be differentiated beyond pattern analyses, if one wants to loo at real physician conversation behaviour not only as deviance compared with the ‘ideal types’ of the basic model but instead as flexible adaptation performance in the face of a situational need of patient participation.

534 Psychooncological Care at an Interdisciplinary Breast Center: Demand and Reality Ditz S, Mu¨ller B, Bauer L Gynaecology and Obstetrics, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany PURPOSE: At a University Hospital a comprehensive psychooncological model of care for breast cancer patients was developed and implemented according to the guidelines of the German Association of Psychosocial Oncology. What is its acceptability for the women concerned? METHODS: Starting from the concept of ‘minimally invasive psychotherapy for physical disorders’, the offers for psychooncological care comprises among other things: support after the disclosure of the diagnosis, screening methods for the early identification of mental disorder, supportive interventions for anxiety and depression, relaxation techniques, psychosocial support of relatives, supportive group therapy (coping), information for health prevention. RESULTS: So far it has only been partially successful to implement the psychosocial counselling and therapy offer. This is

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due on the one hand to the demand behaviour of the patients and on the other hand to the internal general conditions of the clinic (e.g. available rooms and personnel). Not all breast cancer patients need psychooncological care, but for particularly strained women, it should be available on short notice and non-bureaucratically. CONCLUSION: Low frequent offers improve the acceptance of psychotherapeutic interventions. Decisive for the compliance of accepting an offer for psychosocial support is the individual, personal counselling session through psychosomatically trained specialists and the time point chosen for it. An essential goal therefore is the optimization of the physician–patient communication. Physicians at certified breast centers should have at least basic psychooncologic knowledge. They should get through a communication training course, which was adjusted specifically for the requirements for the treatment of breast cancer patients.

535 A Comparative Study of Psychopathological Conditions and Quality of Life in Women with Breast Cancer and Lymphoma Domingues V, Cabral AS, Carvalho A, Santos M, Santos Z Psychiatry, Coimbra University Hospital, Coimbra, Portugal PURPOSE: Oncologic disease is known to be related with psychosocial distress and implications in patient’s quality of life, varying in different types of cancer. The aim of present study is to compare the quality of life and psychopathological condition among patients under chemotherapy treatment for Breast cancer and Lymphoma. METHODS: Fifty women currently in chemotherapy treatment in the Oncology Day Unit of the Coimbra University Hospital for Breast Cancer or Lymphoma were assessed throughout a brief demographic questionnaire, the Brief Symptom Inventory (BSI) and the Medical Outcomes StudyShort Form (SF-36). A comparison of the results of women with Breast Cancer versus women with Lymphoma has been made. RESULTS AND CONCLUSIONS: Based on the results, the authors make some reflections and sustain the conclusion that oncology must strictly look to the care of psychopathologic condition and quality of life of patients.

Copyright # 2006 John Wiley & Sons, Ltd.

536 Critical Aspects Related to Prostate Cancer (PC). A Psychological Evaluation Donegani S, Spatuzzi A, Valdagni R Prostate Programme, National Cancer Institute, Milan, Italy PURPOSE: In March 2005 Milan National Cancer Institute Prostate Program started an exploratory survey to analyze psychological, emotional and relational consequences of PC diagnosis and radical therapies (prostatectomy, radiation therapy  hormonal therapy). METHODS: From March 2005 to March 2006 257 psychological interviews with PC patients were performed. Patients were questioned about needs, problems, emotions and perceptions of their sexuality and body; replies were recorded in a diary. RESULTS: The main discomforts emerging are the following: mood swing feeling of losing control regarding one’s present and future life anger and sense of helplessness due to the diseasecaused limits effort to reorganize everyday life. Effects on sexuality and relationships: fear of losing one’s masculinity self-awareness due to the social stigma towards the erectile dysfunction shame and embarrassment due to a changing body image apathy due to loss of libido. Peculiar ways of coping with side effects of therapies on sexuality: maintaining a ‘false’ altruistic sexuality exaggeration of the seductive behaviour underlining some possible family roles only. CONCLUSION: Despite an often favourable prognosis, PC diagnosis and therapies seem to have several psycho-social consequences for the patient. In particular, social and sexual domains appear to be significantly compromised. In order to assure constant attention to personal needs, clinicians should consider these emotional and relational difficulties, helping patients and family members to elaborate functional strategies to cope with the disease. ACKNOWLEDGEMENTS: The psychological support to PC patients is supported by a grant from Fondazione Monzino, Milan.

537 Cancer Risk Management Behaviours of French Canadian Women Following BRCA1/2 Genetic Testing Dorval Ma,b, Power Tc, Maunsell Ea,d, Patenaude AFe, Simard Jd

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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Unite´ de Recherche en Sante´ des Populations Centre de Recherche du CHA, Que´bec, Canada; b Faculty of Pharmacy, Universite´ Laval, Que´bec, Canada; cDepartment of Psychosocial Resources, Tom Baker Cancer Centre, Calgary, Canada; d Faculty of Medicine, Universite´ Laval, Que´bec, Canada; eDepartment of Psychiatry, Harvard Medical School, Boston, USA This study assessed how BRCA1/2 test results influenced cancer screening and risk-reduction behaviours of 449 French-Canadian women, from 182 families, who underwent BRCA1/2 testing between 08/1998 and 07/2004. Questionnaires completed at pre-test genetic counselling and 12 months post-disclosure were used to assess frequency of breast screening behaviours, intention concerning and uptake of prophylactic surgeries. Age at pre-test varied between 20 and 79 years (mean ¼ 51 years). Ninety-six women were found to be carriers of the familial mutation, 128 noncarriers, and 225 had an inconclusive result. The majority of women who had previously had cancer performed surveillance in the year prior to genetic testing (mammogram (85%), clinical breast exam (92%), breast self-exam (61%)) and continued one year post-disclosure (mammogram (91%), clinical breast exam (95%), breast self-exam (72%)), irrespective of their test result. Among noncarriers without cancer history, the proportion who had a mammogram in the year after disclosure (48%) was lower than in the year preceding genetic counselling (73%) (p50.0001). Uptake of prophylactic surgeries was low; among carriers without cancer history (n ¼ 34), only one (3%) had undergone prophylactic mastectomy and two (6%) had oophorectomy at one year; three (9%) and four (12%) women had made the decision to have prophylactic mastectomy and oophorectomy, respectively. Our findings suggest that high-risk French-Canadian women place more value on cancer screening than risk-reduction interventions to manage their risk of breast cancer. Longer-term follow-up will provide a better estimate of maintenance of cancer screening behaviors and prophylactic surgery uptake in this population.

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Douma KFLa, Aaronson NKa, Vasen HFAb,c, Gerritsma MAa, Leiker EMAa a Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; bThe Netherlands Foundation for the Detection of Hereditary Tumours, Leiden, The Netherlands; cDepartment of Gastroenterology Leiden University Medical Center, Leiden, The Netherlands PURPOSE: Familial adenomatous polyposis (FAP) is a hereditary condition characterized by the development of a large number of polyps in the colon which, without surgery, will develop into colorectal cancer by the age of 45 years. In this nationwide, cross-sectional study we are investigating, among other issues, cancer-specific worry about cancer and about future surgery among individuals from FAP families. METHODS: All individuals from FAP families are invited to complete a self-report questionnaire (estimated n ¼ 750); a sub sample (n ¼ 60) also is invited to undergo a semi-structured interview. The CancerSpecific Worry Scale was used, consisting of 7 questions about cancer worries and their impact on daily functioning. An additional, study-specific question addresses worries about future surgery. RESULTS: Preliminary results based on the first 90 respondents (men n ¼ 38; women n ¼ 52) indicate that only a small percentage of individuals (2–13%) had frequent worries about cancer. Of individuals with a clinical FAP diagnosis, 26% reported being ‘often’ or ‘almost always’ worried about the possibility that they will one day need surgery (again), compared to 6.3% of those (as yet) without a FAP diagnosis (p ¼ 0:06). CONCLUSIONS: These preliminary results suggest that few individuals from FAP families have significant levels of worry about the risk of developing cancer (again) and the need for surgery. These results are comparable with those of an earlier study of individuals from HNPCC families (Bleiker et al., 2003). ACKNOWLEDGEMENTS: This study is financially supported by the Dutch Cancer Society (NKI 2004-2987).

539 538 Cancer Worries of Individuals from Families with a High-risk for Familial Adenomatous Polyposis (FAP)

Copyright # 2006 John Wiley & Sons, Ltd.

Double Grief}Psychosocial Support Needs of Grandparents Who Lose a Grandchild to Cancer Drew D, Goodenough B Centre for Children’s Cancer and Blood Disorders, Sydney Children’s Hospital, Randwick, Australia

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PURPOSE: 1. To review literature on grief experiences and support needs of grandparents who have lost a grandchild to cancer 2. To present preliminary data on potentially unique bereavement phenomena for grandparents relative to other grieving adults in the same families. METHODS: Scientific and lay literature were reviewed for materials relevant to the specific needs of grieving grandparents, both within and beyond the cancer domain. Obtained resources informed a pilot 32 adults (8 grandparents) from 5 Australian families who had lost a child to cancer (minimum bereavement length 6 months). Each adult completed a ‘Support Needs and Bereavement Experiences’ questionnaire. This instrument surveyed support services and resources (accessed or needed including literature, support groups and counselling) and comprised a 50-item (not true–very true) of bereavement phenomena. RESULTS: Few resources were identified specifically for grieving grandparents. The Australian study indicated grandparents accessed fewer resources than parents, especially group or counselling support. This was despite grandparents rating themselves to similar magnitudes on such bereavement phenomenology as ‘question value of life’, ‘worry about siblings’, ‘expected to move on’, and ‘expected to be stronger than I really am’. Grandparents were more likely to endorse feeling family responsibilities had increased, with half endorsing ‘not strong enough’ to support parents plus experiencing ‘double grief’ (own plus that of adult child). CONCLUSIONS: Bereaved grandparents have been called the ‘forgotten grievers’. Notwithstanding sparse evidence of specific psychosocial needs, this population is likely to be under resourced. Focused research should address whether this generalises across the paediatric cancer spectrum, not just bereavement.

540 Use of Five Psychological Parameters for Modulating the Quality of Communication of First Call Letter for the Colorectal Cancer Screening Programme, Adapting it to Different Socio-economic and Cultural Clusters of Lazio Region’s Population Federici A, Guarino A, Serantoni G, Barca A School of Psychology, University of Rome ‘La Sapienza’, Rome, Italy The screening for oncologic prevention is an intervention of proven effectiveness for the reduction of mortality for cancer: the population’s

Copyright # 2006 John Wiley & Sons, Ltd.

attendance and an appropriate communication represent essential requisites. As for first call letter and relationship with the users, the quality and the weight of communication methods and processes constitute the essential instruments for influencing users’ aware adherence. The users, that are mostly healthy people, expect positive confirmations as regard to their health; but users, especially in wide regions, come from different socio-economic and cultural milieu that could bias the understanding of complex standard call letters and therefore the users’ adherence. Psychology can supply right means for implementing the users’ adherence to the screening. The Lazio Region’s experience shows the weight of a standard first call letter for a colorectal cancer screening programme: the standard letter has been converted into three prototype-letters adapted to the five socio-economic and cultural clusters of Lazio (highaverage, average, low clusters). The clusters have been characterized analyzing the following variables: width of town, cultural standard, concentration of old-aged population, technological profile, yield per capita. The three letters’ contents have been developed by a team of psychologists, applying five psychological parameters to the standard communication for adapting it to the different clusters: cognitive plainness, emotional impact, action’s directivity, protective attitude and responsibility of decisional behavior. The organizational model and the availability of an information system based on individual records will allow to estimate quantitatively the effectiveness of this kind of call letters.

541 The Transtheoretical Model Applies to The Secondary Prevention of Breast Cancer Queipo Peirats S, Andreu Vaillo Y, Dura´ Ferrandis E, Galdn Garrido MJ Personality, Evaluation and Psychological Treatments Department, Faculty of Psychology, University of Valencia, Valencia, Spain The aims of this paper were group the women by their stage of mammography adoption (Precontemplation, Contemplation, Action, Action} Maintenance and Relapse), defined by their past and present screening behaviour and their intention to get mammograms in the future. Analyze the beliefs and attitudes of the women toward screening according to stages of mammography adoption. Analyze if significant differences

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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between the stages exist, in each of the demographic and cognitive variables measured. The sample was consisting of Spanish women, aged 47–70 years. They were evaluated by the same questionnaire, which measured three types of variables: Demographic: age and level of studies. Cognitive: perceived severity of breast cancer, perceived susceptibility to breast cancer, general health motivation, benefits and barriers perceived to mammography, social pressure, perceived control on this preventive behaviour and the degree o information about mammography. Practice of mammography screening: stages of adoption of mammography screening. All the cognitive variables, except the perceived susceptibility to breast cancer, have significant differences depending on the stage of mammography adoption. According to the stages of adoption, the women differ as for their beliefs towards mammography screening and breast cancer, differ also in the control and social pressure that they perceive to undergo mammograms, and in the degree of information that they have about breast cancer screening mammography.

542 Prevalence and Temporal Evolution of Acute and Posttraumatic Stress Responses, and Neuropsychological Distress Among Breast Cancer Patients Perez Rodriguez S, Andreu Vaillo Y, Dura Ferrandis E, Galdon Garrido MJ, Ibanez Guerra E Personality, Evaluation and Psychological Treatments Department, Faculty of Psychology, University of Valencia, Valencia, Spain Psychological morbidity of breast cancer patients can be understood from the theoretical framework of acute stress disorder and posttraumatic stress disorder. Receiving a diagnosis of breast cancer and the process of treating the illness (surgery, chemotherapy and/or radiotherapy) can trigger acute stress reactions, posttraumatic stress and psychological distress. PURPOSE AND METHODS: One of the major aims of the present longitudinal study was, on one hand, to evaluate in an initial sample of 175 breast cancer patients the prevalence of those cases liable to receive an acute stress or posttraumatic stress disorder diagnosis along different phases of the illness process. On the other hand, we focused on evaluating the presence of psychological distress clinically relevant after diagnosis, surgery, treatment and medical follow-ups. RESULTS: Results

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of this work revealed that 17% of breast cancer patients was liable to receive an acute stress disorder diagnosis following initial communication of possible/probable malignancy. Moreover, this percentage showed a reduction after surgery and successive phases of illness. Estimated prevalence of posttraumatic stress disorder fluctuated between 27% on post-surgical treatment phase and 23% on follow-up, six months after the end of treatment. Finally, 23% of patients showed initially clinical levels of psychological distress, but theses levels displayed a reduction on following stages. CONCLUSIONS: These data point out the relevance of putting special attention on acute and posttraumatic stress in breast cancer patients, as in our sample these were quite common reactions. ACKNOWLEDGEMENTS: This research has been supported by Generalitat Valenciana and Ministry of Science and Technology (R+D Project).

543 Acute Stress Disorder as a Predictor of Posttraumatic Stress Disorder Among Breast Cancer Patients Perez Rodriguez S, Andreu Vaillo Y, Dura Ferrandis E, Galdon Garrido MJ, Ibanez Guerra E Personality, Evaluation and Psychological Treatments Department, Faculty of Psychology, University of Valencia, Valencia, Spain Previous research has revealed the predictive power of Acute Stress Disorder as a precursor on the development of future Posttraumatic Stress reactions. In fact, this has been one of the major reasons for including Acute Stress Disorder (ASD) diagnosis on DSM-IV. Initial impact of a cancer diagnosis and following treatments can trigger acute and posttraumatic stress reactions on breast cancer patients. PURPOSE: The main objective of this study is to explore the predictive power of Acute Stress Disorder on the development of future Posttraumatic Stress Disorder in breast cancer patients. METHODS: We estimated in a sample of 175 breast cancer patients those cases that fulfilled clinical and sub-syndromal (or partial) criteria for ASD and PTSD. We as well analysed the course of clinical cases along the different phases of the illness: initial suspicion of malignancy, surgery, post-surgery treatment, end of treatment and medical follow-up. RESULTS: In this work, results suggested that ASD showed

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on initial phase is a good predictor of PTSD on post-surgical treatment and following phases among our sample. CONCLUSIONS: For this reason, is specially relevant the early detection of acute stress symptoms in breast cancer patients and the application of psychological interventions that allow to prevent the future development of PTSD. ACKNOWLEDGEMENTS: This research has been supported by Generalitat Valenciana and Ministry of Science and Technology (R+D Project).

544 The Ce´dric He`le Institute, The National Institute for the Promotion of Psychosocial Care in Oncology Eelen Sa, Bauwens Sb, Vanderlinden Lc, Verzelen Ad, Mathys Rd a Ce´dric He`le Institute, Mechelen, Belgium; bOncology Centre, Academic Hospital, Free University of Brussels, Brussels, Belgium; cSocial Service, Universitary Hospital of Leuven, Leuven, Belgium; d Oncology Centre, ZNA Middelheim, Antwerp, Belgium BACKGROUND: In Belgium the need to expand and to improve psychosocial care in oncology was great for two reasons. First not all cancer patients were reached, nor their relatives. Second, a lot of caregivers liked to raise the quality of their interventions. METHODS: A couple of caregivers joined their strengths under the pulse of the Flemish Liga against Cancer and tried to formulate an answer to those needs by establishing a multidisciplinary Flemish institute for psychosocial oncology, the Ce´dric He`le institute. All of this in discussion with care providers and in close cooporation with policy agents. OBJECTIVES: Actually the Ce´dric He`le institute pursues these objectives: in relation to caregivers: organise and coordinate training in psychosocial care create and support a inter- and intra-disciplinary network of caregivers encourage and gather scientific research and information in relation to cancer patients: create a platform to point out needs of cancer patients and their surroundings in relation to the government: indicate needs in psychosocial oncology. RESULTS: The Ce´dric He`le institute already organised several courses for different target groups: work accompaniment for young and experienced social workers, a course ‘communication’ for nurses and a workshop ‘bad

Copyright # 2006 John Wiley & Sons, Ltd.

news conversation’ for doctors. In association with a number of Flemish universities the institute started in 2006 a two-year training in psychooncology for masters in psychology. ACKNOWLEDGEMENTS: The Ce´dric He`le institute could be founded thanks to the support of the national society ‘Flemish Liga against Cancer’.

545 Development of an EORTC Questionnaire to Assess Information Received by Cancer Patients: The EORTC QLQ-INFO 26. Present Results and Future Steps Arraras JIa, Efficace Fb, Holzner Bc, KuljanicVlasic Kd, Bjorda Ke a Oncology Hospital de Navarra, Pamplona, Spain; b Quality of Life Unit, EORTC Data Center, Brussels, Belgium; cPsychiatry, Medical University Innsbruck, Innsbruck, Austria; dGynaecology and Obstetrics, Clinical Hospital Center Rijeka, Rijeka, Croatia; ePalliative Care Research, Radiumhospitalet Trust, Oslo, Norway PURPOSE: It is important to evaluate information in studies and in daily clinical practice. We report the development of an instrument to measure the level of information received by cancer patients. METHODS: The development followed the EORTC guidelines for developing Quality of Life (QOL) questionnaire modules which consist of a four phase process. In Phase I and II a literature review was conducted and items formulated. In Phase III, the 26 item questionnaire was tested in order to identify and solve potential problems in its administration. To determine the need for additional questions or the elimination of others, structured interviews with each patient were conducted after completion of the questionnaire. Cross cultural aspects have been taken into account. RESULTS: 133 cancer patients with various diagnoses were interviewed in eight countries. These represented northern, central and southern Europe and Korea. Clinical and demographic data were recorded. The resulting module (EORTC QLQ-INFO 26) consisted of 26 items grouped into four scales (information about the disease, the medical tests, the treatment and other services) and other single items such as satisfaction with information and desire to receive more information. There were no differences among subgroups of the whole sample for disease stage, treatment modality, level of information or

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gender. CONCLUSIONS: after these three phases we can conclude that the EORTC QLQ-INFO 26 is a robust instrument to be used in cross-cultural studies. FUTURE: we have just started a field study with a larger sample of patients coming from different cultural areas.

546 Investigating the Quality of Patient-reported Outcome Research in Complementary and Alternative Medicine Interventions in Oncology Efficace Fa, Horneber Mb, Lejeune Sc, Van Dam Fd, Aaronson Nd a Quality of Life Unit, European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium; bHaematologie und Knochenmarktransplantation Medizinische Klinik 5 und Institut fu¨r medizinische Onkologie, Nu¨rnberg, Germany; cCAM-CANCER Project European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium; dDivision of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands PURPOSE: To systematically evaluate the methodological robustness of patient-reported outcomes (PROs) evaluation in randomized controlled trials (RCTs) investigating in complementary and alternative medicine (CAM) in oncology. METHODS: CAM RCTs with a PRO endpoint published between 2000 and 2005, retrieved in Medline or CENTRAL were included. CAM was classified according to the five categories of the National Center for Complementary and Alternative Medicine. The ‘Minimum Standard Checklist for Evaluating HRQOL Outcomes in Cancer Clinical Trials’ was used to assess the quality of the PRO reporting. RESULTS: Fortyfour RCTs enrolling 4912 patients were identified: 6 studies involved alternative medical systems, 14 involved mind body interventions, 15 dealt with biologically based therapies, 7 involved manipulative and body-based-methods, and 2 energy therapies. Eighty-nine percent of studies used a PRO as a primary endpoint and 59% documented PRO missing data. Although 84% of the studies used a validated PRO questionnaire, only 3% stated an a priori hypothesis and 20% addressed clinical significance of the outcomes. Overall, 64% of the studies reviewed had some methodological drawbacks. Studies investigating mind-body interventions seemed to have higher methodological

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quality than studies investigating other CAM interventions. CONCLUSIONS: If PROs are to fulfil their potential of allowing patients and clinicians to make informed decisions about the overall value and impact of a given CAM treatment in terms of patients’ well-being, investigators are encouraged to continue to improve the design and the reporting of key methodological aspects as identified in this work.

547 The Patient in the Family: A Discursive Analytic Study of Dying Patients’ (and their family’s) Talk on the Do-not-resuscitate Decision Eliott JAa,b, Olver INa,b,c a Royal Adelaide Hospital Cancer Centre, Royal Adelaide Hospital, Adelaide, Australia; bMedicine, University of Adelaide, Adelaide, Australia; cCancer Council Australia, Sydney, Australia PURPOSE: Within the medical/bioethical literature, family are commonly cited as supporting patient autonomy and appropriate surrogate decision-makers, though their suitability in this role has been subject to theoretical and empirical challenges. However, analysis of patient talk about family in these roles is sparse. METHOD: As part of a study about the decision to refrain from CPR (the DNR decision), 28 (15 male) patients with cancer close to death were asked who should make such decision about the patient; in 14 interviews, family attending occasionally contributed to discussions. Semi-structured interviews were recorded, transcribed, and analysed using discourse analysis, focusing on similarities and differences between and within interviews, and considering how individuals justified or negotiated the positions espoused. RESULTS: Participants selectively invoked different aspects of autonomy, and drew upon normative characteristics constituting family to identify family as both appropriate (by virtue of a presumed knowledge of, and care about the patient) and inappropriate surrogates (by virtue of a presumed emotional attachment to patient taken to preclude rational consideration, and relatedly, as liable to suffer harm through being asked to determine whether the patient lives or dies) surrogates. Family similarly invoked autonomy and actively engaged with the patient to articulate (and sometimes shape) patients’ decisions. Both identified competing considerations that affected and problematical the choice about (forgoing) resuscitation.

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CONCLUSION: Family preferences were central, but not equivalent to the patient’s. Both identified the decision as a moral and social dilemma. Autonomy sometimes functioned to oblige patients to ignore their preferences.

548 An Investigation on The Disclosure of BRCA1/2 Genetic Test Results to Daughters Esplen MJa, Clarke Sb, Messner Sc, Eisen Ac, Ambus Id a Behavioral Sciences and Health, Toronto General Research Institute, Toronto, Canada; bFaculty of Nursing, University of Toronto, Toronto, Canada; c Preventive Oncology, Sunnybrook and Women’s Health Sciences Centre, Toronto, Canada; dClinical Genetics, North York General Hospital, Toronto, Canada PURPOSE: To explore experiences associated with disclosure of genetic test results in BRCA1/2 families. METHODS: A mixed research design included quantitative surveys of standardized measures and in-depth interviews with adolescent (age 12–18) and adult daughters (age 19–25) t explore the impact of knowledge of a genetic mutation in the family. RESULTS: This presentation will focus on the daughters survey findings and themes from the in-depth interviews. The mean age of daughters interviewed to date is 21.7  7.2 (range 16.6–28.9), 60% stated their BC risk was high or very high and 2 daughters had received their own genetic test results (one positive and one negative). Mean levels of genetic testing-specific distress on the IES (7.0  2.2) and global distress on the BSI (T-score ¼ 47) were in the non-clinical range and family communication on the McMaster FAD (2.1  1.1) was within the normative range. Emerging qualitative themes included: Genetic Information as Informative & Empowering; Increased Vulnerability to Cancer; Concerns About Screening and Challenges Associated with Notifying Significant Others about Genetic Risk. Interviews with adolescent daughters are continuing and final results will be presented. CONCLUSIONS: Preliminary findings demonstrate that daughters are able to assimilate genetic information without elevating levels of distress. In-depth studies of daughters at various ages and stages of development are required in order to understand the impact of notification of this life altering information.

Copyright # 2006 John Wiley & Sons, Ltd.

ACKNOWLEDGEMENTS: Grant #015694} Canadian Breast Cancer Research Alliance.

549 Designing a Core Curriculum for Catalan (Spain) Psychooncology Estape´ T, Gondon N, Ba´rez M, Espasa R, Martin C Psycho-oncology Working Group, Catalan Official College of Psychologists (COPC), Barcelona, Spain PURPOSE: In Catalonia (Spain) there is not a defined core curriculum for psychooncology, The authors have designed a document with the following aims: To describe psychooncology as a speciality in the field of psychology; To describe the professional profile of the psychologist aiming to train in psychooncology. METHODS: The authors recollected the information available on different training models (including IPOS curriculum) and from their own direct observation of Catalan current state of the health care. RESULTS: The outcome work was a consensus document including as main areas: Training, Professional role, Target people, Sphere of activity, Different therapeutic models. CONCLUSIONS: In Catalonia (Spain) there is a lack of official guidelines defining the core curriculum on psychooncology. The present document unified the different criterion being now part of the professional role accepted by the Catalan Official College of Psychologists (COPC). ACKNOWLEDGEMENTS: The authors wish to express their thankfulness to the COPC for the given opportunity to perform this work and to help in its spreading. Also to Mrs Cristina Bierg and Mrs Imma Diaz, psychologists, for their contribution. Finally, to the different outstanding professionals giving their recognition to this document.

550 How do Spanish-speaking Breast Cancer Patients (BCP) Who Use Internet Differ from Those Who Do Not Use? Estape´ Ta, Estape´ Jb, Boixado´s Mc, Alberro JAd a Psychooncology Fundacio´n FEFOC, Barcelona, Spain; bMedical Direction Fundacio´n FEFOC, Barcelona, Spain; cPsychology Degree, Universitat Oberta de Catalunya, Barcelona, Spain; dUnidad de Mama Hospital Oncolo´gico, San Sebastian, Spain

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PURPOSE: Internet is still not used by most cancer patients. We want to compare Spanishspeaking BCP internet users (IU) with internet non-users (INU) in different areas of interest. METHODS: A 42 item interview was selfadministered by INU BCP having finished treatment and set up simultaneously in our web. Interview covered a general overview of information on BC, satisfaction with information received and consequences of illness and treatment. RESULTS: 78 BCP INU and 153 IU (recruited online) answered the interview. IU were significantly younger (x ¼ 46:24; x ¼ 56:79; p50.0001). To avoid age bias we divided sample by age (50 percentile: 553 and >54 years). Significant results showed that in younger group IU compared with INU have higher academic level, more use of private medical system, are better informed on BC risk factors and more chance to have found their tumour in a screening mammography. Also they qualified as worst the support received from their partner and more couple conflict since BC. IU older group showed more chance of troubles in medical insurances after treatment than INU. Both age groups showed no differences for use of internet in: need of psychological support, troubles in work after treatment and on information about own illness, except in tumour size (IU better informed). Anova results indicated that time perceived on information given by doctor did not differ according to internet use, except referring to diagnosis disclosure. CONCLUSIONS: There are still some different profiles in Spanish speaking IU.

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viewpoints and trying to construct the preliminary model of existential-cognitive psychotherapy. METHODS: Four terminal cancer inpatients with MDD transferred to receive psychotherapies after signing letters of informed consent. The whole courses of psychotherapies were digital-recorded. Texts were the verbatim of psychotherapies. According to Heidegger’s dasein hermeneutics, texts were analysed by the method of Colaizzi’s seven steps. RESULTS: There were 22 valid texts. The factors of depression included loss of ability, indignity, physical pain, automatic negative thought, disintegration of meaning of life, and meaninglessness of dasein. The interventions included ensuring the patient’s consciousness, facilitating self-awareness of illness, being aware of automatic negative thoughts, challenging to automatic negative thoughts, facilitating patients to be here and now, being with patients, discussing patients’ previous meanings of life, and facilitating patients to construct the present meanings of life. The factors of patients’ changes were therapists empathy, empowerment of dignity, improvement of physical suffering, affect by other beings, patients’ choices at present, integration of the meaning of life, reconstructing the meaning of being in the final stage of life, and power of love. After psychotherapies, all patients died naturally. CONCLUSIONS: Psychotherapies were able to relieve the four patients’ depression in terminal stage. The model of existential-cognitive psychotherapy might be developed and examined by further evidence-base research.

552 551 Psychotherapy Among Terminal Cancer Patients with Major Depressive Disorder: The Preliminary Construction of Existential-Cognitive Model Fang C-Ka,b, Li P-Yc a Department of Psychiatry & Center of Suicide Prevention, Mackay Memorial Hospital, Taipei, Taiwan; bOffice (Secretary General), Taiwan Academy of Hospice Palliative Medicine, Taipei, Taiwan; cDepartment of Educational Psychology and Counselling, National Taiwan Normal University, Taipei, Taiwan

The Psychotherapeutic Process Associated with a Surgical Procedure Faria FPa, Perina EMb, Mastellaro MJc, Oliveira AGd a Mental Health Department, Boldrini’s Children Hospital and State University of Campinas, Campinas, Brazil; bMental Health Department, Boldrini’s Children Hospital and State University of Campinas, Campinas, Brazil; cOncology Division, Boldrini’s Children Hospital, Campinas, Brazil; d Pediatric Surgical Department, Boldrini’s Children Hospital, Campinas, Brazil

PURPOSE: There are few literatures about psychological intervention among terminal cancer patients with major depressive disorder (MDD). The purposes of the study included finding the factor of depression in existential-cognitive

INTRODUCTION: Psychological preparation has been considered more and more important for the cases of invasive procedure in children and adolescents with cancer. Such preparation aims helping the patient face, elaborate and accept the

Copyright # 2006 John Wiley & Sons, Ltd.

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moments which will spend in the hospital environment. PURPOSE: Demonstrate the importance of the psychotherapeutic process in the preparation for surgical procedures and contribute for the elaboration of the psychic conflicts related to this experience. METHOD: A qualitative research has been carried out involving a sixyear-old child adrenal carcinoma survivor who would undergo a surgical procedure, being the information concerning the psychotherapeutic assistance discussed and analyzed. RESULTS: The psychological assistance was a way to come into contact with the child’s fantasies, projections, fears and anguish related to the surgery. This assistance was provided before and after the surgery and we believe that this psychotherapeutic process did make a significant difference in the post-surgical recovery. CONCLUSION: The elaboration of the experience for children and adolescents undergoing a surgical process is of major importance. Taking into account the complexity of the human nature, we consider the interdisciplinary work relevant for a better understanding of how the physical aspect can be experienced by the mind.

553 Temperament-character Issues and Adjustment Disorders in Patients with Breast Cancer Early Diagnosis Fei La, Periti Ja, Abrardi La, Distante Vb, Muzzi Mb a Department of Neuro-Psychiatric Sciences, University of Florence, Florence, Italy; bDepartment of General Medicine & Surgery, University of Florence, Florence, Italy PURPOSE: In this study we investigate the relationship between early depressive and/or anxiety symptoms after breast cancer diagnosis and temperament & character issues. METHODS: The sample group, heterogeneous for age education and tumour stadium, was of 37 women with early (max. 1 month) diagnosis of breast cancer. Patients with neurological and/or psychiatric pathology or previous ones and patients with any other oncologic pathologies were excluded. The sample was studied by HADS for affective symptoms and Temperament and Character Inventory (TCI). RESULTS: One month after diagnosis 60% of the patients showed anxiety symptoms and 47% showed depressive symptoms, in order to HADS scales. The presence of affective symptoms has been correlated

Copyright # 2006 John Wiley & Sons, Ltd.

with HA (‘harm avoidance’) and RD (‘reward dependence’) scales of TCI. In details, Spearman rank correlations were significant between TCI’s HA2 subscale and all HADS scales scores (p50.05) and between TCI’s RD2 subscale and HADS total scores (p50.05). HA subsc.2 and RD subsc.2 measure, respectively, the fear of uncertainty and the tendency to withdraw. So a subject with these traits, after the diagnosis of cancer, may fell himself close to his death and ‘abnormal’ towards other healthy men. These conditions can enhance the risk of affective disorders. CONCLUSIONS: In our sample the incidence of affective symptoms is higher than in normal people. Because of exclusion criteria, we can suppose these symptoms like onset signs of Adjustment Disorder with depressed mood. Te character issues found may be seen as vulnerability factors for it.

554 Depressive Symptoms and Quality of Life in Cancer Patients Fei L, Periti J, Abrardi L, Simeone M, Fontani S Department of Neuro-Psychiatric Sciences, University of Florence, Florence, Italy PURPOSE: The aim of this study is an evaluation of relationship between Affective Disorders and Quality of Life (QoL) in cancer patients. METHODS: 40 patients with different cancers were evaluated by BDI and TEMPS-I scales for the measurement respectively of depressive symptoms and affective temperament, in order to Akiskal’s assessment, that can show the presence of subthreshold affective symptoms. The sample was evaluated also by SF-36 scale for Qol measurement. RESULTS: Spearman rank-order correlations between BDI and TEMPS-I vs SF-36 scores were significant only in 4 of 9 areas of SF-36: AS-social activities (r ¼ 0:367; p ¼ 0:02); SM-mental health (r ¼ 0:461; p ¼ 0:003); RE-role vs emotions (r ¼ 0:328; p ¼ 0:039); VT-vitality (r ¼ 0:340; p ¼ 0:032). CONCLUSIONS: In this sample the presence of affective disorders makes the quality of life worse compromising social activity, work and vitality of cancer patients. The lack of correlation with other QoL areas (e.g. physical impairment) in order to evaluation by SF-36, is probably due to the presence, in this sample, of mild intensity affective disorders like Adjustment Disorders, as commonly can be verified in oncologic patients.

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555 Effectiveness of s-citalopram in the Treatment of Depressive Disorders During the Course of Cancer Fei L, Periti J, Abradi L, Iliadis I, Fontani S Department of Neuro-Psychiatric Sciences, University of Florence, Florence, Italy PURPOSE: The authors investigate the effectiveness of various antidepressants in the treatment of depressive disorders during the course of cancer (Adjustment Disorder, Major Depression, Dystymic Disorder, Post Traumatic Disorder). METHODS: A sample of 85 patients (heterogeneous for sex, age, education, psychopathological condition, type and stadium of tumor) were treated in different times for at least two months with one or more antidepressants with low side effects (citalopram, sertraline, fluvoxamine, s-citalopram, mirtazapine). Each subject has been previously evaluated by SCID I. Follow up was assessed by HADS, BDI and CGI-S scale at baseline, week 1, week 2, week 4, month 2, month 3 and month 6. Relevant side effects were monitored. RESULTS: From week 2 until month 6, s-citalopram and sertraline revealed their effectiveness and superiority versus the other drugs in terms of lower drop-outs, tolerability and maintenance of antidepressive response. S-citalopram seems to show a better antidepressive efficacy than sertraline in order to BDI and CGI-S scale scores. CONCLUSIONS: s-citalopram and sertraline seemed to be more effective in the treatment of depressive disorders during the course of cancer. Their superiority can be understood in order to tolerability and maintenance of efficacy. The lower working time lag of s-citalopram can explain its better antidepressive efficacy in our sample, in order to the relevance of a rapid response in oncologic patients.

556 Magnolia Project: Art-therapy and Physiotherapy as Support Activities During Bone Marrow Transplantation Ferrandes Ga, Agnese Ab, Albarello Mb, Riccardi Fa, Luzzatto Pc a Clinical Psychology and Psychotherapy, ‘San Martino’ Hospital, Genoa, Italy; bHematology, BMT Unit ‘San Martino’ Hospital, Genoa, Italy; c Art Therapy, Art Therapy Italiana, Bologna, Italy OBJECTIVE: Patients in isolation for Bone Marrow Transplant (BMT) face several weeks of

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isolation, with heavy physical and emotional discomfort. It has been difficult to identify the most suitable supportive interventions. At Memorial Sloan Kettering Cancer Center (MSKCC), New York, music therapy, art therapy and massage are offered to these patients. In connections with the experience at MSKCC, the BMT Unit, ‘San Martino’ Hospital, Genoa, (Italy), has devised the ‘Magnolia Project’, to assess the response of BMT patients to a integrated program of two non-verbal supportive modalities: art therapy and physiotherapy. METHOD: During a period of six months, in 2006, thirty BMT patients in isolation have received an integrated service of weekly art therapy and physiotherapy sessions. The art-therapy sessions were based on free drawing and facilitating techniques. The physiotherapy sessions were based on metamorphic massage, relaxing and active muscular distension, sensorial stimulations, breathing exercises. The patients filled two self-assessment questionnaires: at the time of admission, and at the end of the hospitalization. OUTCOME AND CONCLUSION: This pilot study support the hypothesis that providing a combination of art therapy and physiotherapy to patients in isolation may fulfil their two most important needs: relaxation and self-expression. Art Therapy has offered a space for dealing with fantasies and emotions; physiotherapy has encouraged relaxation and the dialogue with one’s body at a psychophysical level. The Magnolia Project hopes to introduce these two forms of supports into the standard treatment, to improve the ‘quality of care’ for patients in isolation for bone marrow transplant.

557 Playing and Making Art in a Children’s Cancer Hospital Ferrer ALa, Lisboa Ca, Perina EMb, Packer MPa, Mazzon Na a Play-Room Boldrini’s Children Hospital, Campinas, Brazil; bMental Health Department Boldrini’s Children Hospital, Campinas, Brazil PURPOSE: Who said that children with serious diseases can’t play? The Therapeutical Play-Room Ayrton Senna from the Boldrini’s Children Center was created in a partnership with the Ayrton Senna Institute aiming to provide playful moments to children and teenagers who are facing critical treatment against cancer. The use of toys

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and art workshops throughout the hospital helps them to understand their condition and to face their difficult reality. METHODS: The play-room is divided in corners, designed to accommodate the diversity of interests from patients. For those who can’t move to the play-room, a loan system was devised. The professionals in charge are trained people in the field and are helped by a team of volunteers. Very often the play-room is visited by artists. Field trips to places exhibiting art are also very common. RESULTS: Since 2001, about 80 patients or their families per day have been at the play-room. About 420 patients are currently listed as regular borrowers. Currently the play-room offers 1259 toys. CONCLUSIONS: The Therapeutic Play-Room Ayrton Senna has made a difference to lives of kids, assisting in their treatment. The excellent ambient conditions, the availability of a variety of toys and the working people improve the patient’s emotional conditions, which promotes their will to face the harsh treatments and get better. No doubt that playing and making art are good medicines when one is in a hospital.

558 Skin Cancer: What Takes Women to Ignore the Prevention’s Importance? Souza Festugato M, Mu¨ller MC, Loureiro R EADPUC Virtual PUC/RS Porto Alegre, Brazil INTRODUCTION: Skin cancer is the most common, and also the easiest type to be cured, if detected early. And besides, it’s very simple to prevent, and the principal way for doing this is avoiding the sun between 10 a.m. and 4 p.m. Unfortunately, in Rio Grande do Sul, it occupies the first place in the statistics. PURPOSE: This research, realized with women, started out the affirmation that women know the risk time, but still take sunbaths at that time. OBJECTIVE: To verify the motive of this behavior. METHODS: Hypotheses were taken: the association between suntan and health; the high costs of the sunscreens; and the ‘this does not happen to me’. For verifying that hypothesis, a questionnaire with 10 questions about the theme was given to 66 women who used to go to 2 parks of the city. After that, the answers were divided into groups and a descriptive analysis was made, using a simple frequency. CONCLUSIONS: Looking at the results, the question referring to the cost of the sunscreens was not confirmed, at least between the women inter-

Copyright # 2006 John Wiley & Sons, Ltd.

viewed, while the others, were confirmed and seems to have ‘opened the way’ for new studies.

559 Work Productivity in Cancer Survivors: An Emerging Occupational Health Challenge Feuerstein Ma,b, Hansen JAa,c, Calvio LCa, Ronquillo JGa, Johnson La a Department of Medical and Clinical Psychology Uniformed Services, University of the Health Sciences, Bethesda, USA; bDepartment of Preventive Medicine and Biometrics, Georgetown University Medical Center, Washington, USA; c Department of Psychology, American University, Washington, DC, USA OBJECTIVE: The majority of cancer survivors return to work, yet many experience work-related problems. Fatigue, emotional distress and cognitive limitations can impact functioning at work. This study investigated the association of these factors, medical history, health behaviors and problem solving on work limitations. METHODS: Survivors of malignant brain tumors (n ¼ 99), breast cancer (n ¼ 102), and a noncancer comparison (n ¼ 150) group completed a web-based questionnaire. Information on demographics, tumor type and treatment, work history, job stress, mood, problem solving orientation, and cognitive limitations was obtained. RESULTS: Findings indicated that both cancer survivor groups (mean of 2 years post primary treatment) report higher levels of work limitations and time off from work for non-cancer related reasons than the non-cancer comparison group. Two separate multivariate regressions for each cancer type were run. Age (b ¼ 0:188; p50.01), fatigue (b ¼ 0:203; p50.01), depressive symptoms (b ¼ 0:299; p5 0.01), cognitive limitations (b ¼ 0:170; p50.05), enough sleep (b ¼ 0:130; p50.05) and negative problem solving orientation (b ¼ 0:196; p50.05) were associated with work limitations in brain tumor survivors accounting for demographics and treatment history. Using an identical model, fatigue (b ¼ 0:538; p50.001) was the only factor that was significantly associated with work limitations in breast cancer survivors. CONCLUSIONS: Fatigue, depressive symptoms, cognitive limitations and problem solving approaches should be evaluated when cancer survivors experience work limitations even an average of two years post diagnosis. The pattern of these factors can differ dramatically across cancer types. Effective

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interventions for these problems need to be developed to help maximize work function.

560 A Network of Psycho-Oncology Services: Emerging Organizational Model in Tuscany Fioretto La, Alunni Gb, Luzzatto Lc, Focardi Fd, Velicogna Fe a Dipartimento Oncologico Azienda Sanitaria 10, Florence, Italy; bDirezione Istituto Tumori Toscano Regione Toscana, Florence, Italy; cDirezione Istituto Toscano Tumori Regione Toscana, Florence, Italy; dDipartimento Oncologico Azienda Sanitaria 10, Florence, Italy; eInstitute of Constructivist Psychology, Padua, Italy INTRODUCTION: Psycho-oncologic interventions are often considered marginal or incidental appendages of oncology. The Istituto Toscano Tumori (ITT) sustains an organizational model based on network in order to facilitate integration of psychological services and oncology departments. METHOD: The ITT carried out a census of psycho-oncology activities in sixteen Public Health Oncology Units in Tuscany, (Italy). The questionnaire specifically explored clinical activities, expressive activities, staff training, Voluntary Organizations. RESULTS: Only 47% of Health Units had a hired staff member (however partially) devoted to psycho-oncologic activities, and 78% had a counselling Service. Research activities, developed in 72% of Units, are focused mainly on quality of life studies and on test validation and enquiry instruments. Staff training and supervision activities are present in 78% of Units, and are addressed mainly to nurses, then to doctors and volunteers. Moreover 50% of Units offers body and expressive therapies. DISCUSSION: Results highlight a remarkable heterogeneity of psychooncologic activities in Tuscany. Reported clinical activities emphasize a certain resource commitment in psycho-oncologic treatments, giving evidence for progress of a new and wider culture of oncology cares, even if evaluation of quality standard of services is still scarcely developed. In order to improve the quality of psycho-oncology, the ITT set up four thematic working group: 1. Guidebook of Psycho-oncology Services available in Public Health System of Tuscany; 2. Listing of standard quality requirements for public services in psycho-oncology; 3. Selection of approved tests and questionnaires in psycho-oncology areas; 4. Areas of research proposals.

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561 ‘Sex, Drugs and Rock and Roll’: How to Achieve a Better Quality of Life for Cancer Patients and Their Families Foley Sa, Wade Kb, Nitzberg Lc, Iaderosa Sd a Social Work and Sexual Health, University of Michigan, Ann Arbor, MI, USA; bSocial Work and Child Life, University of Michigan, Ann Arbor, MI, USA; c Social Work and Psychiatry, University of Michigan, Ann Arbor, MI, USA; dSocial Work and Oncology, University of Michigan, Ann Arbor, MI, USA This poster will review data from an academic medical center where clinicians and researchers from different departments (psychiatry, sexual health, health care administration, and oncology social work) will present long-term follow-up of patients and their families. Research has shown that psycho-educational models for patients and families are highly effective in treating psychiatric illness and medical illness (Rolland, Schover, and Spinetta). The presenters will discuss novel programs that integrate treatment models in a health system with too-often separate departments. Case reports, including DVD and long-term follow-up of survivors, will illustrate the success of psychosocial interventions that identify and treat depression, address children’s psychological reactions to trauma, and help couples with their sensitive sexual adjustment during cancer treatments and their aftermath. Our discussion will include a unique DVD of two childhood survivors (a boy and a girl) who discuss their 25 years of life since their original diagnosis of cancer when they were adolescents (sarcoma and Hodgkin’s disease) with their oncology social worker. The social worker interviewed them initially in 1980 and recently recorded a retrospective clinical interview at the age of forty-three. The DVD includes footage of the earlier interview which will show a contrast between their youthful outlook when they were struggling with the prospect of death and poor prognosis and now as adults, who have survived and created fulfilling lives. Our poster will have data highlighting current models for psycho-social interventions in academic medical institutions.

562 Personality and Psychological Factors and Diagnostic Delay in Melanoma Patients Forghieri Ma, Galeazzi GMa, Longo Cb, Pellacani Gb, Seidenari Sb

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a

Neuroscienze TCR, University of Modena and Reggio Emilia, Modena, Italy; bDipartimento Misto di Medicina e Specialita` Mediche sez. Dermatologia University of Modena and Reggio Emilia, Modena, Italy PURPOSE: It is still unclear if and how personality factors influence patient-related delay in cancer diagnosis (here reported as time to decide to consult a doctor since first noticed symptom/ sign). Low levels of Harm Avoidance and an intense emotional reaction to first symptoms have been recently linked, respectively, to diagnostic delay in rectal and breast cancer. We tested this hypothesis in melanoma patients. METHODS: 43 consecutively newly diagnosed melanoma patients completed a battery of self-report psychometric instruments: the Harm Avoidance subscales of the Temperament and Character Inventory, the Ways of Coping Scale, the Multidimensional Health Locus of Control Scale and the scale developed by Meechan et al. (2003) to measure emotional response to symptom discovery. Pearson’s correlations between participants’ scores on psychometric instruments and time to decide to consult a doctor since first noticing the suspected lesion were explored. RESULTS: Melanoma patients did not display any statistically significant correlation between scores on the psychometric instruments administered and time to decide to consult. CONCLUSIONS: This exploratory analysis could not confirm the hypothesized role of investigated psychological factors in influencing diagnostic delay in melanoma. Type II errors cannot be ruled out due to small sample size.

563 Helping People to Live with Cancer Through Treatment and Beyond Foster C, Hopkinson J, Wright D, Okamoto I, Roffe L Macmillan Research Unit, School of Nursing and Midwifery University of Southampton, Southampton, England PURPOSE: Our aim is to develop a programme of research to help people live with cancer from the point of diagnosis, through treatment and beyond. METHODS: We involve cancer patients and carers as co-researchers. We work closely with colleagues in palliative care. We are assessing a new complex intervention to address concerns associated with weight loss and eating difficulties

Copyright # 2006 John Wiley & Sons, Ltd.

in advanced cancer. We are examining self management strategies used by patients who have completed treatment. We conduct systematic literature reviews. FINDINGS: (1) Patient and carer priorities for research: patients and carers, including people often under-represented in research, had an opportunity to voice their priorities for research. These findings will feed into the UK strategic agenda for cancer research. (2) Weight and eating related concerns in advanced cancer: distress due to weight loss and eating difficulties may be amenable to intervention. We are currently assessing the value of a new approach, to include the support of self-management, to address the complex problems of weight loss and eating difficulties in people with advanced cancer. (3) Self management strategies to manage problems associated with cancer: Our recent systematic literature review demonstrated that self management is a poorly defined concept in cancer. We are developing research to assess strategies people use to manage day to day problems associated with their cancer. CONCLUSION: We are developing research to help people live with cancer. These studies will inform the development of services and resources to improve the lives of people with cancer. ACKNOWLEDGEMENTS: This research is funded by Macmillan Cancer Support.

564 Physical and Psychological Distress of Children with Cancer and Their Families: Intervention Proposals for a Better Quality of Life During Hospitalization Franco MHPa, Kova´cs MJb a Clinical Psychology, Pontifical Catholic University, Sa˜o Paulo, Brazil; bLaboratory for the Study of Death, University of Sa˜o Paulo, Sa˜o Paulo, Brazil Although childhood cancer has shown good outcomes in the two last decades, this disease still causes great distress in families and patients. One feature considered of great importance in this study was the systemic relation illness–family life cycle-anticipatory grief. The purpose of this study was to describe quality of life issues related to children with cancer and their families (unit of care). Parents and siblings were also studied, even when they were not staying with the children in the hospital. Issues such as coping strategies, staff support, physical and psychological distress were

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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in the focus of interest of the study. The study used the qualitative method, with case studies of each of the 21 units of care. They were patients in a public children’s hospital in the city of Sa˜o Paulo, Brazil. Twelve of the children were boys and 9 were girls, with age from 3 to 17 years. They were diagnosed with ALL (5), AML (4), nonHodkins Disease (2), Rabdomiosarcoma (5), Central Nervous System Tumor (3) and Willms Tumor (2). Data were collected by means of drawings, Child Apperception Test}CAT, playing sessions and interviews, also with family members. Results show that illness adds to the fragile condition of these families, with low income and serious relationship problems. Selfhelp groups were considered by parents as a reliable resource to help them during the worst periods of treatment. Children were aware of the condition and they expected to receive clear information always.

565 To Train Knowing the Needs Means Frigo AL, de Pangher Manzini V UO Oncologia Ospedale San Polo, Monfalcone, Italy PURPOSE: To train knowing the needs means: guaranteed results. METHODS: In 2001–2002 the needs of the patients of the Oncologic Unit of the ASS2-Isontina were compared with the training needs of the personnel acting in the hospital and on the territory. We initiated a program for an ‘Ongoing Oncologic Education’ starting ‘Train to Reception’ for all the operators who meet the oncologic patient from the moment of the diagnosis to the exit from the illness. The trained operators form an ‘Oncologic Group’ in charge of going on with the various initiatives. During 2005– 2006 the Group focus was absorbed by a disease with a great impact on the local community given the high frequency of asbestos related cancers: the lung cancer. New basic courses on ‘ReceptionWelcome’ and ‘Change’, using Theatre Forum techniques, were organised stressing different areas of interest, i.e. medical (epidemiology, prevention, diagnosis and therapy), ethical (information and consent, choices for one’s end of life, quality of life), psychological-relational (family, mourning) and spiritual. RESULTS: In order to build a shared culture around oncology, we started a wide ranging project which foresees education for the various professions involved joined by the com-

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munity of the voluntaries, including proper information to the general public. CONCLUSIONS: The training which meets the needs of the oncologic patient must be an ongoing one and cross from the specialised circles of professional to wider circles in order to guarantee Quality and Continuity of the treatment.

566 Ensure Communication Between Ill Mothers of Breast Cancer and Their Children Fuentes S, Giralt M Psycho-Oncology, Hospital St. Jaume Calella Calella-Barcelona, Spain PURPOSE: Creation of an aid instrument (story) that ensures communication of diagnosis and the oncological treatments, between the mothers just diagnosed of breast cancer and their children in scholastic age. METHODS: Because of the necessity arising actually daily in the clinic, and defending the necessity to include the children in the disease processes we have created an informed story. It explains the history of the small Pol, that will share his day to day with the disease of his mother. The text has been written with scholastic letter, that facilitates the understanding of history to children of 3–9 years. The illustrations express the disease experience (hospital admission, mastectomy, breast’s prosthesis, chemotherapy, alopecia, etc.) and life experience (school, affectivity, rolls, games), wishing with it to demystify the cancer disease. RESULTS: The mothers who have used this instrument, have had a most adaptive and healthful communication on the disease with their children, with respect to the mothers who have not used it. CONCLUSION: The specific bibliography creation about breast cancer for children, allows to improve the disease’s understanding and the mothers’ communication with their children.

567 Comparison of Temporal Changes of Psychological Distress Caused by Hematopoietic Stem Cell Transplantation Among Underlying Diseases in Japanese Adult Patients Fukuo W, Sakamoto N, Yoshiuchi K, Kikuchi H, Akabayashi A Department of Psychosomatic Medicine, The University of Tokyo, Tokyo, Japan PURPOSE: The aim of this study was to compare temporal changes of psychological distress caused

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by hematopoietic stem cell transplantation (HSCT) in Japanese adult patients among underlying diseases because they had gone through different chemotherapies, which might cause different psychological distress. METHODS: Patients with hematological malignancy who received HSCT were asked to complete Profile of Mood States (POMS) twice, before and shortly after HSCT. Repeated measures analysis of variance was used to compare temporal changes of each subscale of POMS among acute leukemia, chronic leukemia, myelodysplastic syndrome, and malignant lymphoma. RESULTS: 137 male (M ¼ 39:5 years, SD ¼ 12:1) and 82 female (M ¼ 39:6 years, SD ¼ 12:8) patients completed POMS before HSCT. The mean scores of all POMS subscales before HSCT were not significantly different among underlying diseases. 49 male (M ¼ 38:2 years, SD ¼ 11:3) and 26 female (M ¼ 34:7 years, SD ¼ 12:5) patients completed POMS shortly after HSCT. There was a significant interaction of group  time for Anger– Hostility scores (p ¼ 0:043). Anger–Hostility scores tended to increase in myelodysplastic syndrome and malignant lymphoma patients, while they tended to decrease in acute leukemia and chronic leukemia patients. CONCLUSION: Anger–Hostility in Japanese adult patients with hematological malignancy changed differently during HSCT among underlying diseases. Therefore, it may be important to support the patients throughout the period of HSCT in consideration of differences in underlying diseases although further studies are necessary on the reason for the results obtained in the present study.

568 Communication Skills Training for Oncologists}2 Years Experience with a Practical and Practice Focussed Workshop Programme Gaisser AEa, Marme´ Ab, Schmid Pc a Cancer Information Service, German Cancer Research Center, Heidelberg, Germany; bDepartment of Gynecology, Eberhard-Karls-University Tu¨bingen, Tu¨bingen, Germany; cCharing Cross and Hammersmith Hospital, Imperial College London, London, UK BACKGROUND: In oncology, doctor–patient communication requires specific communication skills. There is evidence that such skills can be trained. Effective communication enhances coping and patient satisfaction. METHODS: Adapted

Copyright # 2006 John Wiley & Sons, Ltd.

from the NCI funded OncotalkT programme a communication training was developed, focussing on breaking bad news and structuring interviews. Programme and didactics are based on evidence in adult learning. Core element of the 112 day workshops is small group learning in facilitated role plays with trained actors as simulated patients and through structured feedback. As a strategy for structuring interviews, the SPIKES protocol (Buckman and Baile, 1998) is introduced and practiced. Evaluation includes self-rating of communication skills before and after course and rating of the SPIKES strategy. RESULTS: 43 physicians have taken the course since November 2003. Pre-course rating of self-confidence in 9 typical communication tasks on a 1–10 scale (1 ¼ not at all, 10 ¼ very) varied from 5 to 8 (median). Talking to angry, demanding, misinformed patients and patients in denial was rated most difficult. Assessment of the workshops was very good in all categories, role play with actors and group feed-back being valued highest. Follow-up rating of self-confidence shows overall increase of median 2 points, but also more critical self-assessment in allegedly ‘easy’ situations. The SPIKES protocol is easy to use and helpful. CONCLUSION: This communication skills workshop programme was uniformly assessed as useful and relevant for clinical practice and increases self-confidence in difficult situations as well as self-reflection.

569 The Impact of Cognitive Dysfunction Upon the Non-Metastatic Colorectal Cancer Patient’s Psychosocial Adjustment and Quality of Life Galica JPa, Vardy Ja, Pond Gb, Tannck Ia a Department of Medical Oncology and Hematology, Princess, Margaret Hospital, Toronto, Canada; b Department of Clinical Study Coordination and Biostatistics, Princess Margaret Hospital, Toronto, Canada PURPOSE: Chemotherapy has been associated with cognitive impairment in some patients. Here we evaluate effects of cognitive impairment on Quality of Life (QOL) and on psychosocial adjustment}i.e. the ability to interact with others and the environment. METHODS: Patients with non-metastatic colorectal cancer (CRC) are evaluated for cognitive function (Cambridge Neuropsychological Test Automated Battery [CANTAB]); QOL (Functional Assessment of Cancer Therapy}

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General [FACT-G]); and psychosocial adjustment (Psychosocial Adjustment to Illness Scale}Self Report version [PAIS-SR]). The sample consists of 4 groups: A & C (stage III/ high-risk II disease), with A assessed pre-chemotherapy and C postchemotherapy; and B & D (stage I/II disease) who do not require chemotherapy, with B assessed post-operatively and D 6-months post-operatively. RESULTS: Twenty-two of a projected sample of 88 participants have been analyzed. Preliminary data indicate a strong association between FACT-G and PAIS-SR scores (Spearman correlation ¼ 0:80; p-value 50.001), indicating that QOL is associated with psychosocial adjustment. The median (range) of PAIS-SR scores for those with cognitive impairment was 52 (38–75), and for those without impairment it was 49 (23– 65) (p ¼ 0:19). CONCLUSIONS: Early results suggest that cognitive changes influence patients’ relationships and functional roes, which are associated with QOL. Mature results will be presented at the meeting. This information will assist practitioners in developing interventions that enable coping or rehabilitation of persons who develop cognitive dysfunction as a result of cancer or its treatment.

570 Transcultural Validation of the Portuguese Version of EORTC QLQ-IN PATSAT32 Gama G, Barbosa A Palliative Care, Academic Unit Centre of Bioethics, Faculty of Medicine of Lisbon, Lisbon, Portugal PURPOSE: EORTC QLQ-IN PATSAT32 translation to Portuguese and pilot-testing in a cancer patient sample METHODS: Translation and back translation, following the EORTC guidelines, of the English version of EORTC QLQ-IN PATSAT32 (a comprehensive, multidimensional assessment of satisfaction with care, rated on a 5level Likert scale, with scales regarding doctor’s, nurses behaviour and services regarding the technical, communication and interpersonal skills, availability and coordination, waiting time, access, comfort, kindness and helpfulness of other hospital personnel and a scale of overall). We study the EORTC QLQ-IN PATSAT32 psychometric properties: descriptive general analysis, internal consistency and convergent validity. RESULTS: Cronbach test had a regular mean of 0.96 in all the items and a convergent validity (ranging from 0.44 to 0.77) confirming data of other European

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samples (France, Poland, Sweden, and Italy). We found also a good discriminant validity with significant statistical differences between different groups of cancer patients (general hospital, palliative care units, home care) in almost all the dimensions. CONCLUSION: EORTC QLQ-INPATSAT32 prove to be an easy, useful and powerful instrument to assess satisfaction with care. We stress the importance of having homogenising satisfaction survey methodology for research in order to neutralize confounding effect of semantic, experiential and conceptual factors and to better understand the relation between satisfaction and quality of care.

571 Cancer Patient’s Satisfaction with Care in Outpatient and Inpatient Settings Gama G, Barbosa F, Barbosa A Palliative Care, Academic Unit Centre of Bioethics, Faculty of Medicine of Lisbon, Lisbon, Portugal PURPOSE: To compare the satisfaction with care in three settings of cancer patients: home care and hospital or palliative care unit METHODS: A sample of cancer patients (N ¼ 140) from sequential groups of patients in Palliative Care Units (N ¼ 64), General Hospital (N ¼ 50) and Home Care (N ¼ 26), age X ¼ 62:3; 50% male, 63.2% married, 62.5% retired, were assessed by a sociodemographic and clinical questionnaire, the Portuguese versions of EORTC QLQ-C30 and EORTC QLQ-IN PATSAT32 (a comprehensive, multidimensional assessment of satisfaction with care, rated on a 5-level Likert scale, with scales regarding doctor’s, nurses behaviour and services regarding the technical, communication and interpersonal skills, availability and coordination, waiting time, access, comfort, kindness and helpfulness of other hospital personnel and a scale of overall). RESULTS: Nurses and Doctor’s items did not differ between the 3 groups except on less availability on the Home Care group. Service’s items show great differences between groups with the Palliative care unit group presenting a significantly higher satisfaction in all the items except waiting time compared with both the other two groups. CONCLUSION: Cancer patient’s in Home Care appear to be less satisfied with care and the Palliative care unit group the more satisfied in almost all the dimensions. Using standardized instruments is an easy, useful way to show discrepancies on quality of care helping to

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design and evaluate strategies to overcome some of the difficulties detected.

572 Quality of Life after Liver Transplantation in Cancer Patients Gangeri La, Brunelli Ca, Bosisio Ma, Tamburini Ma, Mazzaferro Vb a Psychology Unit, National Cancer Institute, Milan, Italy; bLiver Transplantation Unit, National Cancer Institute, Milan, Italy PURPOSE: Over the last two decades, orthotopic liver transplantation (OLT) has become an established treatment for patients with hepatocellular carcinoma. The present study aims at describing the quality of life in a population of cancer patients who have undergone OLT. METHODS: A mail cross-sectional survey was conducted on a sample of 199 patients who have undergone OLT at least one month before. Two standardised selfcompilation cancer specific instruments were employed for quality of life evaluation: the GIVIO and the Functional Assessment of Cancer Therapy-General (Fact-G). RESULTS: 176 patients (89%) returned complete questionnaires. Quality of life results from the FACIT questionnaire show that patients who have undergone transplantation are comparable to an adult cancer patients sample scores as regards emotional well being, functional well being and FACT general total scores while they show a better physical and a worse social well being. When comparing this sample to a general adult population sample we found no relevant differences on any of the FACT scales. On 176 patients answering the GIVIO questions on working activity, 40% still keeps working, 33% stopped working for reasons different from health, 8% stopped for unknown reasons and only 20% stopped because of health problems. Of the 71 patients who still work only 20% declare that health has caused trouble to their job in the previous four weeks. CONCLUSIONS: The results presented show that restoring to physical, psychological and social ‘normality’ is possible for the majority of patients who have undergone liver transplantation.

573 Nonverbal Expressions in the Children Newly Diagnosed with Cancer: A Prospective Analysis Ganuza BM

Copyright # 2006 John Wiley & Sons, Ltd.

Psychooncology, GACC}Grupo de Apoio a Crianc¸a com Caˆncer, Sa˜o Jose´ dos Campos, Brasil PURPOSE: The psychological impact of pediatric cancer is largely known.This study examined nonverbal expressions in children newly diagnosed with cancer over a 2-year time period. METHODS: Seventy-five patients participated in the study (N ¼ 75) aged 4–11 years old. The measures consisted of children’s ratings of mood using schematic faces and play expressions using a sand tray and figures. Semi-structured interviews were also conducted with the patients parents. RESULTS: A significantly higher percentage of patients (70%) showed chaos, angry, hospital and death figures and expressions for 6 months post diagnosis. Chaos and angry expressions decreased with time. No differences were found based on age, diagnosis or presence of metastatic disease. These findings are discussed in terms of the junguian approach. CONCLUSIONS: These findings suggest that psychological distress can be observed at nonverbal expressions of the pediatric cancer patients. Appropriate interventions are proposed to reduce the risk of maladjustment and improving overall patients well-being and quality of life.

574 Group Intervention with Breast Cancer Patients: Psychological Distress and Self-esteem Garcia Valverde A, Narvaez A, Cortes-Funes F, Abian L Psycho-Oncology Unit, Hospital 12 De Octubre, Madrid, Spain Breast cancer has been largely studied in the last decades. As a result of all these works, patients can be diagnosed earlier and live longer. The number of patients diagnosed and free of illness has significantly increased. Breast cancer and its treatments strongly influence the psychological variables of those who have been diagnosed and treated for the illness. The goal of this study is to intervene in the variables that are related to psychological distress. The sample is composed of 8 illness and treatment free women. The group met for an hour and a half minutes on a weekly basis during three months. We measure psychological distress (HAD- hospital anxiety and depression), self-esteem (Rosenberg Self-Esteem Scale), coping (Caepo), and personality (Ipde-International Personality Disorder Exam). We conclude

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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that group intervention is very useful to help breast cancer patients improving their self-esteem and reducing psychological distress.

575 A Global Approach to the People with an Oncological Illness: A Journey with So Many Partners Gasparini Ia, Bagnulo Ab, Ligabue MBc a Internal Medicine}Psychoncology Unit, San Sebastiano Hospital, Correggio (RE), Italy; b Internal Medicine, San Sebastiano Hospital, Correggio (RE), Italy; cRehabilitation Medicine, San Sebastiano Hospital, Correggio (RE), Italy Our approach comes from the ascertainment of the importance of multidisciplinary answers for tumours. In our oncological Day Hospital the assistance can count on professionals integrated in a process with the patient in the centre and the use of, beyond of traditional surgical therapies, chemo/radio and psychological support, counselling, relaxation techniques, complementary and rehabilitation medicine, psycho-motion and Chinese medicine. Principal objectives of the activity: (1) rehabilitation treatment of early and late outcomes of the oncological therapies (surgery, chemo- and radiotherapy); (2) improvement of the quality of life during the whole oncological journey and at the end of the same one; (3) modification of the own perception of health and an easier re-approach to the daily life; (4) dietetic advices about therapy and prevention of oncological pathologies; (5) use of group treatments in order to gain the sense of patient’s solitude and to manage pain and fear, sharing them with people who have experimented the neoplastic illness. Synthesis of the results: (1) best compliance with therapy; (2) acknowledgment of the right to the global cure and maintenance of a good quality of life; (3) improvement of the communication skills and the mutual acquaintance between operator and patient through adequate coping styles; (4) increase of cross-sectional competences in every member f the team; (5) internal improvement of the operators and systems in which they work, through positive feedback of the interventions with consequent good level of satisfaction of the operators.

576 The Journey: A Resource Guide for Patients and Their Families in an Oncology Day Hospital Division

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Gasparini Ia, Bagnulo Ab, Zoboli Ab, Ferretti Gb a Internal Medicine}Psychoncology Unit, San Sebastiano Hospital, Correggio (RE), Italy; b Internal Medicine, San Sebastiano Hospital, Correggio (RE), Italy The oncologists, nurses and the psychologist of our division with the help of a professional graphic artist, produced this informative booklet. It was supported by the Hospital Administration, which has kindly helped the distribution to other oncology divisions. The booklet will be given to patients on their first admission, including the talk performed by the nurse and psychologist with the patient and their families. The booklet is addressed to patients candidate to chemo/radiotherapy and developed from the value information sharing during all the steps of the patient care program. Graphic issue was inspired from the symbolic message generated by the metaphor of the journey. The five images, done in aquarelle painting technique, show the phases of a hypothetic journey, then the filling of a travel bag, the start and the overviews you meet, the weakness you, the possibility to receive help and the arrival at final destination. With this booklet we want to facilitate transmission of medical and health issues through messages that came from emotional and relationship point of views. The booklet is easily consultable and doesn’t substitute the patient/health worker’s dialogue, but its an integration and supporting means to the development of a strong interaction between the care team and patient. We also underline the support intervention of the family and friendly network to reduce the sense of loneliness so often referred.

577 A Parent with Cancer: Children, Communication and Cancer-related Distress Gazendam-Donofrio SMa, van der Graaf WTAb, Hoekstra HJc, van de Wiel HBMa, HoeksraWeebers JEHMa,d a Psychosocial Services, University Medical Center Groningen, University of Groningen, Groningen, Netherlands; bMedical Oncology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands; cSurgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands; dSupportive Care, Comprehensive Cancer Center North-Netherlands, Groningen, Netherlands

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PURPOSE: Communication is thought to help families adjust more easily during stressful events. We investigated possible relationships between cancer-related distress and communication patterns in families with parental cancer. METHODS: 70 parents diagnosed with cancer (age M ¼ 42:5  5:1; 63% women), 55 spouses (age M ¼ 43:0  5:8; 38% women) and 69 adolescents (age M ¼ 14:6  2:1; 56% girls) filled in the Impact of Event Scale and the Parent–Adolescent Communication Scale: within 4 months of diagnosis (T1), and six (T2) and twelve months later (T3). The IES measures intrusion and avoidance. Summarized these provide a total score; scores 526 indicate clinically-elevated levels. The PACS measures both openness and barriers in communication. Correlations were calculated between distress and communication. RESULTS: Clinically-elevated distress levels were found at T1 in 36% of patients, 31% of spouses and 29% of adolescents; by T3, levels declined to 21%, 16%, and 14%, respectively. Adolescents scored comparably to the norm in communication levels, except at T2 where they reported fewer communication barriers with fathers (p ¼ 0:02). Weak to moderately strong significant relationships were found between adolescents’ distress and communication, with more relationships for daughters (25 of 36 possible relationships) than sons (15/36), more between barriers (24/36) and distress than openness (16/36), and more at T2 (17/24) than at T1 (14/24) or T3 (10/24). For parents, only four moderately strong relationships were found for T1 and T2. CONCLUSION: Cancer-related distress decreased over time. Communication, barriers in particular, seems to be more related to children’s distress levels than to parents’. Daughters seem to be more affected than sons.

578 Improving Cognitive Functioning and Quality of Life in Glioma Patients: A Prospective, Randomized Study Gehring Ka, Sitskoorn MMa, Taphoorn MJBb, Aaronson NKc a Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands; bNeurology, Medical Center Haaglanden, Den Haag, The Netherlands; c Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands

Copyright # 2006 John Wiley & Sons, Ltd.

PURPOSE: This randomised study evaluates the efficacy of a multifaceted cognitive rehabilitation program for glioma patients. METHODS: The study sample includes 150 adult patients with low-grade gliomas or anaplastic gliomas, with favourable prognostic factors, recruited from 10 hospitals in The Netherlands. Recruitment started in January 2005 and will continue until October 2006. Patients, who have both subjective and objective cognitive deficits, are randomized to either the intervention group or to a waiting-list control group. The intervention incorporates a computer-based attention retraining program (which will be demonstrated at the congress), and a component aimed at teaching compensatory strategies for attention, memory and executive functioning. The program consists of 6 weekly, individual 2-hour sessions plus homework. Both study groups complete neuropsychological tests and questionnaires at baseline, after 7 weeks and 6 months. RESULTS: As of mid-April 2006, 265 patients received an information letter, of whom 134 (51%) had cognitive complaints and were otherwise eligible. Of these patients, 93 (69%) scored in the deficit range based on neuropsychological testing, and were randomized. The mean age of the participants is 43.6 years (SD ¼ 10:1), and 55% is male. To date, patient attrition is 8.6%. 41 patients completed the cognitive rehabilitation program. Qualitative feedback from these patients indicates that they found the intensity and duration of the program acceptable, and that they learned useful strategies for coping with cognitive deficits. Formal evaluation of changes in cognitive function and health-related quality of life over time is forthcoming.

579 Longitudinal Evaluation of Anxiety, Depression and Quality of Life in Patients with Conformal Radiation Therapy (CRT) for Prostate Cancer Geinitz Ha, Thamm Ra, Keller Mb, Molls Ma, Zimmermann Fa a Klinik fuer Strahlentherapie Technische Universitaet Muenchen, Muenchen, Germany; bSektion Psychoonkologie Universitaetsklinik Heidelberg, Heidelberg, Germany PURPOSE: To prospectively evaluate anxiety, depression and quality of life (QoL) in patients with CRT for prostate cancer. METHODS: 110 patients were entered into the study. The Hospital Anxiety and Depression Scale (HADS), the

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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EORTC QLQ-C30 and the prostate cancer module PR25 were applied before CRT, at 40 Gy and 60 Gy and 2, 12 and 24 months after CRT. RESULTS: HADS anxiety declined during CRT (p ¼ 0:01) and remained significantly lower than pre-treatment levels throughout follow-up. HADS depression scores remained within pretreatment levels during and after CRT. Global QoL did not change significantly during CRT, however, scores were superior to baseline levels during follow-up after CRT (p50:001). PR25urologic symptoms (p50:001) deteriorated during CRT but recovered as soon as 8 weeks after treatment. PR25-bowel symptoms deteriorated during CRT and remained inferior to the baseline throughout follow-up (p ¼ 0:018). Anxiety (rho ¼ 0:503; p ¼ 0:001), depression (rho ¼ 0:620; p50:001), PR25-urologic symptoms (rho ¼ 0:512; p50:001), fear of disease progression (rho ¼ 0:358; p50:001), PR25-bowel symptoms (rho ¼ 0:258; p ¼ 0:013), hormonal treatment for biochemical recurrence (rho ¼ 0:242; p ¼ 0:017) and concomitant disease (rho ¼ 0:238; p ¼ 0:022) correlated with global Qol 2 years after CRT. CONCLUSIONS: In patients with prostate cancer conformal radiation therapy does not increase anxiety or depression and it does not deteriorate global QoL.

580 Changes in the Semantic of Time in the Oncologic Patient Under Treatment: A Quality Research Gelati Pa, Chiari Sa, Collova` Eb, Fava Sb a UO Cure Palliative Ospedale Civile Legnano, Legnano, Italy; bUO Oncologia Ospedale Civile Legnano, Legnano, Italy Subjective time of the oncologic patient is totally different from that of the medical staff and of his family. It is necessary to understand which semantic attribution patients give to present and future time in relation to the past. This allows to intervene cognitively if the perceptive difference begins to look as a harmful distortion, both towards life and in relation to the therapy. In order to obtain information semantically important, we inquired into the most remarkable areas of the patient’s hic et nunc: life expectations, illness, therapy, family relationships, social relationships. The area of ‘the flowing of time’ has been granted a value independent of each other area, so that patient’s description would have been indirectly linked to them. We did that

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throughout a structured interview, completed then by a list of adjectives among which the patient spots out the one that describes his perception. Adjectives are divided into five semantic groups: 1. the speed of flowing; 2. the wideness of time; 3. planning; 4. thickness; 5. the fifth group has got only one description: ‘as usual’; The analysis of the first data allows us to suppose that in almost all cases the semantic of time is bound to the perception of the seriousness of the illness, to the evaluation of the therapy effects and to the quality of family relationships. We noticed that family relationships are nearly the only relational field in which the patient expects to spend all his future time.

581 Promoting Effective Practice and Leadership in Palliative and End of Life Care Gerbino SB, Chachkes E Social Work, New York University, NY, USA PURPOSE: NYU School of Social Work offers a post graduate social work certificate program in palliative and end of life care. The certificate program focuses on advancing practice, including effective leadership in interdisciplinary settings. The program, initially funded by a Soros Foundation grant, was instituted to support the participation of social work in the developing area of palliative care as well as in more traditional settings, such as hospitals and hospices. To date, the program has trained close to 100 social workers, most often working with oncology patients in diverse settings. METHODS: This presentation will discuss the elements of the curriculum, its development over 6 years, the pedagogical approach to teaching, supervisory models and plans for the future. CONCLUSIONS: Training is especially needed that addresses the needs of seriously and terminally ill patients and families, given the managed care environment and the shorter lengths of stay in inpatient settings. Education must reflect current research and practice wisdom as well as the knowledge and information that clinicians need in real-world practice settings. Feedback from the student body has identified areas of needed skill development, which include complex clinical practice issues, ethical dilemmas, and further knowledge about the organizational context of care. Social work professionals who are providing palliative and end of life services are too often

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isolated from one another. This program has served to promote the sharing of experience and knowledge and the development of peer support and mentoring.

582 Psychological Preparation to the First Chemotherapy Session: A Research about a Support Group Experience Ghinelli C, Barbi F, Vandelli M Servizio di Psicologia Azienda Ospedaliero-Universitaria di Modena Policlinico, Modena, Italy PURPOSE: Since 2004 at the Modena Cancer Centre (Centro Oncologico Modenese) a psychological preparation to the first chemotherapy session has been provided to patients. It consists in a support group experience devoted to those patients who are going to start a chemotherapy. Research aims are: (1) studying the impact of the group activity on patients’ coping strategies, (2) understanding needs and feelings of those who are going to undertake a chemotherapy and (3) assessing how useful the group is for the patients. METHOD: 15 patients who attended the group (3 men and 12 women aged between 32 and 67) were interviewed with a narrative approach about their experience and their feelings. Interviews were recorded, transcribed and then analyzed using the content analysis method. RESULTS: From the analysis six descriptive themes emerged: (1) the illness; (2) the chemotherapy; (3) the patient’s social network and his/her need for support; (4) the psychological preparation group; (5) the doctor–patient relationship; (6) existential and spiritual issues. The more frequently cited topics were ‘the illness’ and ‘the chemotherapy’: this shows how strong is the patients’ need for communicating their feelings about the experience that they have been living. CONCLUSIONS: Results from our research show that: (1) information about disease, treatment and services devoted to patients, given during the group experience are useful to their psychological preparation to treatments; (2) to meet in the group the personnel of the Cancer Centre enhances the welcome of new patients and (3) meeting other patients, talking about their experience and listening to others’, expressing their own feelings, being understood etc. represent an important support during the difficult period of therapy and help patients in feeling that they are not alone.

Copyright # 2006 John Wiley & Sons, Ltd.

583 Tumors and Immunity: A Perceptual ‘Figure– ground’ Problem Gidron Ya, Vannucci Lb a Psychology & Health Tilburg University, Tilburg, The Netherlands; bImmunology and Gnotobiology, Institute of Microbiology, Prague, Czech Republic Advances in a science may occur when adopting frameworks from other scientific domains. We offer a new perspective from cognitive-perceptual sciences to understand the interplay between tumors and immunity. A major challenge in cancer immunology is the immune system’s limits in recognizing tumor cells. This originates from the nature of tumor cells (modified self cells), reduced expression of MHC molecules (which present cells’ ‘identity card’), activation of inflammatory responses and immuno-editing (weakening tumor-antigens), all making tumor cells less ‘visible’ to the immune system. After presenting these challenges, we will present models conceptualizing the immune system as a cognitiveperceptual system and the ‘figure–ground’ problem. We then demonstrate that two types of cancer therapies fit a ‘figure–ground’ perspective. First, we will present Vannucci et al.’s (2005) study showing that animals raised in germ-free (GF) conditions prior to tumor implantation had reduced tumor growth. Presumably, the GF environment yielded cleaner immunological backgrounds near the tumor, making the latter more salient. Second, studies in which tumors were induced to produce immune stimulating molecules, or tumor-associated antigens (vaccines) were administered, increased the antigenic salience of tumors (the figure). Thus, by shadowing tumors’ immunological background or by enhancing tumors’ antigenic salience, the immune system may better ‘perceive’ tumors and mount a more effective anti-cancer response. This framework has scientific and clinical significance: shadowing tumors’ inflammatory background and enhancing tumors’ immunological salience may yield stronger anti-cancer immunity. These implications need to be tested in future.

584 The Experience of Severe Fatigue in Long Term Survivors of Stem-cell Transplantation Gielissen MFMa, Schattenberg AVMb, Verhagen Cb, Rinkes MJc, Bleijenberg Ga

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Expert Centre, Chronic Fatigue Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands; bDepartment of Haematology, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands; cDepartment of Medical Oncology, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands Haematopoietic stem-cell transplantation (SCT) is a highly aggressive and demanding medical therapy with a profound impact at both physical and psychological levels. Relatively little is known, however about the long-term effects of a SCT. Studies investigating fatigue complaints after treatment for cancer (SCT not included) found that 20–30% of the patients experience severe fatigue complaints after about 4 years after curative treatment for cancer has ended. There are indications that receiving only surgical treatment reduces the chances of chronic fatigue. In this study we investigated fatigue in cancer survivors with a long treatment, namely the survivors of the Nijmegen allogeneic transplantation programme, which started in May 1981. We answered the following research questions: 1. What is the prevalence of severe fatigue in patients after a stem-cell transplantation? 2. Is fatigue severity associated with former disease and treatment characteristics? 3. Are there differences in fatigue related to time since treatment? Severe fatigue was present in 35% of the cancer survivors. Somatic variables like cancer type, kind of transplantation, presence or absence of Graft versus Host Disease (grade I or II), duration of treatment, complications after SCT, HB at the moment of research, were not related to the severe fatigue. The percentage severe fatigue did not differ between patients who finished stem-cell transplantation relatively recently and patients who finished stem-cell transplantation long ago. CONCLUSION: Rate of severe fatigue in cancer survivors after a stem-cell transplantation is higher than after other cancer treatments and remains high.

585 Mood Changes in a Family Psychological Support Group Giesecke A, Corte´s-Funes F, Narvaez A, Albian L, Garcia-Valverde A Psycho-Oncology Unit, Hospital 12 De Octubre, Madrid, Spain

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Family group therapy has been proved to be helpful to the relatives of the hospitalized patient. The expression of emotions from the closest caregiver is helpful for the release of tension and worries, also demystify some irrational ideas about the illness. The expression of feelings and sharing experience, improves the way of understanding their own feelings and allows them a space in which their necessities can be expressed. During hospitalization it is difficult to find a proper timing for the reunion, also to get relatives to attend. There are several reasons for that, but mainly because they are devoted to the patient. Some improvement has been noticed by doing one question about their feelings at the beginning of the session, and the same one at the end, only by doing once this reunion all the participants showed a relief in their feelings. The topics that are talked, are mainly about their feelings, their fears, myths about the illness and any other subject that they bring up. The resources of the participants are reinforced and they share their experience of coping to this new or not new situation. The importance of self-care and the participant’s own needs are always a topic for discussion, because they usually do not allow themselves to take a space to adjust both needs.

586 Reception and Listen of the Patients Admitted to the Oncology and Haematology Department of the Ravenna City Hospital, from the Volunteers of I.O.R (Oncology Institute of Romagna) Cavallari Ga, Corbelli Ab, Lombardi Db a Psychologist I.O.R., Italy; bOn Behalf of I.O.R Group of Volunteers, Italy The psychosocial research evidences that the role of the volunteers who operate in Oncology has various and different aspects. It is conditioned by the changing situations, by the needs of the patients and the skill to adaptation to the group of the same volunteers. The volunteers have characterized the main necessities for the hospitalised patients: 1. Practical and social requests and services 2. Information and 3. To listen. Moreover, the volunteers have faced more frequent emotional moods experienced: distrust in the outcome of the therapies and pessimism, confidence and optimism, knowledge of disease and need of emotional support, anger, fear and despair, physical mortification and changes of social and family role (loss of role).

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The answers evidence that 44% of the patients requires an emotional support and dialogue; 56% information and practical assistance. Finally, the patients admitted to the Medical Oncology Unit live their disease with different but equally distributed emotional figures: optimism and awareness (33%), pessimism, refusal and anger (34%); feelings of isolation and solitude, mortification and loss (33%). The project of ‘listen and reception’ of the volunteers, therefore, has demonstrated its importance for giving an amicable presence and an emotional and practical support to the patients in order to support them in the disease way. More details of the research will be presented being the data on processing at the moment of writing this abstract.

587 Dimensions of ‘Patient Competence’ in the Context of Oncology: Results of a Multi-Center-Study Giesler JM, Weis J Psychosocial Department, Tumor Biology Cente, Freiburg, Germany PURPOSE: In oncology as well as in other fields of medicine, the concept of ‘patient competence’ is frequently used to refer to continuously growing demands of integrating the patients’ perspective into treatment and treatment decisions more strongly. It appears to be more straightforward, however, to conceptualize ‘patient competence’ as a hypothetical construct describing a patient’s ability to handle the tasks and distress that derive from a life-threatening illness and its treatment, thereby being guided by personal goals and using resources provided by either significant others or the health care system as a whole. Starting from this definition, we developed a questionnaire measure of ‘patient competence’ and tested its reliability and factorial structure in order to provide a basis for further investigations on possible determinants and health effects of ‘patient competence’. METHOD: 536 cancer patients rated the degree to which each of 140 statements describing behaviors, thoughts, or feelings concerning their disease applied to them; these statements had been judged before as valid indicators of ‘patient competence’ in two exploratory studies. In addition, participants were asked to provide selected demographic and medical data. RESULTS: Factor analyses revealed five problem-centered and three emotion-centered

Copyright # 2006 John Wiley & Sons, Ltd.

dimensions of ‘patient competence’ (e.g. ‘Seeking information on diagnosis and treatment’, ‘Being assertive interacting with physicians’, or ‘Handling emotional distress successfully’). Scales formed on this basis mostly show satisfactory reliability (Cronbach-alphas between 0.64 and 0.87). CONCLUSIONS: The developed questionnaire appears to provide reliable measures of distinct components of ‘patient competence’ and a fruitful basis for further research.

588 Proactive, Routine Monitoring and Intervention to Reduce the Psychosocial Impact of Cancer and Its Treatment in Outpatient Oncology Services Girgis Aa, Boyes AWa, Clinton-McHarg TLa, Ackland Sb, Harnett PRc a Centre for Health Research & Psycho-oncology, The Cancer Council NSW, University of Newcastle & Hunter Medical Research Institute, Newcastle, Australia; bMedical Oncology, Newcastle Mater Misericordiae Hospital, Newcastle, Australia; cCancer Care Centre, Nepean Hospital, Sydney, Australia PURPOSE: Practice guidelines recommend screening for cancer patients’ psychological wellbeing at appropriate intervals throughout the cancer journey. Although up to 40% of cancer patients experience significant levels of distress, fewer than 10% receive appropriate psychosocial care. Barriers for not using psychosocial measures in clinical settings include concerns about resources, feasibility and clinical relevance. In partnership with cancer centres, we are implementing a 4-step system for the ongoing assessment, identification and management of cancer patients’ psychosocial well-being as part of routine care. METHODS: In Step 1, all cancer outpatients at three specified clinic visits complete an on-line psychosocial assessment via touch screen computers. On completion of the survey, a tailored report summarising the individual patient’s level of distress is printed and placed in their medical file (with their consent) for follow-up by their health care team (Step 2). As well as identifying the patient’s current issues of concern, the report provides evidence-based strategies for managing the identified issues to facilitate the offer of care tailored to the patient’s level and type of need (Step 3). Step 4 involves benchmarking service performance across cancer centres and against cancer population norms to facilitate improvement of service delivery. RESULTS: This system

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is currently being implemented in three cancer care centres. Results will be presented from the first group of patients, with a focus on discussion of how the system is working within the routine care setting. SIGNIFICANCE: This system has the potential to improve patient-centred care and provide more objective utilisation of psychosocial resources.

589 Overview of a Research Program to Improve Needs Based Palliative Care in Australia Girgis Aa, Currow DCb, Johnson CEa, Waller AEa, Kristjanson LJc a Centre for Health Research & Psycho-oncology, The Cancer Council NSW, University of Newcastle & Hunter Medical Research Institute, Newcastle, Australia; bPalliative & Support Services, Flinders University, Adelaide, Australia; cCurtin University of Technology, Perth, Australia PURPOSE: Late referral, crisis referral and in some instances, non-referral of patients to specialist palliative care (PC) services impacts significantly on the quality of life of people with a life limiting illness and their caregivers. We are undertaking a national program of work to improve needs-based access to specialist palliative care. METHODS: Phase 1: A national qualitative study (n ¼ 40) exploring perceptions of PC and issues surrounding referral. COMPLETED Phase 2: A national survey of doctors’ (n ¼ 1173) current referral practices and predictors of referral to specialist PC services. COMPLETED Phase 3: Development of Palliative Care Needs Assessment Guidelines, a screening Tool and supportive resources. COMPLETED Phase 4: Evaluation of the impact of the Guidelines and Tool on PC referral, utilisation and complexity of care variables and on patient and caregiver outcomes. 2006–2008 Phase 5: National dissemination of the Guidelines and Tool, training of referrers and PC services. 2008–2009 Phase 6: Generalising the resources to non-cancer palliative populations. 2008–2009. RESULTS: Phases 1 and 2 have highlighted a focus on physical symptoms and prognosis as the main triggers to referral to PC services. The Guidelines and Tool have been developed to assist health professionals to identify when psychological, spiritual, social or physical problems are evident and to facilitate access to the level and type of care required to meet their patients’ and caregivers’ needs. The Guidelines

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have been subjected to a national consensus process and the Tool has been extensively pilot tested. The results so far and the planned evaluation will be discussed.

590 The Role of the Family in Treatment Decision Making by Cancer Patients Zhang AYa, Siminoff LAb a FPB School of Nursing, Case Western Reserve University, Cleveland, OH, USA; bDepartment of Bioethics, School of Medicine, Case Western Reserve University, Cleveland, OH, USA PURPOSE: To examine family disagreements about treatment decisions for advanced cancer patients. METHODS: 37 stage III or IV lung cancer patients and 40 caregivers (24 primary and 16 secondary caregivers) were interviewed; a total of 26 families were studied. The interviews were audiotaped, transcribed verbatim and analyzed qualitatively. RESULTS: 65% of families reported various family disagreements that mainly concerned routine treatment decisions, trade-off decisions about discontinuation of therapeutic treatment, and utilization of hospice care. 12% families fully supported patients’ decisions to discontinue therapeutic treatment; 35% of families had disagreements about patient trade-off decisions. Families were highly guarded on the issue of hospice care, which complicated the treatment decision process at the end of a patient’s life. CONCLUSIONS: Family disagreements about treatment decisions for advanced lung cancer patients are common and concern a wide range of issues. Family members play an important role in the selection of patient’s doctors, hospitals, treatment options, and provision of care. The findings suggest that clinicians should be aware of differences of opinions between the advanced cancer patient and caregivers with the understanding of their disparate needs and feelings. Knowledge of the family disagreements about treatment decisions can help clinicians integrate the family into the decision-making process in a clinical setting, in order to facilitate family communications and improve patient’s and caregiver’s satisfaction with treatment decisions.

591 A Motto, A Mantra, and A Mission}Building a Foundation for Cancer Survivorship Goldberg WG

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Consultation-Liaison Psychiatry and Josephine Ford Cancer Center Henry Ford Health System, Detroit, USA PURPOSE: ‘Cancer Survivor’ includes all patients, their families, significant others, and caregivers from the time of diagnosis through the remainder of life (NCI and NCCS). This inclusive definition poses both challenges and opportunities for those charged with meeting the psychosocial needs of this diverse group. I have developed an existential approach to working with survivors that helps those affected by cancer find purpose and meaning in life. METHODS: This approach is both an attitude and a method for interaction that utilizes the principles of constancy (remaining the same), robustness (shifting temporarily), and resilience (revising/changing) to explore and then create a dynamic foundation for preserving the self. Each encounter focuses on building a triad of meaning that reflects the unique characteristics of the individual survivor: (1) A Motto}a core set of beliefs, (2) A Mantra}a way(s) of soothing oneself, and (3) A Mission}a reason to get up in the morning; a purpose for living. RESULTS: Benefits include the ability to: (1) endure difficult treatments, (2) resume role functions, (3) resolve crippling distress, (4) interact with significant others, and (5) modify life-style/ goals while living with cancer. CONCLUSIONS: This approach is a practical foundation for psychotherapy and an effective model for teaching colleagues how to intervene on behalf of survivors. Realistic and hopeful, this intervention seeks to make satisfaction and meaning possible no matter the stage or phase of illness. ACKNOWLEDGMENTS: The concepts constancy, robustness and resilience are based on the work of Hansson and Helgesson.

592 Music Therapy: Oncology Application Gondo`n Espinasa N Psychooncologic Jouell, Gabinet Psicolo`gic, Barcelona, Spain PURPOSE: The music mediation across of the structured methodology of the musical phenomenon can improve the quality of life of the oncology patient in the physical, emotional, social, psychological and cognitive areas. The author has worked on this document with three aims: 1. To describe the music therapy: Definition and concept

Copyright # 2006 John Wiley & Sons, Ltd.

2. To describe psychooncology ranges where the music therapy is applicable 3. To describe the positive effects of the music therapy in psychooncology. METHODS: The author has called the information of different models of studies and across the work and direct observation. RESULTS: This work includes an appreciations to the physical, emotional, social, psychological and cognitive reactions later to apply music therapy to oncologist patients. CONCLUSIONS: The music therapy aids oncologists and patients in different time of the evolution of this illness to have a better coping to illness and so to get better quality of life.

593 Anxiety, Depression and Level of Knowledge in Breast and Gynaecological Cancer Patients in a Public University Hospital in Brazil Gorayeb Ra, Matthes HTZa, Andrade JMb a Neurology, Psychiatry and Medical Psychology, School of Medicine at Ribeira˜o Preto, Sa˜o Paulo University (USP), Ribeira˜o Preto, SP, Brazil; b Gynaecology and Obstetrics, School of Medicine at Ribeira˜o Preto, Sa˜o Paulo University (USP), Ribeira˜o Preto, SP, Brazil PURPOSE: As cancer can cause anxiety, depression, stress and emotional problems that may disturb the overall treatment efficiency and patient’s quality of life, the patients were evaluated in a Gynaecology and Senology Ward of a Public University Hospital in Brazil. METHODS: A structured interview was carried out, evaluating levels of knowledge and emotional aspects related to the disease, clinical treatment and surgery and it was administered the Hospital Anxiety and Depression Scale. RESULTS: Participated in the study 230 patients between 2002 and 2005, with an average age of 52.6 years (SD ¼ 12:9), being 40.9% of them diagnosed with breast cancer and 59.1% with gynaecologic cancer. The majority of patients, (85.2%) said to have information about the surgery procedure, but 14.8% did not. From the patient’s point of view, the worst moments of the treatment were chemotherapy (33%); diagnosis (22.2%) and surgery (14.3%.) There was a positive correlation between the results of anxiety and depression. There was no significant difference in anxiety between diagnoses. Moderate depression was significantly higher in breast cancer patients and mild depression in gynaecologic cancer patients. Regarding age, younger patients

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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present less depression than older patients, and, inversely, older patients present less anxiety than younger ones. CONCLUSIONS: These data point out the importance of the evaluation of emotional aspects, as well as of the multiprofessional approach, with special emphasis in the psychologist role, to the improvement of patient’s quality of life and successful treatment of the cancer.

594 ‘Always the ‘What if?’’: Spirituality as an Aspect of Survivorship for Women with Breast Cancer Gould Ja, Wilson Sb a Ontario Breast Cancer Community Research Initiative, Women’s College Hospital, Toronto, Canada; bFaculty of Community Services, Ryerson University, Toronto, Canada PURPOSE: To understand the role of spirituality in the breast cancer experience and how this might change over time. METHODS: The research team interviewed 28 women from diverse spiritual/ religious affiliations at one year post-diagnosis to explore how they defined and experienced ‘spirituality’; their experience of spirituality in the context of a breast cancer diagnosis; their relationship with God or a ‘higher power’ (if applicable); and, what, if any, spiritual resources they wanted made available at community-based cancer agencies and cancer treatment centres. This first round of interviews was completed in 2004 (Time I). Because we are focused on understanding spirituality as an aspect of survivorship, we contacted each woman to participate in a second interview (Time II) approximately two years following their first interview. RESULTS: This second round of interviews with 20 of the original 28 women was completed in early 2006. We applied a thematic analysis to explore the data both at Time I and Time II (Patton, 2001). Themes and sub-themes emerging from the interviews at Time I include Transpersonal Connection (Methods to engage, Qualities of engagement and Qualities of disengagement); Intrapersonal Connection (Finding meaning and Transformational experiences); and, Interpersonal Connection (The hand of ‘God’, The faith community, Cancer support groups, and Giving back). Using participants’ narratives we will illustrate, compare and contrast these themes with these that emerge from the Time II interviews. CONCLUSIONS: We will discuss how community-based cancer

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professionals might respond over time to the spiritual needs expressed by women.

595 Effects of Combined Pelvic Floor Muscle Exercises and Support Group on Urinary Incontinence and Quality of Life of Patients with Prostatectomy Zhang AYa, Strauss GJb, Siminoff LAc a FPB School of Nursing Case, Western Reserve University, Cleveland, OH, USA; bPsychiatry, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA; c Department of Bioethics, School of Medicine, Case Western Reserve University, Cleveland, OH, USA PURPOSE: The study examined the effect of combined Pelvic Muscle Exercises and social support group on urinary incontinence and quality of life of patients with stage I–III prostate cancer. METHODS: 29 incontinent patients with post prostatectomy learned the pelvic muscle exercises (PFME) through biofeedback and ere randomized to the control group (n ¼ 15) and support group (n ¼ 14). The control group participants practiced PFME individually at home, while the support group participants were invited to six biweekly group meetings facilitated by a health psychologist. Assessment of urinary incontinence and quality of life was conducted at baseline and 3-month follow-up. RESULTS: 86% support group participants vs 46% control group participants practiced PFME 4–7 days weekly. At 3 months, the support group reported less urinary incontinence on a 0–10-point VAS rating scale than the control group (mean ¼ 3:2 vs 4.7); fewer support group participants used pads (50%) than control group participants (84.6%). More support group participants than control group participants reported that they could stop the urge to urinate and prevent leakage at 3 months (71.4% vs 38.5%, p50.05). The support group also scored significantly lower on the severity of problems in daily living caused by urinary incontinence than the control group (p ¼ 0:037) at 3 months, especially in relation with spouse (p ¼ 0:038) and going out to public places (p ¼ 0:022). CONCLUSIONS: The study findings provided promising evidence regarding the effect of this new intervention on adherence to PFME, urinary incontinence, and quality of life. Implication of the findings for standard care is discussed.

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596 Post-traumatic Stress Disorder and Cancer Grangeia R, Costa A Psychiatry, Hospital Sa˜o Joa˜o, Porto, Portugal Post-traumatic Stress Disorder (PTSD) is a quite new diagnosis, in what concerns the evaluation of cancer patients, mainly because only recently the international criteria (DSM IV}TR) included being diagnosed with a life-threatening illness, as an example of a traumatic event. This work pretends to corroborate this diagnosis category, in this particular group of patients, by focusing a brief schematic review of the most relevant scientific articles published in the last ten years, which approach the epidemiology of PTSD in cancer patients. The authors also mention the main difficulties in making the diagnosis, as well as the differential diagnoses, risk and protective factors, comorbidity and psychopharmacological interventions (according to specific symptoms). Neuroanatomical changes are focused as well as the psycho-biological features of this mental disease (psychophysiological effects of trauma, neurotransmitters abnormalities, HPA axis). This is quite an important, but unfortunately most forgotten matter, as PTSD and PTSS (PTSD-like syndrome) seems to be under diagnosed in people suffering from cancer. Its recognition is essential to the appropriate approach of psychiatric comorbidity in oncologic patients, as it requires specific treatment.

597 Cancer, Cytokines and Depression Grangeia R, Costa A Psychiaty, Hospital Sa˜o Joa˜o, Porto, Portugal Psychoneuroimmunology is a promising area of research, which we hope, might bring us some answers about the aetiology and perhaps treatment of some psychiatric disorders. The interrelation between immune and psychological state is very old: ‘The melancholic woman is more susceptible to disease. . . ’ (Galeno, 200 AC). Depression is a common, disturbing concomitant of medical conditions, including cancer and most auto-immune diseases, and it varies between 5 and 40% (Katon et al., 1990) Cytokines, considered by some as the ‘hormones of immune system’, can be secreted by immune blood and neuronal cells and act as signals between cells to regulate the immune response to injury and infection (Kronfol et al.,

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2000). The authors briefly approach the structure and functioning of cytokines, their effects on CNS (neurochemical and neuroendocrine) and on behaviour, focusing on the ‘depressive symptoms’ caused by the therapeutic use of cytokines (sickness behaviour). They also correlate these substances with the HPA axis, glucocorticoid signalling, diet (polynsaturated fatty acids) and gender (biggest immune activation on women). Antidepressants have been used successfully in treating depressive symptoms associated with various medical conditions (Katon and Sullivan, 1990), and depression induced by cytokines (Levenson et al., 1993). They have protector and therapeutic effect on depression depending on a medical condition, by an ‘anti-cytokine’ effect. This poster discusses ways in which these emerging data may lead to advances in the recognition and management of depressive symptoms in cancer patients.

598 Adjustment and Quality of Life of Men and Their Partners During Treatment for Non-localised Prostate Cancer Green HJa,b,c, Pakenham KIb, Gardiner RAc a School of Psychology, Griffith, University, Gold Coast, Australia; bSchool of Psychology, University of Queensland, Brisbane, Australia; cDepartment of Surgery, University of Queensland, Brisbane, Australia PURPOSE: Adjustment and quality of life were investigated in men with non-localised prostate cancer and their wives or partners as part of a longitudinal treatment study on quality of life and cognitive functioning associated with treatment for prostate cancer. METHODS: Patients were randomly assigned to treatment with leuprorelin, goserelin, cyproterone acetate, or close clinical monitoring. Patients were assessed with neuropsychologica tests and self-report questionnaires at pre-treatment baseline and after 6 and 12 months of treatment (n ¼ 62). A community comparison group of men the same age without prostate cancer completed the same measures (n ¼ 15). Self-report data were provided by 27 partners of patients (60% response rate) and 5 partners of community comparison participants (42% response rate). RESULTS: Sexual dysfunction increased for patients on androgen-suppressing therapies, and emotional distress increased in patients assigned to cyproterone acetate or close

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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clinical monitoring. Compared with pre-treatment, there was evidence of an adverse effect of leuprorelin, goserelin, and cyproterone acetate on cognitive function. The majority of participants currently had partners (73% of patients and 80% of comparison participants). Partners reported comparable or higher levels of distress than patients, and, like patients, reported decreased threat appraisals of cancer over time. CONCLUSIONS: In conjunction with results from he broader study, data from partners suggest that information and support for partners is important in addition to services for patients.

599 Alexithymia, Anergia and Fatigue in Advanced Cancer: A Case-Control Study Gritti Pa, Montone Vb, Resicato Ga, Luciano Gb, Bernardo Aa a Department of Psychiatry, University of NaplesSUN, Napoli, Italy; bUnit of Pain Therapy and Palliative Care, ‘Cardarelli’ General Hospital, Napoli, Italy PURPOSE: To investigate alexithymia, anergia and fatigue in advanced cancer patients vs controls. METHODS: 33 cancer patients (F:M ratio: 0.63; mean  SD age: 62  11.5), undergoing chemo-radiotherapy or palliative care, and 33 healthy controls (F:M ratio: 0.57; mean  SD age: 61  5.7) were recruited. TAS-20, BFI and a BPRS 4.0 subscale were used to evaluate alexithymia, fatigue and anergia. Cancer type and stage was recorded for patients. Functional disability (KPS), and hemochrome values were recorded for both groups. Tas-20 and BFI were self-administered. BPRS was administered by an expert psychiatrist. RESULTS: 39% of patients were alexithymic (Tas-20461) whereas 21% of controls. TAS-20 mean score in patients was 57.5 vs 49.7 in controls (t ¼ 3:318, p ¼ 0:001). BFI mean score was 5.5 in patients vs 3.8 in controls (t ¼ 3:240; p ¼ 0:002). BPRS Anergia Subscale mean score was 8.7 in patients vs 5.7 in controls (t ¼ 3:595, p ¼ 0:001). Anergia and fatigue were associated both in patients (r ¼ 0:412; p50:05) and controls (r ¼ 0:42, p50:05). CONCLUSIONS: Out study suggests that alexithymia may be considered a coping process in cancer patients. Advanced cancer patients develop alexithymic responses more frequently than healthy controls. Fatigue and anergia are common in advanced cancer but not associated with alexithymia.

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Fatigue and anergia seem to be two putative overlapping dimensions. These conclusions are extensively discussed in the paper.

600 Is Knowledge of Pediatric Palliative Care Sustained One Year After a Brief Educational Workshop? Grollman JAa, Baughcum AEb, Gerhardt CAa, Young-Saleme Tc, Klopfenstein Kd a Center for Biobehavioral Health, Columbus Children’s Research Institute, Columbus, OH, USA; bDepartment of Medical Humanities and Social Sciences, Florida State University College of Medicine, Tallahassee, FL, USA; cDivision of Psychology, Columbus Children’s Hospital, Columbus, OH, USA; dDivision of Hematology/Oncology, Columbus Children’s Hospital, Columbus, OH, USA PURPOSE: Medical staff frequently report feeling ill-equipped to manage pediatric end-of-life (EOL) issues. Subsequently, the transition to palliative care is often abrupt. As a pilot study, we developed and evaluated the efficacy of a pediatric palliative care workshop to enhance training for medical fellows. METHODS: Thirty-two US pediatric oncology fellows participated in a daylong workshop on palliative care topics, including pain/symptom management, communication, ethics, and bereavement. Questionnaires assessed fellows’ competence, beliefs, and knowledge regarding palliative care at baseline, post-workshop, 6, and 12 months following the workshop. RESULTS: At 6 months, fellows reported the seminar had significantly influenced their competence, beliefs, and knowledge with regard to pediatric palliative care. Staff and families’ discomfort with death was the most frequently cited barrier to providing effective EOL services. Knowledge of ethics and communication were stable from baseline. Improvements in knowledge of grief and bereavement were maintained at 6 months, but knowledge of pain and symptom management returned to baseline. Evaluations at 2 month are in process and will be included. CONCLUSIONS: Although attitudes toward EOL care improved, the one-day workshop did not produce lasting improvements in knowledge of palliative care uniformly. Sustained knowledge may require integration of more intensive training on palliative care into medical curricula. Continued research on the evaluation of similar educational programs is needed to inform clinical care

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and improve EOL services to children and families.

601 Impact of Maternal Breast Cancer on Children’s Social Functioning Grollman JAa, Gerhardt CAa, Noll RBb, Vannatta Ka a Center for Biobehavioral Health, Columbus Children’s Research Institute, Columbus, OH, USA; b Child Development Unit, Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA PURPOSE: Over 35% of the 2 million women currently diagnosed with breast cancer may have school-aged children. Children of mothers diagnosed with breast cancer (CBRCA) may experience increased depression and anxiety, but it is unknown whether these symptoms or other disruptions in the family adversely affect functioning at school and interactions with peers. We hypothesized that CBRCA would experience more social difficulties than peers, including alterations in social behavior and acceptance. METHODS: Peer-, teacher- and self-reports of social functioning were obtained at school regarding 60 CBRCA (age 8–16, 51% female, 84% Caucasian). A sample of 60 comparison peers (COMP) included one classmate, matched for gender, race, and age, for each CBRCA. The Revised Class Play, Peer Acceptance Ratings, and Friendship Nominations were utilized. RESULTS: Peers described CBRCAs as similar to COMPs in prosocial (t ¼ 0:51; p¼ ns), leadership (t ¼ 0:45; p¼ ns), aggressive (t ¼ 1:21; p¼ ns), and withdrawn (t ¼ 0:49; p¼ ns) behavior. Teachers reported that CBRCAs were less aggressive and disruptive than peers, t ¼ 2:50; p50:05; but similar in terms of other behavior. CBRCAs did not view their own social behavior differently than COMPs, and no differences were found in their peer acceptance or number of friendship. CONCLUSIONS: CBRCAs had little impact on social functioning or social reputation as a result of experience with maternal cancer. Results suggest children who experience cancer in their family may not be at higher risk for social difficulties than peers.

602 Quality of Life Predicts Survival Time Post Allogeneic Haematopoetic Stem Cell Transplantation Grulke Na, Bailer Ha, Larbig Wb, Kaechele Ha

Copyright # 2006 John Wiley & Sons, Ltd.

a

Psychosomatic Medicine, University Hospital of Ulm, Ulm, Germany; bMedical Psychology, University of Tuebingen, Tuebingen, Germany PURPOSE: Several studies report on associations between quality of life (QoL) at the beginning of chemo therapy in cancer treatment and survival time thereafter. Results are heterogeneous. No studies exist in the field of allogeneic haematopoetic stem cell transplantation (HSCT). METHODS: From 9/1999 to 12/2001, 140 patients were recruited from the transplant units at the university hospitals in Ulm and Tu¨bingen, Germany. Each patient was to be followed-up on for at least two years. Patients were administered the EORTC QLQ-C30 (30 items) before starting conditioning for the first allogeneic HSCT. Over all survival was chosen as outcome criterion in a Cox-regression model. To adjust for somatic and physical factors an index (SPIN) combining age and risk for treatment failure was calculated. To reduce the number of statistical tests a principal component analysis was performed with the 15 scores of the QLQ-C30 and a single score reflecting ‘overall-QoL’ (range 0–100) construed. RESULTS: One case had missing values for overall-QoL reducing the valuable sample size to 139. At follow-up (2.1–3.2 years post HSZT), 72 patients had died. Overall-QoL and SPIN didn’t correlate. Both factors were significant covariates in the Cox-regression model. A rise of 10 points for overall-QoL is associated with a decrease in the risk to die (RR ¼ 0:84; 95%-CI ¼ 0:7520:95). CONCLUSIONS: Assessing QoL before starting with the conditioning regimen could contribute towards the prognosis independently. It is unclear in how far overall-QoL reflects other biomedical variables not assessed in our study. ACKNOWLEDGEMENTS: Supported by German Jose´ Carreras Leukaemia-Foundation.

603 Psychosocial Intervention During Inpatient Time for Allogenic Hematopoietic Stem Cell Transplantation Has Positive Effects on ANE-Syndrome Grulke Na, Bailer Ha, Larbig Wb, Kaechele Ha a Psychosomatic Medicine, University Hospital of Ulm, Ulm, Germany; bMedical Psychology, University of Tuebingen, Tuebingen, Germany PURPOSE: To evaluate a behaviour medicine oriented, psychosocial intervention programme by studying its effects on the ANE-syndrome

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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(anorexia, nausea, and emesis). Positive effects are expected for patients receiving the intervention in comparison to patients receiving treatment as usual. METHODS: Data were collected in a prospective controlled study at the transplant units of Ulm and Tuebingen (Germany). 140 patients were recruited. Each day during their inpatient time, participants were asked to assess their suffering from ANE (3 items, 6-point Likertscale). Mean distress scores are calculated for the five days before HSCT (pre-transplant), from day of transplant until day +14 (isolation), from day +15 until day +29 (recovery period), and a total score covering days 5 to +29. Analysis is restricted to patients alive at discharge and providing sufficient valid data. RESULTS: Data on 113 patients could be analysed (15 died, and 12 had too many missing values). A trend (Mann-Whitney U-test, one-sided; 0:075p50:12) is seen for nausea pre-transplant, during isolation and total score. Significant effects result for appetite loss pre-transplant (p ¼ 0:043), and for emesis during isolation (p ¼ 0:022) and total score (p ¼ 0:042). CONCLUSION: Effects were not as large as expected. Aiming at the ANE-syndrome, the intervention programme is effective but probably not efficient. Intervention programmes should not be offered to each patient in general. They should focus on highly distressed patients. ACKNOWLEDGEMENTS: Supported by German Jose´ Carreras Leukaemia-Foundation.

604 The Subjective Experience of Having Changed in Personality After Stem Cell Transplantation Grulke Na, Bailer Ha, Larbig Wb, Kaechele Ha a Psychosomatic Medicine, University Hospital of Ulm, Ulm, Germany; bMedical Psychology, University of Tuebingen, Tuebingen, Germany PURPOSE: Do patients two years post allogenic hematopoietic stem cell transplantation (HSCT) think that they have changed as a person? METHODS: Data were collected in a broader prospective study at the transplant units of Ulm and Tuebingen (Germany). 140 patients were recruited and assessed psychometrically (HADS, POMS, MAC scale, EORTC QLQ-C30) after admission to hospital and before starting the conditioning regimen (T1). For the last follow-up about 26 months post HSCT, data are available for 47 patient. They were asked, if they feel having changed as a person in general, physically and

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psychologically (3 items, 6-point Likert-scale) due to the transplantation procedure and its consequences. Instruments administered at T1 were given again. We explore correlations between psychometric measures and the three items addressing personality changes. RESULTS: Two years post HSCT, more than a third of the patients reported on intense or very intense changes. Analyses of correlations show that the degree of perceived changes mainly reflects psychological distress. Seven of 15 QLQ-C30-scores correlate with perceived physical changes. Several scores measured at T1 (HADS anxiety and depression, POMS depression, and QLQ-C30 emotional functioning, cognitive functioning, and fatigue) significantly correlate with perceived general and psychological change (r 4 0.30 for all coefficients) two years post HSCT. CONCLUSION: Changes in personality after HSCT seem to be common and may reflect psychological distress. ore attention should be directed towards the observation that the higher the initial distress the higher the perceived changes in personality two years later. ACKNOWLEDGEMENTS: Supported by German Jose´ Carreras Leukaemia-Foundation.

605 The Associations Between Living Conditions, Demography, and the ‘Impact of Cancer’ Scale in Tumor Free Cancer Survivors Gudbergsson SB, Fossa SDa, Dahl AA, Ganz PAb, Zebrack Bb a The Cancer Clinic, Rikshospitalet-Radiumhospitalet Trust, University of Oslo, Oslo, Norway; b Johnsson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, USA BACKGROUND: The concept of welfare consists of quality of life and living conditions (LCs), and both are often influenced by cancer survivorship. A new questionnaire ‘The Impact of Cancer Scale’ (IOC) explores survivors’ attitudes in the physical, psychological, social, and spiritual/ existential domains self-rated in 10 dimensions. The aim of the present study was to investigate the associations between demography, LCs, and the IOC dimensions in disease-free Norwegian survivors who have been treated for breast, prostate, or testicular cancer. METHODS: A questionnaire covering demography, LCs, and containing the IOC was mailed to 852 cancer survivors. Valid responses were obtained from 459 (54%)

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survivors. A Living Condition Index score (LCI) was calculated based on social class, employment status, annual income, health, and social participation. RESULTS: Significant associations were observed between gender, health status, employment, and financial worries and five or six IOC dimensions. Survivors with low LCI scores viewed their situation significantly more negatively on the IOC dimensions compared to those with medium and high LCI scores. Cancer survivors with high LCI scores viewed their situation more positively than those with medium or low LCI scores, but disagreed more profoundly to statements that indicated some meaning of cancer. CONCLUSION: The high number of significant associations between LCs indicators and dimensions of the IOC in tumour-free survivors after breast, testicular, and prostate cancer, are of relevance when health care professionals assist long-term cancer survivors in dealing with the ‘impact of cancer’ as measured by this new instrument.

of illusion. CONCLUSION: The reflection during the discussion was essentially based on MerleauPonty’s philosophy and conducted from four existential dimensions, such as corporeality, spatiality, temporality and relationality. It can help the health professionals to understand the patients’ reflections about morphine and morphine’s effect on the body if they have a better knowledge of the essence of such a phenomenon. One challenge for nurses is to determine the time and the way to pedagogically introduce pain management in an earlier stage of the disease. COMMENTS: The phenomenological notion of embodiment}the lived body}expressed the notion of the bodyfor-itself and the body-in-itself. To start from the notion of embodiment meant to manage pain with consideration about the total perception of pain, as sensation, emotion and in relation to existence and culture. Pain is simultaneously physical and emotional, biological and phenomenological embodied; moreover it is mediated by culture.

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To Begin with Morphine Against Cancer Related Pain; A Phenomenological Study Guedj GSa, Thome´ Bb a Oncology/Psychosocial Unit, Lund University Hospital, Lund, Sweden; bDepartment of Nursing, Faculty of Medicine, Lund, Sweden

Relationship Between PTSD Symptoms, Psychological Defence Mechanisms, and ERP Components Among Breast Cancer Patients Tarabrina NVa, Guens GPb, Korobkova LIb, Kurchaova MSa, Shatalova NEa a Laboratory of Psychology of Posttraumatic Stress, Institute of Psychology of Russian Academy of Sciences, Moscow, Russia; bOncological and Radiological Department, Moscow State University of Medicine and Dentistry, Moscow, Russia

GOAL OF WORK: There are few studies about the patients’ experiences to begin with morphine in the treatment of cancer related pain. To listen to patients’ narratives about illness can help to highlight the understanding about what the patients perceive and how they experience disease and the care they get subsequently. The aim of this qualitative study was to describe the lived experience to begin a treatment with morphine because of cancer related pain. PATIENTS AND METHOD: A phenomenological method based on Van Manens approach was used. Ten patients, five women and five men, with a diagnosis of cancer and in the beginning of a treatment with morphine or morphine-like medicine because of cancer related pain, were interviewed on the oncology ward, at the hospice or at home. MAIN RESULTS: The lived experience to begin with morphine appeared in four essential themes: a consciousness of the severity of the disease, an unbearable possibility to make an existential choice, addiction as a reality and an experience

Copyright # 2006 John Wiley & Sons, Ltd.

PURPOSE: The purpose of the study was to define relationship between intensity of PTSD symptoms and types of psychological defence among breast cancer patients (BC) and ERP response to emotionally significant stimuli. METHODS: Methods included SCL-90-R, IOES-R, MS, LSI, EPI questionnaires and ERP recording. Photographs from the International Affective Picture Systems (CSEA-NIMH, 1995) were used as stimuli. EEG was recorded from frontal, temporal and parietal-occipital areas. ERPs to the pictures of emotionally significant contents were compared to those of neutral images. Subjects were 22 females with the history of BC surgery. RESULTS: High level of P140, P300 amplitude at the left frontal area in response to pictures displaying various scenes of death correlated with low distress level (SCL-90-R, MS),

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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mild intrusion symptoms (IOES-R) and high intensity of avoidance symptoms (IOES-R), as well as with increase of ‘Denial’ and ‘Intellectualization’ (LSI) and reduction of ‘Regression’ (LSI) and ‘Neuroticism’ (EPI). The increase of P140, P300 amplitude at the right frontal area in response to pictures displaying positive scenes negatively correlated with the distress level (SCL-90-R, MS), the physiological arousal scores (IOES-R) and positively correlated with level of the feelings of interpersonal sensitivity (SCL-90-R). CONCLUSIONS: The results show that left frontal area is responsible for the psychological defences based upon censorship and rational interpretation of traumatic information, and right frontal area}for defences based on the decline of intensity of the emotional experiencing.

608 Externalizing Problems (ADD-H, OD, CD) in Children with Cancer Lo´pez Soler Ca, Herna´ndez Sa, Dura´ Eb, Ferna´ndez Va a University of Murcia, University Hospital ‘Virgen de la Arrixaca’; bUniversity of Valencia PURPOSE: The aim of this work is to show the psychopathological manifestations of externalizing problems that children with cancer present. The two more frequent oncological diagnoses are Acute Lymphoblastic Leukaemia (ALL) and Brain Tumours. METHODS: The sample uses 50 children from the Paediatric Oncological Department of the University Hospital Virgen de la Arrixaca in Murcia (Spain), of whom 21 are girls and 29 boys. All of them have been given the ICI Inventario Clı´ nico Infantil (Child Clinic Checklist) for parents, based on the Achenbach Child Behaviour Checklist (CBCL) and Conners scale. The ICI provides information on Attention Deficit and Hyperactivity Disorders, Oppositional Defiant and Conduct Disorders. RESULTS: 28% present Attention Deficit Disorders with Hyperactivity (10% moderate); 22% OD (16% moderate) and 40% CD (24% mild; 16% moderate). Alpha coefficients are 0.68; 0.80 and 0.81, respectively. CONCLUSIONS: The more frequent externalizing problems in children with cancer is conduct disorders of mild intensity. Compared with internal disorders, the external disorders are less frequent in children with cancer.

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609 Psychological Distress, Posttraumatic Stress Symptoms, and Coping Style in Parents of Children with Cancer Herna´ndez Sa, Dura´ Eb, Lo´pez-Soler Ca, Andreu Yb, Galdo´n MJb a University of Murcia, University Hospital ‘Virgen de la Arrixaca’; bUniversity of Valencia Significant advances have been made in the treatment of paediatric cancer. Given the increasing survival rates, it is necessary to address psychosocial needs of children and parents and how the mothers and fathers cope with this dramatic situation. PURPOSE: To study the emotional distress, posttraumatic stress symptoms and coping strategies in 50 mothers/parents of children with cancer from Hospital Universitario Virgen de la Arrixaca (Murcia, Spain) and to determine whether treatment-related data (active treatment vs off treatment) is correlated with the psychological status. METHODS: Parents completed three standardised questionnaires, Brief Symptom Inventory (Derogatis, 1983), Impact of Event Scale-Revised (Weiss and Marmar, 1997) Brief COPE (Carver, 1997). RESULTS: Children’s sociodemographic and medical variables are presented. The results indicate no statistical differences between both parent groups (children in medical treatment vs children who had successfully completed cancer treatment). Analysis was carried out with the entire sample. Parents present anxiety, intrusive thoughts and active coping. CONCLUSIONS: The results of this study suggested that illness phase (treatment vs remission) is no predictor of emotional distress, posttraumatic stress symptoms and coping strategies in parents of children with cancer.

610 Affective and Anxiety Problems of Childhood Cancer Lo´pez Soler C, Herna´ndez S, Ferna´ndez V University of Murcia, University Hospital ‘Virgen de la Arrixaca’ PURPOSE: The aim of this work is to show the psychopathological manifestations of a depressive or anxious type show by minors in oncological treatment. METHODS: The sample uses 50 children from the Paediatric Oncological Department of the University Hospital Virgen de la Arrixaca in Murcia (Spain), of whom 21 are girls

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and 29 boys. The two most frequent oncological diagnoses are Acute Lymphoblastic Leukaemia (ALL) and Brain Tumours. All of parents of them have been given the ICI, Inventario Clı´ nico Infantil (Child Clinic Checklist), based on the Achenbach Child Behaviour Checklist (CBCL). The ICI comprises 96 items which provide information on affective problems and anxiety (Achenbach, 2001). The symptoms of empiric depressive syndrome are: little enjoys, cries, harms self, doesn’t eat well, worthless, guilty, tired, lacks energy, sad and sleep problems. The anxiety can be recognised by: dependent, fears, fears school, nervous, fearful and worries. The presence of clinical disorder can be classified in two levels; light and moderate. RESULTS: The analysis of reliability of the scales has been made through the Cronbach alpha coefficient (depression: 0.80; anxiety: 0.65). The 44% present emotional problems (22% moderate alteration). In anxiety problems, the 60% show significant symptoms (38% moderate). CONCLUSIONS: More than half the children do not show significant emotional problems, whilst the majority do have significant anxiety disorder.

611 Filling in the Picture: Talking About Death and Dying Guy HLa, Oyebode JRb, Howard RAb, Tolosa Ic a Clinical Psychology, Walsall Primary Care Trust NHS Walsall, England; bClinical Psychology, Doctorate University of Birmingham, Birmingham, UK; cClinical Psychology, University Hospital Birmingham, Birmingham, UK PURPOSE: Previous studies of communication have tended to focus upon the breaking of bad news. There is a dearth of studies exploring communication about death and dying. The aim of the present study was to elicit and explore helpful and unhelpful aspects of communicating about death and dying from the perspective of patients who were facing the end of their life. METHODS: Semi-structured interviews were conducted with six participants selected from three hospices and a cancer centre in the West Midlands (England) between September 2004 and July 2005. Participants represented different genders, ages and cancers. All were aware that they had a terminal prognosis. Participants were asked about their previous experiences of communicating about death and dying, and to identify

Copyright # 2006 John Wiley & Sons, Ltd.

helpful and unhelpful aspects of communication. RESULTS: Grounded theory analysis identified five themes inherent to the process of communicating about death and dying, (1) staging, (2) filling in the picture, (3) blocking, (4) protecting, and (5) maintaining contact. A core category of Approach–avoid related to all five themes. CONCLUSIONS: Identification of these processes from the perspective of the patient may provide a useful framework for a wide range of health care professionals. The importance of enabling conversations about death and dying as well as treatment, was a key finding. This highlights the need for eliciting communication processes at all stages in the cancer journey.

612 Introducing the Australian and New Zealand Psycho-Oncology Co-operative Research Group (PoCoG) Hagerty RGa, Butow PNa, Girgis Aa, Dhillon Hb a School of Psychology, University of Sydney, Sydney, Australia; bCentre for Health Research and Psycho-oncology, University of Newcastle, Newcastle, Australia BACKGROUND: PoCoG was conceived in response to the recognised need in Australia to develop the capacity and co-ordinated collaboration to conduct large-scale, multi-centre psychooncology and supportive care research. In 2005, PoCoG was successful in achieving infrastructure funding for two years from the Cancer Institute, NSW, and has already achieved a multidisciplinary national membership of over 150. MISSION: PoCoG’s mission is to improve the outcomes of patients in Australia and New Zealand experiencing a diagnosis of cancer, their families and carers through evaluation and implementation of psychosocial and supportive care interventions for patients, carers, health professionals and the health care system. AIMS: (1) To bring together researchers, clinicians, health care professionals and consumers with an interest in Psycho-Oncology to foster collaboration and the exchange of ideas. (2) To develop large-scale, multi-centre Psycho-Oncology studies of clinical relevance and importance, which would be difficult for any one team to mount. (3) To develop formal links with cancer clinical trial groups to facilitate quality of life and psychosocial sub-studies. (4) To promote Psycho-Oncology research and support emerging new researchers in this area. (5)

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Form links with international Psycho-oncology Groups. It is hoped that the PCoG will attract leading researchers and Psycho-Oncology health professionals in this region and will facilitate a flow of increased collaborations and the development of high-quality psycho-oncology research with strong links to the clinical cancer community. PoCoG has the potential to become a leading group for psycho-oncology research, attracting research collaborations from around the globe.

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that the QPL facilitated question-asking overall and that it facilitated question-asking about prognosis.

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A Pilot of a Question Prompt List Designed to Facilitate Communication about Prognosis in First and Second Oncology Consultations Hagerty RG, Butow PN, Tattersall MHN Medical Psychology Research Unit, University of Sydney, Sydney, Australia

Experiences with Rapid Genetic Counseling and Testing in Newly Diagnosed Breast Cancer Patients Hahn DEEa,d, Bleiker EMAb,d, Aaronson NKb, Valdirmarsdottir HBc, Verhoef Sd a Psychosocial Service & Support, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; bPsychosocial Research, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; cOncological Sciences Mount Sinai School of Medicine, New York City, USA; dFamily Cancer Clinic, The Netherlands Cancer, Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands

AIMS: To determine the utility of a new question prompt list (QPL) designed to facilitate communication about prognosis between oncologists and their new patients, as compared with a previously evaluated QPL, in the first and second consultation. PARTICIPANTS: 30 new cancer patients attending their first and second appointments with one of 7 participating oncologists at two outpatient clinics. METHOD: The QPL was presented to patients 30 minutes prior to their initial and second oncology appointment. Demographics, information and involvement preferences and state anxiety were measured immediately prior to the first appointment. Feedback on the QPL, understanding of illness, achievement of information and involvement preferences, and psychological outcomes were measured after each consultation. Consultations were analysed for number of questions and concerns, use of the QPL, and prognosis discussion. Participants were matched with those of a previous QPL study to determine the impact of the new QPL on the first consultation. RESULTS: 50% of patients used the QPL in the first consultation and half of those who had a second consultation used it in that consultation. More questions were raised if the doctor endorsed the QPL early in the consultation. No significant differences were identified between the current and matched comparison samples. No adverse affects on patient psychological outcomes were found. SUMMARY: Whether or not the QPL was used in the consultation, the majority of patients and doctors supported its future implementation, and reported

PURPOSE: Little is known about the psychological and behavioral impact of rapid genetic counseling and/or testing (RGCT) for inherited cancer risk among newly diagnosed breast cancer patients. This pilot study addressed the following questions: (a) What is the interest and uptake of bilateral mastectomy (BLM)? (b) To what extent does the offer of genetic counseling add to the stress caused by the diagnosis and treatment of breast cancer? (c) To what extent are the participants satisfied with the offer of RGCT? METHODS: Eight women who were offered rapid genetic counseling following their breast cancer diagnosis during 2004–2005, were invited to undergo a semi-structured interview (mean age 34.8 yrs). RESULTS: Six women had rapid counseling only and underwent DNA testing after their surgical treatment. Two women had also undergone DNA testing before treatment, but only one awaited the DNA test results before deciding on the treatment. Both underwent a bilateral mastectomy with direct breast reconstruction. Those who chose to delay testing indicated that they did not believe that test results would change the nature or course of their primary treatment, which was bilateral mastectomy in all cases. CONCLUSIONS: All women who had rapid counseling (with or without testing) underwent bilateral mastectomy. RGCT did not significantly add to the stress already felt due to the diagnosis of breast cancer. All women were satisfied with the offer of RGCT and appreciated a standard psychosocial contact as part of the procedure.

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Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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615 ‘Every Word Has Meaning’: A MultidisciplinarySystem Wide Approach to Achieving Communication Skills Competency Hammelef Ka, Wintermeyer-Pingel Sa, Steiger Jb, Riba Mc a Patient Support Services, University of Michigan Comprehensive Cancer Center, Ann Arbor, USA; b Center for Research on Learning and Teaching, University of Michigan, Ann Arbor, USA; cPsychiatry/PsychOncolgy, University of Michigan, Ann Arbor, USA PURPOSE: Cancer patient communications occur throughout health systems; involving a variety of healthcare providers. These providers routinely handle difficult conversations, yet many are uneducated in patient communication skills. This NCI designated Comprehensive Cancer Center’s PsychOncology Program sought to improve communications with cancer patients and families at interactions throughout the center via a performance enhancing program involving a multidisciplinary staff. METHODS: The program targeted >300 cancer faculty and staff (physicians, midlevel providers, nurses, clerks and support staff) and included 3 phases of program development. Phase 1 examined communication skills needs through the use of videotaped patient interviews followed by multidisciplinary team discussions. Phase 2 provided training materials and activities during routine department meetings. The ‘CRLT Players’, a UM acting troupe, provided interactive performances, engaging staff in skill building exercises. Common patient interactions were acted out, illustrating various communication skills, followed by actor/staff discussions. Homogeneous staff educational sessions were held later, targeting role specific skills. In Phase 3, the communication ‘competency’ was integrated into the health system’s annual staff competency program. RESULTS: Participant evaluations were conducted after each phase. To date the evaluation of phase 1 demonstrates an increased awareness of the need for skills training, increased multidisciplinary discussion of the issue, and improved leadership and donor support for the initiative. Program development strategies and outcomes will be reported in this presentation. CONCLUSION: Targeting a skills building program to a multidisciplinary staff encourages discussion of the problem, facilitates mentoring,

Copyright # 2006 John Wiley & Sons, Ltd.

illuminates the complexity of patient interactions and fosters teamwork

616 An Interdisciplinary Dialogue on the End of Life Impasse Back Aa, Bakos Ab, Harris Lc, Lannamann Jd, McNamee Sd a Gastrointestinal Oncology, University of Washington, Fred Hutchinson Cancer Research Center Seattle, Washington, USA; bNational Institute of Nursing Research, Bethesda, MD, USA; cHealth Communication and Informatics Research Branch, National Cancer Institute, Bethesda, MD, USA; d Department of Communication, University of New Hampshire Durham, New Hampshire, USA; e Health Communication Research Laboratory, St. Louis University, St. Louis, MO, USA PURPOSE: Researchers from the fields of communication and nursing have joined in proposing that communication is part of the problem and the solution to moving from curative to palliative cancer care. This presentation is part of a larger interdisciplinary research project that examines the potentials of a dialogic approach to end of life issues. The research team proposes an intervention in which oncologists prescribe family-led dialogues during which members self-organize around post diagnosis planning. These researchers explore the question: How could family led end-of-life dialogues be integrated into the workflow of providers and the life flow of patients and their families? METHODS: The team has invited an oncologist and a family member who has recently experienced the loss of his father to cancer to join them in a mediated dialogue regarding their proposed intervention. The mediated dialogue methodology, ‘Resource Inquiry,’ is a process by which members of disparate disciplines are supported in their efforts to envision a future working together in harmony. In this case, oncologists and family members are given opportunities to imagine how family-led post diagnosis planning could be integrated into the existing patterns of provider interactions, family interactions and family/provider interactions. RESULTS: The results of the Resource Inquiry dialogues will be presented; first from the perspective of a research team member, followed by the accounts of the oncologist and the family member. CONCLUSION: This presentation will conclude with next steps toward

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implementing this proposed intervention in a clinical setting.

617 The Role of Religiosity in Coping with Metastatic Breast Cancer Hasson-Ohayon Ia,b, Braun Ma, Galinsky Da a Oncology, Sharett Institute, Hadassah Medical Center, Jerusalem, Israel; bPsychology, Bar-Ilan University, Ramat-Gan, Israel PURPOSE: The study examines the role of systems of belief and hope in women coping with metastatic breast cancer. Based on previous literature, it is hypothesized that religious women cope better than secular women, and that this difference is mediated by belief and hope. METHOD: 233 Jewish women diagnosed with metastatic breast cancer were randomly selected (mean age ¼ 56:5; SD ¼ 11:43; mean Karnofsky ¼ 87:47 ; SD ¼ 14:26). The instruments used were the Brief Symptom Inventory (BSI), Mental Adjustment to Cancer Scale (MAC), Impact of Events Scale (IES), Systems of Belief Inventory (SBI-15) and the Hope Scale. RESULTS: No differences were found between religious and secular women on various outcome measures. However, within group correlations between Hope and outcomes, and Systems of Belief and outcomes differed significantly between the groups. While stronger significant correlations were found between Hope and various subscales of the BSI and MAC only for secular women, Systems of Belief had significant and stronger correlations with various subscales of the MAC only for religious women. CONCLUSION: Hope for secular women and systems of belief for religious women appear to play a similar positive role in coping with metastatic breast cancer. While hope relies more on the self, religious belief appears to rely more on the community and God. Clinical implications involve the meaning of hope and belief in psychotherapy. ACKNOWLEDGEMENTS: This study was partially supported by the Israel Cancer Association.

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PURPOSE: Understanding of pre-treatment information is vital to be confident patients can give informed consent. Research highlights that poor recall of this information may reduce patients’ ability to cope with their condition and side effects. This research aims to determine whether time and particular demographic or psycho-social variables effect recall of treatment information. METHODS: Thirty-three consecutive breast or colorectal cancer patients undergoing adjuvant chemotherapy were prospectively followed over chemotherapy cycles. Patients completed two questionnaires regarding recall, satisfaction, trust and social support at their second and fourth chemotherapy cycles. RESULTS: There were no significant differences of patient recall over time for either the number of chemotherapy drugs received ðp ¼ 0:48Þ or the drug names ðp ¼ 0:10Þ: Binary logistic regressions indicated that collectively the variables gender, English as a first language, satisfaction and trust significantly predicted recall of the number of chemotherapy drugs received ðp ¼ 0:03Þ: With regards to patient recall of the drug names, age, gender and education were significant predictors ðp ¼ 0:03Þ: Whilst the two models were significant, no individual predictors were significant. The small sample size may have impacted on these findings however accrual is ongoing. CONCLUSIONS: Independently, patients’ experience of chemotherapy does not appear to benefit their recall of treatment information. Recall of the number and names of drugs were predicted by different interactions of demographic and psycho-social variables suggesting different factors underlie patient recall of treatment details. Repeated measures over a longer follow-up period are necessary before definitive conclusions can be made.

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The Impact of Refractory Suffering: Educating Clinicians in Awareness and Capacity Building Through an Online Multidisciplinary Postgraduate Programme Hegarty MM, Devery K, Breaden K, Currow DC Department of Palliative and Supportive Services, Flinders University, Adelaide, Australia

Improving the Chemotherapy Consent Process: Longitudinal Assessment of Patient Recall Hedayati H, Whitford H, Olver I Medical Oncology, Royal Adelaide Hospital Cancer Centre, Adelaide, Australia

PURPOSE: Refractory suffering profoundly affects the patient, family and oncology/palliative care professionals. It influences clinical decision making processes and challenges notions of professionalism, the therapeutic relationship and

Copyright # 2006 John Wiley & Sons, Ltd.

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professional boundaries. Refractory suffering is the most insistent reminder of our own professional and personal vulnerabilities and the limits of the care we can offer. Educating clinicians in increased awareness and capacity in working with patients with refractory suffering involves the development of skills in recognizing the dynamics of refractory suffering and patterns of response and in understanding their language and implications for practice. This presentation explores the ways one educational model has developed to achieve this. METHODS: The Flinders Refractory Suffering Framework is taught as a tool for decision making within an educational approach which informs learning and reflective practice through a range of educational strategies. This educational approach provides experience in shared cross-disciplinary perspectives involving students from differing clinical settings; role-plays incorporating role switching; theory, research evidence and narrative. RESULTS: Student feedback acknowledges increased awareness and understanding of patients’, families’ and clinicians’ psychological responses to intractable suffering. Students value the systematic approach the framework provides for both acknowledging the significance of emotion in clinical care situations and, at the same time, increasing capacity for decision making unclouded by emotion. CONCLUSIONS: The Flinders Refractory Suffering Framework and educational approach are effective in working towards a common language across disciplines and in translating academic knowledge into integrated clinical practice.

620 Knowledge as a Tool}A Pilot Study of a Short Format Informative Intervention for Cancer Patients Hellbom M, Guedj G, Schildt EB Department of Oncology, Lund University Hospital, Lund, Sweden PURPOSE: Cancer patients often express feelings of uncertainty about how to proceed with rehabilitation after completed medical treatment. Furthermore, they frequently express a lack of information about the disease and medical followup. The purpose of this pilot study was to investigate a short format informative group intervention. METHODS: Breast cancer patients were invited to participate when called to their first adjuvant radiotherapy treatment. The inter-

Copyright # 2006 John Wiley & Sons, Ltd.

vention consisted of four one-hour lectures by medical oncologist and oncology nurse, psychologist, physiotherapist, social counsellor, and surgical nurses from a breast cancer unit. Lectures covered the areas breast cancer biology and radiotherapy, psychological aspects of returning to every-day life, physiotherapeutic aspects of rehabilitation, medical follow-up routines and social support options. Patients were asked to evaluate each lecture. RESULTS: Fifty-three patients and 19 partners participated in the intervention (mean 12 participants/group). One hundred and seventeen satisfaction forms were completed. In general, patients expressed that they were satisfied with the content and the format of the lectures, and that they had received much needed information. Many patients spontaneously commented that all cancer patients ought to be offered this. The large majority would definitely recommend a close friend to participate in this type of intervention. CONCLUSIONS: The short format with separate lectures was well accepted and perceived as very useful by the participants. The approach with short lectures is cost-effective and admits flexibility in content. It can easily be adjusted to needs and requests of other groups of cancer patients.

621 Predictors of Anxiety and Depression in Breast Cancer Patients: Physician–patient Communication or Coping? Helmes AW, Vogel BA, Bengel J Department of Rehabilitation Psychology, University of Freiburg, Freiburg, Germany PURPOSE: Physician–patient relationship, information exchange and decision-making are the three key elements of communication in medical care. In this study we examined the role of these elements on breast cancer patients’ anxiety and depression in comparison to the role of four different coping strategies. METHODS: One hundred and six breast cancer patients were recruited at two breast cancer centers in Freiburg, Germany. Study staff approached patients within a week of either surgery or the beginning of neo-adjuvant chemotherapy and invited women to complete a self explanatory questionnaire. RESULTS: Patients showed elevated levels of anxiety (mean: 6.9, SD: 4.3) and depression (mean: 5.5, SD: 4.4) on the HADS. Regression analysis showed that three ways of coping (focus

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on positive, active coping and evasive coping) as well as satisfaction with the decision making process were significant predictors for anxiety ðR2corrected ¼ 0:45Þ: Not significant were variables whether the amount of information met the patients’ needs, how patients rated the physician– patient relationship and supportive coping. The same predictors proved to be significant for depression ðR2corrected ¼ 0:39Þ: CONCLUSIONS: Breast cancer patients rate the relevance of communication with their physician as high. Most important in respect to patients’ anxiety and depression is the decision-making process. However, patients’ coping strategies play an even more important role and for some patients with elevated levels of anxiety and depression psychological counseling may be indicated.

622 A Group Therapy Program: ‘Below the Belt: Life After Prostate Cancer’ McKinnon S, Yuen T, Costello T, Hendricks K, Siddons H Department of Urology, The Royal Melbourne Hospital, Melbourne, Australia PURPOSE: Surgical treatment cures many men from localised prostate cancer, but commonly causes sexual dysfunction. Although many men prioritise a cure over sexual function, post-surgery sexual dysfunction is the most significant source of ongoing psychological distress. Research into the effectiveness of psychological interventions to assist patients treated for prostate cancer is extremely limited. A pilot-study was conducted to assess the efficacy of a cognitive–behavioural group-intervention, which aims to reduce psychological distress related to a diagnosis of prostatecancer and post-surgery side-effects, including sexual dysfunction. METHOD: Twenty-one men participated (mean age 56 years) across three closed-groups. The 8-session group manual addressed issues such as erectile dysfunction, perception of a loss of masculinity, incontinence, relationship problems and quality of life. Men completed pre- and post-group questionnaires, measuring sexual functioning, prostate-cancerrelated anxiety, and general symptoms of depression, anxiety and stress. RESULTS: Although the small sample limited data analyses, a review of mean scores suggested a trend for men to report lower levels of stress, global anxiety, cancerspecific anxiety, and depression following the

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intervention. There was also a trend of improved overall sexual functioning. CONCLUSIONS: The pilot study provided preliminary support for a cognitive-behavioural group-intervention to help men adjust to the impact of prostate cancer on their lives. The pilot study also justified a randomised control trial to examine the efficacy of this intervention. This phase of the study is currently in progress.

623 Situational Threat as a Moderator of the Mastery– Distress Relationship: A Comparison of Breast Cancer Patients with Healthy Women Henselmans I, Ranchor AV, Smink A, Sanderman R Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands PURPOSE: In this longitudinal observational study it is hypothesized that situational threat moderates the relationship between mastery, a global sense of control over life, and psychological distress. Mastery is expected to buffer the negative impact of a breast cancer diagnosis, especially in women confronted with a relatively bad prognosis. METHODS: To examine the moderating effect of increasing threat, three groups were compared, i.e. (1) a reference group of women who were cancer-free ðn ¼ 58Þ; (2) newly diagnosed breast cancer patients with a fairly good prognosis ðn ¼ 47Þ; (3) breast cancer patients with a poor prognosis, as indicated by the receiving of chemotherapy (CT; n ¼ 32). Mastery and psychological distress were assessed at 3, 9 and 15 months after diagnosis. RESULTS: Patients treated with CT reported more distress and less mastery than women who were cancerfree. Overall, mastery was related to lower levels of distress cross-sectionally. Moreover, at 9 months after diagnosis, the negative relationship between mastery and distress was significantly stronger in patients receiving CT compared to the other two groups. Longitudinally, mastery shortly after diagnosis was related to changes in distress over the next 6 months only in the group treated with CT. Yet, this relationship was not significantly weaker in the other two groups. CONCLUSIONS: The results of this study suggest that, in the first year after diagnosis, a high level of mastery might have a stress-buffering effect particularly in patients facing a relatively bad prognosis.

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624 Feelings of Control and Adjustment to Breast Cancer During the Course of Treatment (FACT Study) Henselmans I, Ranchor AV, Smink A, Sanderman R Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands PURPOSE: Perceived control over life is believed to be an adaptive personal resource when facing a stressor, but on the other hand, is also threatened by the confrontation with adversity. This longitudinal observational study plans to gain more insight in the mechanisms underlying the maintenance or loss of perceived control after a breast cancer diagnosis. It will be examined whether the adaptive value of control maintenance is dependent on these mechanisms. Furthermore, cognitive and behavioral mediators of the relationship between perceived control and adjustment will be studied. METHODS: The study has a quasiprospective design with 6 assessment points linked to stages in the illness process, i.e. before the diagnostic test-results (T0), after diagnosis (T1), after surgery (T2), after completion of adjuvant therapy (T3), 2 and 5 months after the end of treatment (T4,T5). The study includes both women diagnosed with breast cancer and a matched control group of women with negative diagnostic test-results. Data will be collected through questionnaires, semi-structured interviews and medical files. RELEVANCE: Theoretically, this study will provide more insight in the processes underlying the relationship between perceived control and adjustment. Both moderators, like control illusions and compensation strategies, and mediators, like engagement and threat appraisal, will be examined. Furthermore, perceived control is a key variable in most psychosocial interventions in clinical practice, implicitly or explicitly. Understanding the mechanisms of control maintenance and their adaptive value is of importance when designing interventions to protect or restore perceived control in cancer patients.

625 Immune Regulation Via Psychological Interventions in Adults Cancer Patients: A Systematic Review of Evidence, Clinical Relevance and Recommendations

Copyright # 2006 John Wiley & Sons, Ltd.

Naaman Sa, Filion Lb, Fergusson Dc, Johnson Sa a Faculty of Graduate and Post Graduate Studies: Clinical Psychology, University of Ottawa, Ottawa, Canada; bFaculty of Medicine, Department of Microbioology and Immunology, University of Ottawa, Ottawa, Canada; cClinical Epidemiology, Ottawa Health Research Institute, Ottawa, Canada Significant psychiatric morbidity, which may accompany a diagnosis of cancer, can also impair critical immune function or the mechanisms thereof. Although previous clinical research supports the efficacy of psychological interventions in attenuating emotional morbidity associated with cancer, they are laden with mixed findings with respect to their potentiating effects on immunity. This state of affairs is argued to be, in large measure, related to an incomplete appreciation of immune mechanisms relevant specifically to cancer as well as consensus as to the degree of change deemed to be clinically meaningful. The purpose of this systematic review was to critically examine and appraise existing clinical trials, on both methodological and clinical grounds, that addressed this impact. Results indicated extensive heterogeneity and non-robust methodological design precluded meaningful statistical comparisons, thus the findings were judged to be inconclusive. More importantly at this stage, a discussion of the sources of error inherent within studies as well as recommendations and ameliorations to shape future trials, with particular emphasis to adult cancer survivors, is presented.

626 Development of a Comprehensive Psycho-Oncology Service in the Republic of Ireland: The First Three Years Steggles Sa,b, Hession Na a Psycho-Oncology Services, St. Luke’s Hospital, Dublin, Ireland; bDepartment of Psychology, University College Dublin, Dublin, Ireland St. Luke’s Hospital in Dublin is the largest public national referral centre for radiation oncology treatment in the Republic of Ireland. It receives in excess of 5000 new cancer patients per year from all over the country. In late January 2003 a new Psycho-Oncology Services Department was created at St. Luke’s Hospital with the hiring of the first full time Clinical Psychologist specializing in Psycho-Oncology in Ireland. This poster will describe the establishment and the first 3 years of development of the Psycho-Oncology Services

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Department at St. Luke’s Hospital. It will provide details on the development of this comprehensive service within the following functional areas: (1) Clinical Services; (2) Education; (3) Research; (4) Administration; and (5) Community involvement. Details of the mission, goals, referral processes, current projects, academic linkages, participation in the Irish Health Services accreditation scheme, involvement with the establishment of the Irish Psycho-Oncology Group (IPOG), and other accomplishments in the first 3 years of the service will be provided. Finally, a brief account of future developments will be outlined.

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subgroup of women with distress at baseline remained anxious. Predictors of elevated BC anxiety were global anxiety and depression with a monitoring coping style showing a trend towards significance. 77% of women with distress reported corresponding life-events. Age, BRCA1/2 status and modality specific anxiety were not related to BC specific anxiety in this sample. CONCLUSION: Despite the high false positive rate, MRIbased screening had no detectable adverse psychological effects on BRCA mutation carriers in this study.

628 627 Distress and Breast Cancer Anxiety Among BRCA Mutation Carriers Participating in MRI-based Screening Hill KAa, Warner Ea,b, Esplen MJc,d, Butler Kc, Bigenwald Ra a Department of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada; bDepartment of Medicine, University of Toronto, Toronto, Canada; cBehavioral Sciences and Health, Toronto General Research Institute, Toronto, Canada; dDepartment of Psychiatry, University of Toronto, Toronto, Canada PURPOSE: To determine whether intensive MRIbased breast screening increases breast cancer worry or distress in BRCA mutation carriers. METHODS: Women participating in an intensive MRI-based breast surveillance study were asked to complete psychosocial questionnaires: 1–2 weeks before, 4–6 weeks and 6 months after heir imaging. Questionnaires included the hospital anxiety and depression scale (HADS), a modified Lerman breast cancer anxiety scale, the Miller monitor/blunter coping scale and a modality specific rating of anxiety. RESULTS: 57 women (29 BRCA1, 25BRCA2) completed at least 2 questionnaires. Mean age was 44 (range 27–64). At baseline, 42% of the sample had elevated global anxiety, 9% demonstrated depressive symptoms and 32% had increased breast cancer specific distress. Thirty-four (59%) of participants had a monitoring coping style with 30 (52%) demonstrating moderate/high levels of MRI related anxiety. Over the study period 14 had recalls, 4 had biopsies and 1 was diagnosed with breast cancer. There were no significant increases in global anxiety, depression, BC or modality specific anxiety during the study period, although a

Copyright # 2006 John Wiley & Sons, Ltd.

Physical Activity and Psychological Adjustment in Japanese Early-stage Malignant Pulmonary and Mediastinal Disease Patients after Surgery Hirai Ka,b, Arai Ha, Tokoro Ac, Sawabata Nb, Okumura Mb a Center for the Study of Communication Design, Osaka University, Osaka, Japan; bGraduate School of Medicine, Osaka University, Osaka, Japan; c Department of Psychosomatic Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Osaka, Japan PURPOSE: The aim of this study was to explore the relationship between physical activity and psychological adjustment in Japanese early-stage malignant pulmonary and mediastinal disease patients after surgery. METHODS: The study design was one arm prospective study. The sample was consisted of 16 early-stage maligant pulmonary and mediastinal disease patients after surgery with written informed consent for enrolment in a 4-week study. Physical activity was recorded by using uniaxial accelerometry (Lifecoder1, Suzuken, Co. Ltd) and psychological adjustment was measured by Hospital Anxiety and Depression Scale (HADS). RESULTS: We compared the average steps by accelerometry and HADS score between first week (T1) and forth week (T4). The average step during T1 was 5349 ðS:D: ¼ 3088Þ steps, and T4 was 5149 ðS:D: ¼ 2766Þ steps. The average score of HADS anxiety of T1 was 4.2 ðS: D: ¼ 4:2Þ; and that of T4 was 4.1 ðS:D: ¼ 4:3Þ: Repeated measures MANOVA revealed a statistically significant effect of HADS depression of T1 on steps (Fð1; 13Þ ¼ 4:70; p50:05). There was no significant effect of HADS anxiety of T1 (Fð1; 13Þ ¼ 1:52; n.s.) and change of steps from T1 to T4 (Fð1; 13Þ ¼ 0:61; n.s.). CONCLUSIONS: Our findings suggest that high physical activity

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might improve psychological adjustment, or good psychological adjustment might enhance physical activity. ACKNOWLEDGEMENTS: This work is supported by Grant-in-Aid for Scientific Research (No. 16730350) from Japan Society for the Promotion of Science.

629 Fatigue in Long-term Hodgkin’s Disease Survivors Hjermstad MJa, Fossa SDb, Oldervoll LMc, Holte Hb, Jacobsen ABb a Department of Oncology, Ulleval University Hospital, Oslo, Norway; bDepartment of Medical Oncology, Norwegian Radium Hospital, Oslo, Norway; cDepartment of Clinical and Molecular Medicine, Norwegian University of Technology and Science, Trondheim, Norway PURPOSE: To describe total (TF) and chronic fatigue (CF) in 476 long-term Hodgkin’s disease (HDSs) survivors. The development in CF over time was explored in 280 of the patients who had also been assessed eight years earlier. METHODS: In 2003, the Fatigue Questionnaire (FQ) was mailed to 610 successfully treated HDSs at the Norwegian Radium Hospital from 1971 to 1997. Mean TF scores and occurrence of CF were compared with general population (GP) values. RESULTS: 476 (81%) complete forms were received (median age 46 years, 56% males, median follow-up: 195 months). There was a positive association between age and TF ðP50:05Þ; while presence of B-symptoms at diagnosis and treatment before 1980 were associated with CF. Mean TF scores were elevated relative to the GP: 14.6 (95% CI 14.1–15.7) vs 12.1 (95% CI 11.9–12.3, P50:001), as was the proportion with CF: 30% vs 11%, OR 3.6, P50:001: The 70 patients with CF eight years earlier, still reported higher TF at follow-up than the 210 without CF at the previous assessment: mean 17.0 (95% CI 15.6–18.3) vs 13.1 (95% CI 12.9–14.1), P50:001: Significantly more patients with persisting CF had B-symptoms at diagnosis compared with those who had recovered ðP ¼ 0:05Þ: No significant association with treatment modality and intensity was found. CONCLUSION: Fatigue remains a major complaint in HDSs several years after treatment, but the association between treatment and fatigue still remains unclear. Many HDSs may recover from CF, in particular those without B-symptoms at diagnosis.

Copyright # 2006 John Wiley & Sons, Ltd.

630 The EPCRC}A Novel Approach to Symptom Assessment and Treatment Hjermstad MJa, Loge JHa,b, Kaasa Sb a Department of Oncology, Ulleval University Hospital, Oslo, Norway; bDepartment of Clinical and Molecular Medicine, Norwegian University of Technology and Science, Trondheim, Norway PURPOSE: Pain, depression and fatigue are highly prevalent in cancer. Adequate management depends on comprehensive symptom assessment. In palliative care, modern computer technology may facilitate assessment and minimize the burden on the patient. The overall objective is to develop a comprehensive, computer-based tool for assessment of symptoms and functioning in palliative care, ultimately leading to the establishment of treatment guidelines. METHODS: A European Palliative Care Research Collaborative (EPCRC) is established, consisting of 8 European oncology centers, focusing on: genetics/bio-markers for enhanced understanding of symptoms, assessment/classification issues and treatment guidelines. The first step consists of a Norwegian multi-centre study to test computer-based assessment and is currently undertaken in 9 oncology/ palliative care units, subsequent to a pilot study. The program prototype covers pain, cognitive (CF) and physical (PF) function, aiming to: collect large data samples on pain/PF/CF for statistical analyses; test computerized data handling in different clinical settings; test the user friendliness of computerized symptom assessment. RESULTS: The pilot showed that computerized assessment was well accepted by 85% of the patients, also those above 80 years. Mean time for completion was 26 minutes, regarded as acceptable to 90%, the majority found the text easy to understand. Gatekeeping from staff was a major obstacle for access to patients. CONCLUSIONS: Modern computer technology may facilitate symptom assessment. Advanced statistical models will be used to define and extend the appropriate software content to other symptoms, in collaboration with basic scientists and clinicians.

631 Life After Cancer: Couple and Partner Psychological Adjustment and Supportive Care Needs Hodgkinson Ka, Butow Pb, Hunt GEa, Wyze Rb, Wain Gc

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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Department of Psychological Medicine, University of Sydney, Sydney, Australia; bMedical Psychology Research Unit, University of Sydney, Sydney, Australia; cDepartment of Gynecological Cancer, Westmead Hospital, Sydney, Australia PURPOSE: Partners of cancer patients experience significant distress and may experience persistent difficulties and care needs, although little research has examined their longer term outcomes. METHODS: 154 cancer survivors who were disease-free and 1–11 years post cancer diagnosis and their partners completed mailed questionnaires. RESULTS: Partners demonstrated psychological resilience and reported positive outcomes. However, partners also reported elevated anxiety and supportive care needs, most frequently concerning relationships and the impact on their own lives. Partners within couples reported both shared and unique needs, although agreement on ratings of shared needs was low. Needs did not diminish over time and were associated with poorer psychological adjustment. Predictors of needs and the implications for cancer care service delivery will be discussed. CONCLUSIONS: Health care professionals need to be cognizant that partners are not merely providers of support, but that they need support themselves}their supportive needs appear to persist over many years and in the context of apparently cured disease. Partners require individualised assessment and intervention across the survivorship continuum in order to improve longer term outcomes for all affected by a cancer diagnosis. ACKNOWLEDGEMENTS: This research was supported by funding from the NHMRC and NSW Institute of Psychiatry.

632 Developing Shared Cancer Care. From Opposition to Interaction Hlge-Hazelton B Research Unit of General Practice, Center for Health and Society, Copenhagen, Denmark PURPOSE: This abstract introduces a new study which focuses on the young adult cancer patient in the intersection between home and the hospital and with special emphasis on the role of the general practitioner. The aim of the study is to create new knowledge about young adult cancer patients and to identify further possibilities of

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developing shared cancer care at a time where patients as well as the general practitioner can be described as individualized and marginalised. METHODS: As the study exist at the cutting edge between health- humanistic and social science, data analysis will be carried out relating to the following perspectives: 1. subjective perspective}the young patient with cancer and the general practitioner 2. cultural perspective}cultures of patients/youth/ doctors and practice 3. societal perspective}power and knowledge structures and systems 4. action perspective}how the existing care can be improved. RESULTS: The first part of the study has found a striking similarity at the level of subjective perspectives: The youth describe themselves as left in limbo and the general practitioners describe themselves as not prepared for the care of these patients due to lack of knowledge, action possibilities and tradition of corporation between sectors. CONCLUSIONS: The lack of shared care becomes problematic for young people with cancer as well for their general practitioners as it leaves both groups with the feeling of being isolated with their frustrations.

633 Psychosexual Outcomes of Prophylactic Oophorectomy and Ovarian Screening in High Risk Women Hopwood Pa, Evans Gb, Shenton Ab, Watson Mc, Eeles Rc a Psycho-Oncology, Christie Hospital NHS Trust, Manchester, UK; bDepartment of Clinical Genetics, St Mary’s Hospital, Manchester, UK; cPsychological Medicine, The Royal Marsden Hospital, Sutton, UK; dSection of Cancer Genetics, The Royal Marsden Hospital, Sutton, UK PURPOSE: To conduct a two-centre 5-yr retrospective comparison of psychosexual outcomes for high risk women undergoing prophylactic oophorectomy (PO) before age 50 with matched controls on an ovarian screening (OS) programme. METHODS: PO and OS women matched for age and risk level received standardised questionnaires evaluating mental health (GHQ), cancer worry (CWS), menopausal symptoms (FACTES), sexual functioning (SAQ) and HRT usage. RESULTS: 50 (66%) PO women and 50 (53%) OS women, (mean age 45 yrs, range 34–54 for both groups) participated. Mean ovarian cancer risks were 32% (PO) and 26% (OS), respectively; 40% PO and 14% OS were BRCA1 carriers whilst

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12% PO and 8% OS were BRCA2 carriers. CWS median scores were comparable (PO 10.0; OS 11.0) and median GHQ scores were identical (2.0). 16% women in both groups scored as GHQ ‘probable cases’. Menopausal symptoms were non-significantly worse for PO women (ES median score15.0 vs 13.0): PO had worse scores for loss of libido ðp ¼ 0:004Þ; increased vaginal dryness, weight gain and night sweats. Overall 80% PO women had ever used HRT (9% OS), but one third discontinued. Three quarters of women in both groups were sexually active but sexual functioning scores were non-significantly better for OS than PO women. CONCLUSIONS: Results suggest a trade off between risk reduction through PO and more negative effects on aspects of quality of life, despite HRT usage, compared with women who chose screening. High-risk women need detailed information to support risk management decisions.

634 Factors Affecting Short and Long Term Body Image Concerns in Early Breast Cancer Experience in the START (Standardisation of Breast Radiotherapy) Trial Hopwood Pa, Mills Jb, Sumo Gb, Bliss JMb a Psycho-Oncology Service, Christie Hospital, Manchester, UK; bClinical Trials & Statistics Unit, The Institute of Cancer Research, Sutton, UK PURPOSE: To explore the contribution of age, clinical and psychological factors on body image over 5 years follow-up in women with early breast cancer. METHODS: Women participating in the quality of life (QoL) sub-study completed the Body Image Sale (BIS), HADS, and standardised QL measures, at baseline [post surgery/adjuvant chemotherapy (CT) but pre radiotherapy (RT)] and 6, 12, 24 and 60 months follow-up. Independent effects of age, clinical factors (time from surgery, type of surgery, chemotherapy, endocrine therapy, breast symptoms), depression and anxiety were identified using multiple regression analysis. Change over time was tested using the Generalised Estimating Equations model. RESULTS: 2181 (99%) women completed baseline QoL questionnaires, (mean age 56.5 years, range 26–87). 82.9% underwent conservative surgery; 33% received CT. At baseline 75% women reported body image concerns: significantly worse BIS scores ðp50:001Þ were associated with younger age, having mastectomy, adjuvant

Copyright # 2006 John Wiley & Sons, Ltd.

CT, greater anxiety and depression. BIS scores improved significantly from baseline to 12 months ðp50:001Þ and remained stable over time. The same factors except CT predicted worse BIS over time. Post RT breast symptoms and altered skin appearance also had a significantly adverse effect on long term BIS scores. CONCLUSIONS: Body image improves over time but the negative impact of age, clinical and psychosocial factors persist. Post RT kin and breast changes add to this effect. A subgroup of patients at risk of body image concerns can thus be identified and patients’ progress monitored.

635 Significant Relationship and Depressive Symptomatology in a Breast and Colon Cancer Patients Group Hospital Aa, Mirapeix Ib, Alcan˜iz Mc, Orgaz Pd, Bayo´n Ce a Psychiatry, La Paz University Hospital, Madrid, Spain; bPsychiatry, Prı´ncipe de Asturias University Hospital, Alcala´ de Henares (Madrid), Spain; c Psychiatry, La Paz University Hospital, Madrid, Spain; dPsychiatry, La Paz University Hospital, Madrid, Spain; ePsychiatry, Prı´ncipe de Asturias University Hospital, Alcala´ de Henares (Madrid), Spain Relatives of oncology patients have been recognized as their main social and emotional support as well as a significant variable to understand patient’s adjustment to their illness and their adherence to treatment (1, 2, 3, 4). OBJECTIVES: The aim of the present study is to explore both the relationship between depressive symptomatology and the presence of a caregiver and to compare the percentage of caregiver’s presence in depressive patients with colon cancer or breast cancer. METHOD: We selected a sample of 159 patients diagnosed of breast cancer and 183 patients diagnosed of colon cancer on ambulatory treatment. In order to establish the depression diagnosis, the Hospital Anxiety and Depression Scale as well as a clinical interview have been used. In addition, sociodemographic data and caregiver’s presence were reported. RESULTS: Regarding breast cancer, we found 23.7% ðn ¼ 3Þ of patients for a HADS rate over 11 ðn ¼ 13Þ on the depression subscale without a caregiver and 8.21% ðn ¼ 6Þ of the sample with HADS rate under 11 ðn ¼ 146Þ on the depression subscale without a caregiver. Regarding colon cancer, we

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found 25% ðn ¼ 3Þ of patients for a HADS rate over 11 ðn ¼ 12Þ on the depression subscale without a caregiver and 7.60% ðn ¼ 13Þ of the sample with HADS rate under 11 ðn ¼ 171Þ on the depression subscale without a caregiver. Significant differences on caregivers presence between depressive patients and non-depressive patients have been found (chi square; p50:05) on both cancer types. DISCUSSION: The lack of caregiver seems to be a risk factor for depression disorder on oncology patients. This study is included on a more wide one (FIS PI no. 050737 and FIS PI no. 052062) about the efficiency of psychotherapy.

636 Symptom Clusters and Their Effect on the Quality of Life of Chinese Cancer Survivors Hou La, Zheng Yb, Peng Pb, Wang JJa, Shen WZc a Department of Medical Oncology, Second Military Medical University Affiliated Changzheng Hospital, Shanghai, China; bDepartment of Cancer Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China; cDepartment of Management, Pengpu Community Heath Service, Shanghai, China PURPOSE: A cross-sectional study was conducted to determine the effect of the symptom cluster of pain, fatigue, anorexia and insomnia on the change of quality of life (QOL) of cancer survivors in community. METHOD: We investigated 200 cancer survivors living in Pengpu Community based on ‘Shanghai Cancer Patient Database’. Following questionnaires were adopted to investigate: Chinese version of Functional Assessment of Cancer Therapy-General (FACT}G) scale and Brief Self-Rating Symptom Inventory. RESULT: The incidence of the symptom cluster were: fatigue (28.0%); insomnia (26.0%); anoxia (14.5%); constipation (14.0%); pain (12.5%); nausea (3.5%). Partial correlation analysis showed that the FACT}G score were associated with symptom severity of insomnia and fatigue. There was no significant association between the score of SOCIAL/FAMILY WELL-BEING and symptom cluster. Multiple Linear regression models explained 13.2% of the variance in FACT}G score, explained 41.8% of the change of PHYSICAL WELL-BEING, explained 27.0% of the change of EMOTIONAL WELL-BEING, explained 4.2% of the change of FUNCTIONAL WELL-BEING, respectively. CONCLUSION: The symptom

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cluster of pain, fatigue, anorexia and insomnia was associated with cancer survivors’ QOL, named QOL-related symptom cluster. Knowing this symptom cluster may help healthcare professionals understand plausible mechanisms for the aggregation of symptoms and the effect on QOL. It is necessary to be aware of the presence of symptom cluster and their possible adverse effect on cancer survivors.

637 Learning Outcomes of Educational and Professional Development Modules in Psycho-Oncology Wright S, Gallagher P, Scott A School of Nursing, Dublin City University, Dublin, Ireland PURPOSE: Health care professionals and volunteers as service providers, although often considered to be well positioned to respond to the psychosocial challenges experienced by people with cancer, may have inadequate psychosocial skills to support them in this role. The aim of the pilot programmes in psycho-oncology was to facilitate health care professionals and volunteers to address, through the development of prerequisite psychosocial skills, the psychosocial needs of people with cancer and their families, and to reduce their own incidence of burnout through improved coping ability to work in the oncology setting. METHODS: Utilising IPOS/APOS guidelines, educational/professional development descriptors were developed for the modules: (a) Terminal Illness and Bereavement (Level 5}Postgraduate); (b) Working with People Affected by Cancer 2 (Level 5}Postgraduate); (c) Working with People Affected by Cancer 1 (Level 4}Undergraduate); (d) A Programme for Volunteers (Level 2}Undergraduate); Students were required to submit a written assignment to gain university credits. Lectures were evaluated each day with the LecTrain evaluation tool. RESULTS: All study days met with students’ expectations and lectures were evaluated positively. An increase in percentages, post compared to pre lectures, of students’ understanding of psychosocial issues relevant to cancer care, was evident in all modules. CONCLUSIONS: The strong post learning effect demonstrates the impact of training and education on students’ skills development and knowledge acquisition in psycho-oncology. ACKNOWLEDGEMENTS: Project funded by the Irish Cancer Society.

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638 Symptom Clusters and Their Effect on the Depression of Chinese Cancer Survivors Hou La, Zheng Yb, Peng Pb, Wang JJa, Shen WZc a Department of Medical Oncology, Second Military Medical University Affiliated Changzheng Hospital, Shanghai, China; bDepartment of Cancer Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China; cDepartment of Management, Pengpu Community Heath Service, Shanghai, China PURPOSE: A cross-sectional study was conducted to determine the effect of the symptom cluster of pain, fatigue, anorexia and insomnia on the development of depression of Chinese cancer survivors based community. METHOD: We investigated 200 Chinese cancer survivors living in Pengpu Community of Shanghai based on ‘Shanghai Cancer Patient Database’. Following questionnaires were adopted to investigate: Zung Self-Rating Depression Scale (ZSDS) and Brief Symptom Inventory. RESULT: The ZSDS score and the development of depression were associated with symptom severity of insomnia and fatigue. There was no significant association between depression severity and symptom cluster. A multiple Linear regression model explained 16.5% of the variance in ZSDS score. Anorexia severity explained 9.7% of the change, insomnia severity explained 4.9% of the change, and pain severity explained 1.9% of the change. A logistic regression model suggested that there was evidence for increase risks for having depression for each additional severity of insomnia (4.76 times) and pain (1.389 times). Cancer survivors with anorexia (0.269 times) and insomnia (37.722 times) were more likely to development depression than the others. CONCLUSION: The symptom cluster of pain, fatigue, anorexia and insomnia associated with cancer survivors’ depression, could be named depression-related symptom cluster. Knowing this symptom cluster may help healthcare professionals understand plausible mechanisms for the aggregation of symptoms and the effect on the depression. It is necessary to be aware of the presence of symptom cluster and their possible adverse effect on cancer survivors.

639 Relationship of Relatives’ Depression to Chinese Cancer Survivors’ Symptoms, Quality of Life and Depression

Copyright # 2006 John Wiley & Sons, Ltd.

Hou La, Zheng Yb, Peng Pb, Wang JJa, Shen WZc a Department of Medical Oncology, Second Military Medical University Affiliated Changzheng Hospital, Shanghai, China; bDepartment of Cancer Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China; cDepartment of Management, Pengpu Community Heath Service, Shanghai, China OBJECTIVE: A cross-sectional study was conducted to determine the relationship of the relatives’ depression with cancer survivors’ depression, quality of life (QOL) and symptom in a Shanghai community. METHOD: We investigated 200 cancer survivors and their relatives living in Pengpu Community based on ‘Shanhai Cancer Patient Database’. Questionnaires were adopted to investigate: Zung Self-Rating Depression Scale (ZSDS), Chinese version of Functional Assessment of Cancer Therapy}General (FACT}G) scale and Brief Self-Rating Symptom Inventory. RESULT: The incidence of relatives’ depression was 16%. Correlation analysis showed that the relatives’ ZSDS score and the development of depression are associated with cancer survivors’ ZSDS score, depression and FACT}G score. The relatives’ depression grades were associated with cancer survivors’ disease stage, depression, nausea and FACT}G score. A multiple Linear regression model explained 31.5% of the variance in relatives’ ZSDS score. Cancer survivors’ ZSDS score explained 28.3% of the change, FACT}G score explained 1.5% of the change, and score of Physical well-Being explained 1.7% of the change. A logistic regression model suggested that there was evidence for a increased risk for relatives having depression for each additional severity of nausea (40.7%), and when cancer survivors’ ZSDS/FACT}G score increased one scale the risk for relatives’ depression increased 9.4%/11.3%. CONCLUSION: Relatives’ depression was associated with cancer survivors’ depression, quality of life (QOL) and symptom in the Shanghai community. It is necessary to enhance the intervention to the depression of relatives.

640 Distress Symptoms in Parents of Patients After Complicated Cancer and Standard Risk Leukaemia, Respectively Boman KK, Hove´n E

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Department of Woman and Child Health, Karolinska Institutet, Childhood Cancer Research Unit, Stockholm, Sweden

Cancer Research, Copenhagen, Denmark; cInstitute of Anthropology, University of Copenhagen, Copenhagen, Denmark

PURPOSE: To investigate whether illness variables related to diagnosis, treatment, prognosis, and high risk for late sequelae predict, and act as determinants of parental distress following a child’s cancer. METHODS: The category of complicated paediatric cancer included central nervous system (CNS) tumours, acute myeloid leukaemia (AML), and neuroblastoma. Parent distress in that group ðn ¼ 149Þ was compared to parent distress following standard risk acute lymphoblastic leukaemia (ALL, n ¼ 173). Distress was assessed using a 11dimensional questionnaire including: uncertainty, control, illness-related fear, anxiety, depression, and physical symptoms of stress. RESULTS: Illness-related fear was higher in the complicated cancer group compared to the ALL group (t ¼ 1:56; p ¼ 0:015). Comparisons of ALL the sub-groups in the complicated cancer group showed that parents of CNS tumour patients presented more illness-related fear (F½3; 31 ¼ 5:24; p ¼ 0:002). However, ALL parents showed more symptoms of uncertainty than parents of neuroblastoma patients (F½3; 31 ¼ 5:49; p ¼ 0:001). Within complicated cancer group, parents of CNS tumour patients showed higher uncertainty (F½3; 315 ¼ 5:49; p ¼ 0:001) and more illnessrelated fear (F½3; 317 ¼ 5:24; p ¼ 0:002) compared to neuroblastoma group. CONCLUSIONS: Findings show that factors related to diagnosis, and to heightened risk of late-effects influence a variety of parental symptoms after a child’s cancer. In case of complicated paediatric cancer, attention should be paid to increased vulnerability to illness-related parent distress, especially for malignancies characterised by increased risk for functional and cognitive late-effects. Parents of CNS tumour patients appear to be at particular psychosocial risk, and in need of extraordinary care-related support during follow-up.

OBJECTIVE: A positive psychosocial effect has been suggested from the use of internet support group interventions. In light of these findings it is important to identify the social or psychological factors influencing the accessibility of such interventions. METHOD: Between July 2003 to May 2004 230 persons with different cancer types who participated in a week-long rehabilitation course were offered an internet intervention, providing education and internet support groups. Based upon self-reported baseline questionnaire data from 216 participants (94%), on socio-economic status, psychological well-being and quality of life, persons who are motivated to join the internet intervention were compared to persons who chose not to participate. RESULTS: Users and nonusers of the internet support groups were highly socially stratified. Results indicate that users of the internet groups had significantly higher household income than participants who did not use the internet groups. Also difference in employment and marital status between the two groups was highly significant. We observed no difference in quality of life or the adjustment to cancer in the two groups. CONCLUSIONS: This study identifies a socio-economic gap between users and nonusers of internet based support intervention. This is a barrier to the use of the internet in cancer rehabilitation. Despite the psychosocial benefits of internet interventions suggested in previous studies, such interventions may not be accessed by cancer patients with lower social position. On the other hand, our study suggests that the barriers we need to address, when introducing internet interventions in cancer care, are social and not psychological.

641 Psychosocial Characteristics of Participants in an Internet Based Support Group Hybye MTa, Solander KGa, Christensen Jb, Hastrup Kc, Johansen Ca a Department of Psychosocial Cancer Research, Institute of Epidemiological Cancer Research, Copenhagen, Denmark; bDepartment of Statistics of Epidemiology, Institute of Epidemiological

Copyright # 2006 John Wiley & Sons, Ltd.

642 Female Oncology Patients Referred to Psychiatry with Co-morbid Sexual Dysfunction Hughes MK Neuro-oncology, Psychiatry Section, The University of Texas, M.D. Anderson Cancer Center, Houston, USA INTRODUCTION: Sexuality is an important quality of life issue that was not routinely addressed elsewhere in a large metropolitan community cancer hospital. A Clinical Nurse

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Specialist (CNS) in the Psychiatry Section evaluated patients’ sexual function during each consultative assessment. The Psychiatry Section is a Consult-Liaison Service heavily utilized by the oncology services in this institution assessing both inpatients and outpatients. METHOD: Over a 5-year period, 558 oncology patients were referred to this CNS for psychiatric reasons an a sexual function evaluation was performed with each assessment. This was by interview and was subjective. A retrospective chart review was done with the institution’s Internal Review Board approval. RESULTS: Co-morbid sexual dysfunction was found in 77% of all patients and in 78% of female patients. 78% of all patients were female and most had breast cancer. A description of the specific types of sexual dysfunction will be discussed. In all cases, the cancer diagnosis or the cancer treatment was thought to contribute to the sexual dysfunction. CONCLUSION: When a woman has several co-morbid conditions, especially cancer, it is easy to overlook sexual issues. Patients do not readily bring up sexual concerns, so it is important that the clinician do a cursory sexual assessment on all patients. Annon’s PLISSIT model for sexual assessment is a valuable tool for the clinician. Specific interventions will be described and need to be customized for the patient, taking into consideration the patient’s other co-morbid conditions.

643 The Chronic Sorrow of Cancer Hughes MK Neuro-oncology, Psychiatry Section, The University of Texas M.D. Anderson Cancer Center, Houston, USA Cancer is a chronic illness that involves numerous losses which cause grief. These losses are chronic and acute and need to be recognized and discussed with the patient in helping him/her to deal with them. The numerous losses that a patient experiences will be discussed as well as the grief for these losses. The source of grief (cancer) is chronic thus causing chronic sorrow. The concept of chronic sorrow will be discussed. It has been observed in patients with long-term chronic illnesses and is normal, not pathological, and cyclic with predictable upsurges of grief. The clinicians’ awareness of his cycle can allow for interventions and guidance during a patient’s difficult times. This presentation will help differentiate depression

Copyright # 2006 John Wiley & Sons, Ltd.

from grief and chronic sorrow from acute grief. Interventions for helping the patient cope with the cycle of chronic sorrow will be presented. Appropriate patient interventions can be made if the clinician is able to identify chronic sorrow and differentiate it from depression and acute grief.

644 The Importance of Personality in Appraisal and Prediction of Psychosocial Outcome in Cancer Patients: A Systematic Review Hulbert NJa, Dudley HCa, Nel RDa, Wilkinson CEa, Morrison VLb a Department of General Practice, Cardiff University, Centre for Health Sciences/North Wales Clinical School Wrexham, Wales, UK; bSchool of Psychology, University of Wales Bangor, Bangor, Wales, UK PURPOSE: Few studies have rigorously addressed the role of personality in appraisal of cancer diagnosis and it’s relation to psychosocial outcome. Findings are often inconsistent, contradictory, and criticised for quality and methodology. A comprehensive systematic review of the literature is, therefore, required. METHOD: Search strategies were designed for ten key psychological-and medically based electronic databases. Three questions were explored: the importance of personality in cognitive appraisal of diagnosis (13 731 hits); the importance of personality on psychosocial outcome (21 679 hits); and, the relationship between appraisal and psychosocial outcome in cancer patients (23 985 hits). References are being independently assessed by two reviewers against pre-defined inclusion criteria; approximately 1.8% of retrieved hits have been highlighted for possible inclusion. All research (experimental or observational) relevant to any of the three research questions in a sample of adult cancer patients will be included. Commentary articles and opinion-based sources will be excluded. Data extraction and quality assessment will be carried out on included papers in accordance with recommendations from the Centre for Reviews and Dissemination Guidance (2001), the Cochrane Handbook for Systematic Review of Interventions (2005) and other key sources of review methodology literature. RESULTS/CONCLUSION: The review will critically assess published literature in order to synthesise key findings and highlight core methodological issues where research quality is questionable.

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Implications shall be drawn for the development and improvement of personality-based psychosocial oncology research and intervention. The review will be completed by early autumn and the results presented.

645 Sleep Quality in Cancer Survivors and the Influence of Exercise Humpel Na, Iverson DCb a Centre for Health Behaviour & Communication, Research University of Wollongong, Wollongong, Australia; bFaculty of Health & Behavioural Sciences, University of Wollongong, Wollongong, Australia PURPOSE: Sleep problems can seriously influence well being following a cancer diagnosis. Exercise can influence quality of life in cancer patients. This study aimed to explore the relationship between sleep disturbance and exercise in cancer patients. METHOD: Posters and study flyers were placed in cancer related medical waiting rooms. Patients could complete the survey during an interview or by mail. RESULTS: Participants were 91 breast (35%) and prostate (65%) cancer patients (mean age ¼ 61 years). 57% reported > 5 score on the Global Sleep Quality Index (PSQI) which indicates a poor sleeper. There were significant differences in sleep quality by age; those 550 years reporting the poorest sleep (Fð2; 79Þ ¼ 4:54; p50:014). Women reported greater disturbance of sleep ðM ¼ 10:5Þ compared to men (M ¼ 7:8; Fð1; 87Þ ¼ 12:4; p50:001). Poor sleepers reported 69% less minutes of exercise in the last week (63) compared to those reporting good sleep (201; Fð1; 81Þ ¼ 11:8; p50:001). Those reporting the least exercise had a greater problem with sleep latency (1.7 versus 0.7; Fð1; 85Þ ¼ 7:4; p50:008). CONCLUSION: This is one of the first studies examining the effects of exercise on sleep disturbance. If regular exercise is found to influence sleep, there are important implications for improving quality of life, particularly as those who reported poor sleep also reported depressive symptoms. To inform on the causal nature between sleep quality and exercise, future studies need to examine this relationship prospectively.

646 Factors Affecting Treatment Decisions in the Older Woman (>70 years) with Breast Cancer: A Qualitative Study

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Husain Lopa S, Reed M, Collins K Academic Surgical Oncology Unit, University of Sheffield, Sheffield, UK PURPOSE: Primary endocrine therapy, (PET), is the treatment of primary, operable breast cancer with the drug tamoxifen, omitting surgery altogether. It is in widespread use in the UK with 40% of over 70 year olds being treated in this way. PET is associated with inferior local control rates compared to standard surgical therapies, but no survival disadvantage. There has been no research on what older women think about these two types of treatment and what may influence their treatment choice. This study aimed to address this question. METHOD: In-depth qualitative interviews were undertaken to explore the views of a group of 21 purposively selected older women (> 70 years old), who had been treated by PET or surgery for their breast cancer. The interviews were transcribed verbatim and analysed using Framework Analysis. RESULTS: Older women expressed no age specific fears for operative procedures. Both types of treatment were well tolerated. They were passive information seekers, recalled little from their consultations, and relied heavily on ‘expert’ advice. Social support was not a factor in their decision making, although age was a concern for some. Their main concern was to ensure their quality of life remained unaffected. CONCLUSION: Older women have no strong preference for either option but are concerned that treatment is effective and causes little disruption to their quality of life. Medical consultations need to be adapted to reflect the passive acceptance of ‘expert’ advice in this age group. ACKNOWLEDGMENT: This research is funded by SPORG (Sheffield Supportive and Primary Care Oncology Group).

647 Cultural Aspects of Psycho-Oncology: A Chinese Perspective Yin P, Zong Q Chinese Psycho-Oncology Society, Beijing, China While the empirical validity and reliability of medical science as a discipline is universally considered substantial; Psychology, in recent years, deriving in part, from its own experimental etiological roots and beginnings, now finds itself vigorously engaged, in striving to be, in all ways possible, a ‘hard science’. But Psycho-oncology is

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more than a simple combination of psychology and oncology. This article focuses on China}a culture with over 3000 years of continuous history and tradition, as the example, and examines the cultural aspects of psycho-oncology. For example, the common practice of informing family members but not the patient himself of a serious diagnosis of illness, family and friends’ reactions to a diagnosis of serious visceral illness in keeping with cultural expectations, and differing definitions of ‘support’ in the culture, are in direct contradiction to prevailing trends and recommendations from practicing psychologists all over the world. The clashes in world cultures present an increasingly global and multi-cultural challenge. The clashes in values and beliefs even within a single culture present us with the obligation to adjust to fast and furious transformations in the social, economic and legal–political arenas of our great nation. Certainly, it is arguable that in many cases, culture may need to take the greatest precedence. Without the profound understanding of culture, even the recommendations gleaned from the most exhaustive empirically experimentally based research may not result in valid or reliable tools or models to be employed in vivo in clinical practice.

648 Prediction of Psycho-oncological High-risk Breast Cancer Patients by Employing Health Related Quality of Life (QOL) Self-rating Scales Before Treatment Inui Ha, Yoshida Rb, Atsuko Kc a Surgery, Kinki University School of Medicine, Osaka, Japan; bNursing, Kinki University School of Medicine, Osaka, Japan; cPsychosomatic Medicine, Kinki University School of Medicine, Osaka, Japan To investigate the possibility to predict psychooncological high-risk patients before treatment, and to clarify how to improve the QOL of these patients during treatment. METHODS: A total of 75 consecutive breast cancer patients underwent curative resection at Kinki University Hospital from January to December, 2002. Of those, 57 patients underwent breast conserving surgery and 18 mastectomy; 43 patients received chemotherapy. All patients were monitored and given QOL self rating scales questionnaires (STAI, SDS, QOL-ACD (Quality of Life questionnaire for cancer patients treated with AntiCancer Drugs)

Copyright # 2006 John Wiley & Sons, Ltd.

and QOL-ACD-B (for patients with Breast cancer) one week before surgery}one week, three months, six months, and twelve months after surgery. RESULTS: Results six months after surgery: (1) Anxiety levels were the highest, and QOL-ACD were the lowest. (2) The chemotherapy group showed significantly lower QOL compare to the group without chemotherapy (p50.05). (3) There was no difference in the anxiety status of the group with and without chemotherapy. (4) Stage III patients showed significantly higher anxiety and lower QOL levels than Stage I; patients, however, there was no difference in their physical function scores. (5) Twenty-seven patients out of 36 who showed high anxiety status before surgery still suffered from high anxiety status and lower QOL scores without lower physical function scores (p50.01). CONCLUSION: This study suggests that psycho-oncological high-risk patients are predictable before starting breast cancer treatment by employing these self-rating scales before initial treatment.

649 Assessment of Distress in Breast Cancer Patients: The Consideration of PTSD Symptoms in Screening Instruments Isermann Ma, Diegelmann Ca, Kaiser Wb, Priebe Sc a Research and Education ID Institut fu¨r Innovative Gesundheitskonzepte, Kassel, Germany; bPsychiatrische Institutsambulanz Vivantes Klinken Spandau, Berlin, Germany; cNewham Center for Mental Health, Queen Mary University of London, London, United Kingdom PURPOSE: Psychosocial screening in psychooncology has received more attention during the last several years. Different screening instruments have been developed worldwide. Most of them do not explicitly include symptoms of Posttraumatic Stress Disorder (PTSD). New studies indicate that more than 50% of breast cancer patients show relevant symptoms of PTSD. Although most of them do not fulfil the full diagnostic criteria, these very specific symptoms have important implications for medical treatment, coping behaviour, psychosocial interventions, etc. METHODS: In a study sponsored by the European Commission an 8-item screening scale with 3 dimensions was developed, the BC-PASS (Breast Cancer Psychosocial Assessment Screening Scale). One of these dimensions measures PTSD-Symptoms, using 3 items of the IES-R. 142 breast cancer patients

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were divided into high or low PTSD scores by this dimension and examined for Quality of Life using the EORTC-QLQ C-30. Also results of the HADS were checked taking into account the PTSD symptoms. RESULTS: Quality of life was more associated with PTSD symptoms than with the severity of the disease or type of surgery (breast conserving vs mastectomy). This was true not only for the function scales of the QLQ C-30 but also for symptoms like pain, fatigue and therapy side effects. It was also found that the 3-item scale of the BC-PASS identified patients as having significant psychological distress that the HADS did not indicate. CONCLUSION: It is important to include screening for PTSD symptoms in breast cancer patients.

650 Psychological Distress in Patients Before and After Breast Cancer diagnosis}Psychological Characteristics and Negative Life Events Iwamitsu Ya, Hirayama Sa, Kuranami Mb, Todoroki Kc, Miyaoka Hc a Department of Medical Psychology, Kitasato University, Graduate School of Medical Sciences, Sagamihara, Japan; bDepartment of Surgery, Kitasato University, Sagamihara, Japan; cDepartment of Psychiatry, Kitasato University, Sagamihara, Japan PURPOSE: Our objective was to investigate how the level of anxiety, emotional suppression, and life event stress for the past one year influence psychological distress in clinic patients before and after being told their breast cancer diagnosis. METHODS: The study procedure was explained, and written information sent was obtained from 183 female patients at their first visit to the outpatient clinic of the Department of Surgery, Kitasato University Hospital. They were asked to fill out the State and Trait Anxiety Inventory, Courtauld Emotional Control Scale, Life Event Survey, Profile of Mood States (POMS) instrument at their first visit. They were also asked to fill out the POMS immediately after being told the diagnosis of breast cancer. Finally, a total of 116 patients (24 breast cancer patients and 92 benign tumor patients) were analyzed in the present study (age: mean  SD ¼ 50:8  12:6) excluding the missing data. RESULTS: We calculated the Pearson’s correlation coefficients among each scale score. Our results showed that (1) patients who felt chronically anxious and experienced the

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negative life events felt stronger psychological distress both before and after diagnosis (r ¼ 0:638; p50.01). (2) Patients who felt high anxious recognized stress life events negatively (r ¼ 0:410; p50.05). CONCLUSIONS: We found that the psychological distress before and after diagnosis was influenced by high trait anxiety and negative life events. We suggest that patients who have high trait anxiety and experience negative life events need psychological interventions immediately after the diagnosis of breast cancer.

651 Issues for Cancer Survivors Following Completion of Potentially Curative Cancer Treatment}Results from Focus Groups with Survivors and Health Professionals Jefford M, Karahalios E, Pollard A, Schofield P, Carey M Supportive Care Research Group, Peter MacCallum Cancer Centre, Melbourne, Australia PURPOSE: Following often intensive treatment for cancer many patients feel abandoned, uncertain, anxious and unsupported. A significant minority develop long lasting physical, psychological, emotional and other sequelae. Initial work toward the development of acceptable, effective interventions involves focus groups and systematic reviews of the literature. METHODS: Content analysis of transcribed focus groups with survivors and health professionals (HP) focussing on issues faced within 12 months of completing treatment. RESULTS: Separate groups were held for survivors and HP. Three survivor groups involved 22 participants (7 male). Age: 530}1; 30–60}13, >60}8. Patients had been treated for cancers of the breast (7), GI tract (5), lung (3), larynx (1), testis (1), ovary (1), sarcoma (1), lymphoma/ leukaemia (3), with various treatment modalities. Time since completing treatment: 512 months}6; 1–2 years}3; 2–10 years}8; >10 years}3. Four groups with HP involved 6 medical oncologists, 3 haematologists, 2 radiation oncologists, 5 cancer nurses, 2 social workers, 1 occupational therapist and 1 dietician. Five major themes (and numerous sub-themes) were identified: (1) returning to ‘normal’; (2) follow-up planning, fear of recurrence; (3) impact on family; (4) physical consequences of treatment, (5) coping. Suggested resources to support survivors included a website, Internet support groups, DVD/movie, forums and debriefing sessions. CONCLUSIONS:

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The five major themes are consistent with the published literature. These and identified subthemes will act as chapter headings for a DVD (in production) for people who have completed potentially curative therapy for cancer.

652 Developing a Dedicated Mental Health Team for Oncology Jenkins Ka, Young Na,b a Clinical Psychology, Salisbury Healthcare NHS Trust, Salisbury, UK; bInstitute of Health and Community Studies, Bournemouth University, Bournemouth, UK PURPOSE: Guidance produced by the UK’s National Institute for Health and Clinical Excellence (NICE) in 2004 advocates the implementation of a four-tier service model to provide comprehensive psychological assessment and support for people with cancer and their families. Specifically, the Supportive & Palliative Care Improving Outcomes Guidance (NICE 2004) states that ‘commissioners and providers of cancer services should [.] ensure that all patients undergo a systematic psychological assessment at key points in the patient pathway with access to an appropriate level of psychological support.’ In 2005 Salisbury Healthcare NHS Trust was awarded a grant by Wessex Cancer Trust to develop the model through a dedicated mental health team consisting of a psychologist, counsellor and social worker. The project also involves staff education about psychological support and a comprehensive evaluation of the service. METHODS: This project takes a whole team approach and involves training and supporting all disciplines working with people with cancer. Evaluation of the project is multi-layered and includes collection of data through audit, survey and in-depth interview. Links with local academic institutions are being pursued to ensure findings are integrated into future health care profession education. CONCLUSIONS: This presentation will give an outline of the project and explore links with current UK policy and practice. There are a number of lessons around setting up complex projects and working across traditional practice and professional boundaries, and these will be discussed. The presentation will provide an opportunity for others working in similar areas internationally to share their experiences.

Copyright # 2006 John Wiley & Sons, Ltd.

653 Expressive Writing and Breast Cancer: Associations Between Cognitive and Positive Emotional Words and Changes in Perceived Social Support Johansen MBa, Zachariae Ra, Valdimarsdottir Hb, Bovbjerg Db, Zkowski Sc a Psychooncology, Aarhus University Hospital, Aarhus, Denmark; bMount Sinai School of Medicine, NY, USA; cRosalind Franklin University, North Chicago IL, USA AIM: In cognitive processing of stressful experiences, the expression of both emotional and cognitive aspects could be important in changing a person’s social behaviors. Our aim was to investigate the association between cognitive and emotional words and perceived social support in Expressive Writing Intervention (EWI). METHODS: Breast cancer patients ðN ¼ 16Þ were contacted by phone and randomly assigned to write bout their most traumatic experience (EWI) or a neutral topic for 20 minutes once a week for three weeks (control). Their writing was analyzed for the frequency of ‘positive emotional terms’ (PT), ‘negative emotional terms’ (NT), and ‘cognitive terms’ (CT). ‘Total emotional terms’ (TET) were also calculated. RESULTS: The EWI-group had a higher frequency of TET (mean: 4.2; SD: 0.98) than controls (Mean: 1.1; SD: 0.95)(Z ¼ 3:4; p50.01). Associations between change in perceived social support (SSQT, 3 week follow-up) and PT, NT and CT in the writings were analyzed. There were strong, positive correlations in the EWI-group between SSQT change score and PT (r ¼ 0:65; n ¼ 8; p ¼ 0:08) and CT (r ¼ 0:76; n ¼ 8; p50.05), with higher levels associated with beneficial change in SSQT. No relationship was found for NT in EWI. In contrast, inverse correlations were found between change in SSQT and NT, CT and TET in the control group. CONCLUSIONS: These trends suggest a beneficial effect of using positive and cognitive words in EWI on perceived social support in cancer patients.

654 Quality of Life at End of Life Care with Ovarian Cancer Johnson Ra, Johnson Ga, Gil Kb,c a Obstetrics and Gynecology, University of Oklahoma, Oklahoma City, USA; bDepartment of Obstetrics and Gynecology, Akron General Medical

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Center, Akron, OH, USA; cDepartment of Behavioral Sciences, Northeastern Ohio Universities College of Medicine, Akron, OH, USA OBJECTIVE: To analyze symptom distress at the end of life for women with gynecologic cancer. METHODS: Patients were prospectively enrolled into a longitudinal quality of life study following referral to a palliative care program for symptom management that allowed for continued chemotherapy. Patients completed the modified Edmonton Symptom Assessment Scale (mod EAS) at approximately monthly intervals and severe symptoms were managed. Data from the thee interviews preceding death were analyzed. RESULTS: Twenty-one patients completed the mod EAS at three time points preceding death. Sixty-six percent received chemotherapy during the last three months. There were significant declines in well-being and appetite from the third to the last interview preceding death. There were non-significant increases in fatigue, nausea, and pain. There were no changes in patients’ report that their pain was at an acceptable level or in self reported levels of depression and anxiety. Sixtytwo percent reported a very good or moderately good sensation of well being during the last phone interview and most patients reported that their pain control was very acceptable or acceptable. CONCLUSION: In this study patients reported low levels of symptom distress in the months preceding their death. Very few patients reported symptom distress at the highest level, until the last month preceding their death, and even then the majority were not reporting extremes. These results suggest that women who are enrolled in a program that specifically addresses symptom management are able to maintain good quality of life until death.

655 Family Functioning as a Predictor of Depression and Anxiety in Breast Cancer Survivors: 3-year Prospective Study Yamashita Ma, Saeki Ta, Inoue Sb, Mantani Ta, Okamura Hc a Graduate School of Biomedical Sciences Hiroshima University, Hiroshima, Japan; bPalliative Care Unit, Hiroshima City Medical Association-Administered Aki City Hospital, Hiroshima, Japan; c Graduate School of Health Sciences, Hiroshima University, Hiroshima, Japan; dGraduate School of Psychology, Hiroshima University, Hiroshima, Japan

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PURPOSE: Considerable psychological morbidity associated with breast cancer has been documented, and there is some evidence to indicate that family functioning plays an important role for such morbidity. The purpose of the study was to identify family factors related to psychological distress among breast cancer survivors. METHODS: 100 ambulatory patients after mastectomy for stage I or II localized breast cancer drawn consecutively from the outpatient population of the Mammary Gland Dispensary of Hiroshima University Hospital during the 6month period from October 1999 to March 2000. Written consent was obtained after the patients and their husbands had been fully informed of the purpose of the longitudinal study. 74 patients participated in the study at more than three months after mastectomy (Time 1) and 63 survivors were followed up three years later (Time 2). The survivors completed the Zung Self-rating Depression Scale, the Zung Self-rating Anxiety Scale, the 20-item Toronto Alexithymia Scale, and the Family Assessment Device (FAD) at Time 1 and Time 2. RESULTS: Multiple regression analysis showed that Affective Responsiveness, one of 6 domains of perceived family functioning assessed by the FAD, at Time 1 significantly correlated with both depression and anxiety among survivors at Time 2. CONCLUSIONS: The findings of the present study suggested that inappropriate affective responsiveness in the family could predict later psychological distress among breast cancer survivors, and that psychosocial interventions that could improve affective responsiveness among family members might contribute to promoting breast cancer survivors’ psychological well-being.

656 Presentation of Model for Family Counselling: Psycho-social Support to Families with Parental Cancer Juel-Blicher U Danish Cancer Society, The Counselling Center in Aarhus, Aarhus, Denmark The Cancer Society Counselling Center in Aarhus implemented in cooperation with the Institute of Psychology, University of Aarhus, in 2003–2004 a Family Counselling Project. The Project formed part of a larger EU-sponsored research project entitled: Children of Somatically Ill Parents (COSIP). The purpose of the project was to

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establish and methodically develop a model for a family counselling service which aims to improve the welfare of children who are suffering as a result of parental illness. 30 families with parental cancer were offered the counselling service. The method of counselling was developed and based on the assumption that families with parental cancer are themselves in possession of resources which can help them cope with illness. The counselling was characterised by being focused, goal-oriented and within a specific time-frame. The sessions took place in the home, two Counsellors were involved and the children were offered group sessions with children in similar situations. A special feature was the close cooperation with the Institute of Psychology. The result of the project proved that a simple model for short-term, preventive counselling can be developed. The effect of the developed and applied model was a significant improvement in the family general ability to cope including increased communication and a better ability to share emotions. The main effect was that parental competence was strengthened which was the objective of the project. The long-term goal is to establish within the Health Care Sector a systematic awareness of children in cancer families.

657 Getting the New Done: Implementing a Structured Psycho-Oncological Care Program in Six German Hospitals Jung S Public Health Universita¨t Bielefeld, Bielefeld, Germany The project Case Management: Psychooncology aims the implementation of psychooncological benefits into six German hospitals of acute care. The interdisciplinary cooperation between psychotherapists, doctors and nursing staff is coordinated with integrated pathways of care. PURPOSE of this evaluative process-research is to describe how the care program was integrated in daily work, which accompanying interventions had been effective and which barriers and facilitators existed. Concerns of all players had been engaged continuously and achievement of objectives will be measured at the end of the project. METHODS: research design is a multi-method multiple-case study with embedded units of analysis. Methods are document analysis, participating observations, focused interviews, surveys. Main concepts of analysis are, according to the

Copyright # 2006 John Wiley & Sons, Ltd.

innovation research literature, attributes of the care program, accompanying facilities and interventions, characteristics of adopters, determinants of interpersonal networking and coordination within the hospitals as well as their organizational structures and the socio-political context. Data from the different sources will be integrated by coding their impact on the integration process at a 5-point-scale. First RESULTS with the focus on networking and coordination will be presented. 25 people were interviewed at 2 or 3 times. The halfyear-survey was completed by average 8 psychotherapists, 19 doctors, 51 nursing staff at each of 7 times. CONCLUSION: for an effective implementation in health care organizations and to overcome barriers and resistance it is very important to consider the different systems of thinking in the different occupational groups from the early beginning.

658 Improving Informed Consent to Clinical Trials: A Pilot of a Decision Aid for Women Invited to Participate in a Breast Cancer Prevention Trial (IBIS-II) Juraskova Ia, Butow Pa, Lopez ALa, Seccombe Mb, Forbes Jb a Medical Psychology Research Unit, School of Psychology, University of Sydney, Sydney, NSW, Australia; bAustralian New Zealand Breast Cancer Trials Group, University of Newcastle, Newcastle, NSW, Australia PURPOSE: Patients and clinicians report difficulties with the process of informed consent to clinical trials and audiotape audits show that information is often omitted or poorly presented. We developed a decision aid (DA) to assist women considering participation in the Ductal Carcinoma In Situ (DCIS) arm of the IBIS-II (breast cancer prevention) trial. This pilot study aimed to obtain feedback on the content and format of the DA and evaluate the feasibility of the assessment process to be used in the next (RCT) stage. METHODS: 31 women who participated in the IBIS-I breast cancer prevention trial and are currently in follow-up (response rate 87%) were asked to read the IBIS-II DCIS Information Sheet and the DA booklet; complete a set of standardised questionnaires; and provide feedback on the DA via a semi-structured phone interview. RESULTS: The vast majority of participants found the DA helpful in: deciding about the trial

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participation (97%), understanding the Information Sheet (87%), and providing useful additional information to the Information Sheet (97%). Participants found the DA presented the risk management potions in a balanced way (97%) and was not anxiety provoking (100%). Receiving both the DA and the Information Sheet was preferable to receiving only the latter (90%). Qualitative data will also be discussed. CONCLUSIONS: The DA and questionnaire set were well received. A randomised controlled trial evaluating the effectiveness of the revised DA in improving informed consent is underway. ACKNOWLEDGEMENTS: This study is supported by the KOMEN Breast Cancer Foundation.

stabilising of life in families in interprofessional collaboration. It can be used in developing interprofessional health and social care of families with cancer and in developing health and social care professionals’ education.

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PURPOSE: The purpose of this research was to develop a patient classification instrument for measuring radiation therapists’ work in caring for individual patients in radiation therapy. METHODS: Data was collected deductively based on the six sectors of Oulu Patient Classification Instrument (OPC) among radiation therapists ðn ¼ 20Þ who produced the core content of their work in radiation therapy in written form. Data was analysed according to the inductive content analysis. RESULTS: The Patient Classification Instrument in Radiation therapy contains the elements of the plan and accuracy of radiation therapy; radiation fraction and patient’s health; nutrition and medical care; skin, mucous membrane and elimination; activity and treatment position; and survival and emotional support. Each element has its own methods, standards and criteria, which are used in classifying patients into class A, B, C or D according to the care given by radiation therapists. CONCLUSIONS: The development of this patient classification instrument became evident, since demands of the productivity of specialized care as well as efficiency and quality aspects of service provision have increased dramatically recently. On the other hand, cancer patients and their family members are nowadays more aware of their right for quality in specialized care and careful documentation is essential. Thus this new instrument for measuring radiation therapists’ work in radiation therapy is very much required due to administrative, economical and humanistic purposes.

Families Living with Cancer as a Challenge for Interprofessional Collaboration Jussila ALI School of Social and Health Care Oulu University of Applied Sciences, Oulu, Finland PURPOSE: The purpose of this grounded theory research was to develop a substantive theory to explain how families with cancer solve the main concern in their lives. METHODS: Data, consisting of 32 joint couple conversations of 13 families ðn ¼ 26Þ during different stages of cancer trajectory and observations of 26 hours of five families ðn ¼ 19Þ during a boarding course on psychosocial rehabilitation, collected and analysed according to the grounded theory methodology. RESULTS: The main concern of families living with cancer was stabilising of life through facing of hardships and assuming an attitude towards the future which patterned out in four processes. Detaching from the disease consisted of maintaining of hope, living trustingly, changing of the concept of self, progressing of recovery and continuing the habituated life. Fighting against the disease involved the stages of deliberating about falling ill, rebelling against the change in life, overcoming adversities, preparing for worse and ensuring the functionality. Adjusting to life with the disease comprised clarifying of facts, resorting to help, returning to life, intensifying of togetherness and maturing through hardships. Submitting to the disease included life coming to a standstill, succumbing to fear, being burdened by concerns, life turning more difficult and getting caught in being ill. CONCLUSIONS: This substantive theory of family survivorship offers possibilities to promote

Copyright # 2006 John Wiley & Sons, Ltd.

660 The Patient Classification Instrument for Radiation Therapy Jussila ALa, Rytilahti Mb, Parkkonen Tb, Karvali Mb, Paloste Rb a School of Health and Social Care, Oulu University of Applied Sciences, Oulu, Finland; bDepartment of Radiation Therapy, Oulu University Hospital, Oulu, Finland

661 From Molecule to Mind: A Psychoneuroimmunological Counseling Approach to Chronic Cancer Pain

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Just A Mental Health Services, Townsville Hospital, Townsville, Australia INTRODUCTION: Psychoneuroimmunological research evidences that neuroimmune factors are inherent in chronic pain (Banks and Watkins, 2006) and that pain as well as suffering are immunosuppressive agents (Ader et al., 1995; Liebeskind, 1991; Staats, 1998). This makes psychoneuroimmunological considerations important in chronic cancer pain management. PURPOSE: To use psychoneuroimmunological research evidence in clinical practice with a compassionate aim to optimise survival time and promote quality of life. METHOD: Application of ‘Immune System Counseling’ (Just, 1997) RESULTS AND CONCLUSIONS: The qualitative (grounded theory) research findings impress as significant by the responses from participants, as they bring to the fore that ‘Immune System Counseling’ is effective in reducing pain, suffering and improving immune system functioning as perceived by patients. The paper will present the concept of ‘Immune System Counseling’ and provide a detailed design of this treatment approach. REFERENCES: Ader R, Cohen N, Felten D. 1995. Psychoneuroimmunology: interactions between the nervous system and the immune system. Lancet 345: 99–100. Banks WA, Watkins LR. 2006. Mediation of chronic pain: Not by neurons alone. Pain April (article in press). Just A. 1997. A psychoneuroimmunological counseling approach to refractory chronic non-malignant pain. 14th World Congress on Psychosomatic Medicine, 31 August–5 September, Cairns, Queensland. Liebeskind JC. 1991. Pain can kill. Pain 44: 3–4. Staats PS. 1998. The pain– mortality link: unraveling the mysteries. In Assessment and Treatment of Cancer Pain, Progress in Pain Research and Management, vol. 12, Payne R, Patt RB, Hill CS (eds). IASP Press: Seattle; 145–156.

662 A Modafinil Therapeutic Trial for Adult Brain Tumor Patients: I. Neurocognitive Outcomes Kaleita TAa,d, Steh Ba, Nghiemphu Pb,d, Ford JMc,d, Cloughey TFb,d,e a Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, USA; bNeurology, David Geffen School of Medicine at UCLA, Los Angeles, USA; cRadiation Oncology, David Geffen School of Medicine at

Copyright # 2006 John Wiley & Sons, Ltd.

UCLA, Los Angeles, USA; dUCLA Neuro-Oncology Program, David Geffen School of Medicine at UCLA, Los Angeles, USA; eHenry E. Singleton Brain Cancer Research Program, David Geffen School of Medicine at UCLA, Los Angeles, USA PURPOSE: Testing a psychopharmacologic agent, modafinil, in adult brain tumor patients with neurobehavioral dysfunction. METHODS: Patients: 30 adults, 63% male, mean age ¼ 45:3 (SD ¼ 11:7) years. Primary malignant and nonmalignant cerebral tumors: high 18 (60%) and low grade 10 (33%) gliomas. Treatment: neurosurgical resection (93%), radiotherapy (87%), and chemotherapy (70%). All had fatigue and/or attention/memory impairments. Measures: Trail Making A&B (TM-A,TM-B); Symbol Digit Modalities (SDM); Verbal Fluency (VF). Design: Double-blind, dose-controlled randomization: 3 weeks; Washout: 1 week; Open label extension (50–600 mg/day after 100 mg/day  3 days, 200 mg/day  4 days): 8 weeks. Statistical Analysis: Percentages of change: totals of patient standard score mean changes at designated points divided by the total sample means at baseline. Probability estimates: paired t-tests or Wilcoxon Signed Rank Tests. RESULTS: Maximal outcomes 8 and 12 weeks post modafinil initiation include: TM-A, 20% ðp ¼ 0:003Þ at 8 and 20% ðp ¼ 0:003Þ at 12 weeks; TM-B, 24% (p50.0001) at 8 and 25% (p50.0001) at 12 weeks; DM-Oral, 31% ðp ¼ 0:0003Þ at 8 and 28% ðp ¼ 0:005Þ at 12 weeks; SDM-Manual, 30% (p50.0001) at 8 and 27% ðp ¼ 0:0005Þ at 12 weeks; VF, 33% (p50.0001) at 8 and 27% ðp ¼ 0:001Þ at 12 weeks. CONCLUSIONS: Modafinil was most effective at improving verbal fluency and symbolic processing speed in adult brain tumor patients. ACKNOWLEDGEMENTS: Supported by Cephalon, Inc., USA

663 A Modafinil Therapeutic Trial for Adult Brain Tumor Patients: II. Fatigue Outcomes Kaleita TAa,d, Graham CAb,c, Nghiemphu Pb,c, Lai Ab,c, Cloughey TFb,c,d a Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, USA; bNeurology, David Geffen School of Medicine at UCLA, Los Angeles, USA; cUCLA NeuroOncology Program, David Geffen School of Medicine at UCLA, Los Angeles, USA; dHenry E. Singleton Brain Cancer Research Program, David

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Geffen School of Medicine at UCLA, Los Angeles, USA PURPOSE: To test a psychopharmacologic agent, modafinil, in adult brain tumor patients with fatigue. METHODS: Patients: 30 adults, 63% male, mean age ¼ 45:3 (SD ¼ 11:7) years. Tumor locations: frontal 14 (47%), temporal 9 (3%). Treatment: neurosurgical resection 28 (93%), radiotherapy 26 (87%), chemotherapy 21 (70%). All had mild to severe fatigue and/or attention/ memory impairments. Measures: Fatigue Severity Scale (FSS); Visual Analogue Fatigue Scale (VAFS); Modified Fatigue Impact Scale (MFIS). Design: Double-blind, dose-controlled randomization: 3 weeks; Washout: 1 week; Open label extension (50–600 mg/day after 100 mg/day  3 days, 200 mg/day  4 days): 8 weeks. Statistical Analysis: Percentages of change: totals of patient standard score mean changes at designated points divided by the total sample means at baseline. Probability estimates: paired t-tests or Wilcoxon Signed Rank Tests. RESULTS: Maximal outcomes 10 and 12 weeks post modafinil initiation include: FSS, 35% (p50.0001) at 10; 38% (p5 0.0001) at 12 weeks. VAFS, 75% (p50.0001) at 10; 83% (p50.0001) at 12 weeks. MFIS-Total Score, 41% (p50.0001) at 10; 49% ((p50.0001) at 12 weeks. MFIS-Physical Subtotal Score, 43% (p50.0001) at 10; 53% (p50.0001) at 12 weeks. MFIS-Cognitive Subtotal Score, 39% (p50.0001) at 10; 45% (p50.0001) at 12 weeks. CONCLUSIONS: Of the three outcomes, modafinil was most effective at improving fatigue levels in this therapeutic trial for adult brain tumor patients. ACKNOWLEDGEMENT: Supported by Cephalon, Inc., USA.

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mortality. This phase 1 study aimed to identify cultural factors influencing mammography use and incorporate relevant constructs in screening education for women associated with Hawaiian churches in medically undeserved communities. METHODS: Focus groups and individual interviews patterned on the culturally-familiar medium of ‘talk story’ were conducted to obtain in-depth descriptions of cultural factors. Sixty NHW (¼ = > 40 years) were recruited from churches and community organizations in four underserved areas. Verbatim transcripts were analyzed using a priori categories from the PEN-3, a model for developing culturally-responsive health promotions. Six key informants reviewed preliminary findings to ensure accurate interpretation. FINDINGS: Suggested are messages reinforcing collectivist responsibility, holistic wellness that includes spirituality, participation of inter-generational extended family and fictive kin, spiritual leaders as promotional messengers, screening testimonials by cancer survivors and family members articulated through the traditional medium of mo’olelo (stories intended to inspire action) followed by opportunities for ‘talk story’ discussion with survivors. CONCLUSION: Incorporating cultural constructs from indigenous Hawaiian and spiritual traditions may increase screening intent, thereby offering NHW the prospect of avoidable breast cancer mortality. Ongoing dialogue and collaboration with women in churches and community organizations may ensure that program implementation is also culturally-responsive and may help dispel NHW historic distrust of conventional Western research and health services. ACKNOWLEDGEMENTS: This study was supported by funding from the National Cancer Institute.

664 Developing Breast Cancer Screening Education for Native Hawaiian Women: Use of ‘Talk Story’ Dialogues Ka’opua LSIa,b, Kaluai RKa, Meighen Pa, Mitchske Da,b,c, Phosena Aa a School of Social Work, University of HI, Honolulu, USA; bCancer Research Center of HI, University of HI, Honolulu, USA; cCancer Information Services, National Institute of Cancer, Honolulu, USA PURPOSE: Native Hawaiian women (NHW) underutilize mammography and are often diagnosed with advanced disease resulting in increased

Copyright # 2006 John Wiley & Sons, Ltd.

665 Breast Cancer Patients Reasons for Accepting or Declining Participation in a Randomised Psychoeducational Project, CAMMA (Cancer mAMMA) Karlsen RV, Ross L, Boesen E, Johansen C Institute of Cancer Epidemiology, The Danish Cancer Society, Copenhagen, Denmark AIM: This study describes how we identified breast cancer patients’ reasons for accepting or declining participating in a randomised psychoeducational project (CAMMA) in Copenhagen. The patients included in CAMMA were women with primary breast cancer who were randomised

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to a intervention group or a control group. In the intervention group, the women were offered two days of education about their disease and its treatment. They also participated in eight supportive group sessions with 8 other women, a psychologist and a nurse. The control group received only ordinary treatment. In the period from February 2004 to November 2004, 56% of the invited women accepted to participate in the project. This relatively low inclusion rate led us to try to identify the reasons for accepting or declining participating in CAMMA. METHOD: In the remaining inclusion period, from May 2005 to December 2005, the women were given a short questionnaire originally developed by Penman et al. of possible reasons for accepting or declining a randomised study. We had revised the questionnaire considering the fact that education and group sessions might have another impact on the women’s disease or treatment than clinical trials of new medication. RESULTS: 66 women filled out the questionnaire; 44 accepting and 20 declining participation in CAMMA. The most frequently reported reasons for accepting to participate was altruism and the actual need for the treatment offered in the project. Most frequently reported reasons for declining participating were practical reasons, time consumption and not being comfortable with the group sessions.

666 Levels of Distress in Women with a Family History of Ovarian Cancer Kash KM Psychiatry and Human Behaviour, Thomas Jefferson University, Philadelphia, USA PURPOSE: Women with a family history of ovarian cancer may be at higher than average risk for the disease. There have been no systematic studies of women who are at this increased risk. The overall goal of this study is to determine the levels of distress in women with a family history of ovarian cancer and to identify the mediating factors between risk of developing ovarian cancer and distress. With the results generated by this study, specific interventions can be designed and tested to improve adjustment of women at high risk for ovarian cancer. METHODS: The proposed study will use 180 first-degree relatives (FDR) of women diagnosed with ovarian cancer in a cross-sectional design. Information the ovarian cancer index case provides will be used

Copyright # 2006 John Wiley & Sons, Ltd.

to identify maternal relatives (mothers, sisters, or daughters). Women will be queried about their objective and subjective risk status, their knowledge of ovarian cancer and risk factors, their uncertainty about ovarian cancer, levels of anxiety and depression, their personality traits of mastery, tolerance for ambiguity, and optimism, and their interest in genetic testing. RESULTS: We have collected data on 32 women. Their mean age is 57 (range 48–64); the majority are married (42%); education ranges from high school to graduate degree; and most had a sister(s) with ovarian cancer. Further results information will be presented at the World Congress as we anticipate that 80 more women will have completed the questionnaire by the time of the meeting in October.

667 A Novel Psychosocial Cancer Intervention Kash KMa, Monti DAa,b, Kunkel EJSa, Peterson Cb a Psychiatry and Human Behavior, Thomas Jefferson University, Philadelphia, USA; bEmergency Medicine, Thomas Jefferson University, Philadelphia, USA PURPOSE: Cancer patients frequently report high levels of distress and unmet psychosocial needs, both of which can contribute to negative health outcomes. Addressing this problem with different group interventions has significantly benefited patients with a variety of cancer diagnoses. The proposed study is designed to test the efficacy of an innovative, multi-modal group intervention, mindfulness-based art therapy (MBAT), for cancer patients, and comparing it to a standard support group. METHODS: The program was developed with the purpose of enhancing the supportive and expressive aspects of the standard group therapy. This study is intended to build upon the very encouraging results of a recently completed clinical trial ðN ¼ 111Þ that demonstrated highly significant improvements in symptoms of psychological distress and quality of life in a heterogeneous group of cancer patients who received the MBAT intervention, as compared to a similar group who received no intervention. In the proposed study, 339 women will be enrolled (226 with breast cancer and 113 with other cancer diagnoses). The breast cancer patients will be randomized to either the MBAT experimental arm or a standardized breast cancer support group. The women with other cancer diagnoses will be consecutively assigned to the

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MBAT group. Groups will be compared on psychological distress and key aspects of healthrelated quality of life. This study is a crucial step towards testing intervention efficacy and assessing for the advantages of MBAT over a standard support group format. RESULTS: Data collection is ongoing and preliminary data analyses will be discussed.

668 Psychological Distress Among Individuals at Highrisk of Developing Melanoma Due to Strong Family History: Preliminary Findings Kasparian NAa,b, Meiser Bb, Butow PNa, Simpson Jc, Mann Gd a Medical Psychology Research Unit, School of Psychology, University of Sydney, Sydney, Australia; bPsychosocial Research Group, Department of Medical Oncology, Prince of Wales Hospital, Randwick, Australia; cSchool of Public Health, University of Sydney, Sydney, Australia; dWestmead Institute for Cancer Research, University of Sydney at Westmead Millennium Institute, Westmead, Australia PURPOSE: Limited data are currently available on the psychological experiences of individuals with a strong family history of melanoma. To address this issue, we have commenced a prospective study to examine uptake of genetic testing, psychological adjustment to test results, and health-protective behaviours in a sample of high-risk families, with identified family-specific mutations. METHODS: Data are being collected at four time-points: baseline (at time of notification that genetic testing is available), two weeks, one year, and three years after receipt of genetic test results. Participants who decline testing are being surveyed at three time-points: baseline, one year, and three years after notification. RESULTS: At this meeting we will be presenting findings related to psychological distress at baseline. 69 women (52%) and 63 men completed the baseline questionnaire ðN ¼ 132Þ: The Impact of Events Scale was used to assess melanoma-specific distress, in particular intrusion (M ¼ 3:08; SD ¼ 4:84), and avoidance (M ¼ 3:64; SD ¼ 5:94). The Hospital Anxiety and Depression Scale was used to measure anxiety (M ¼ 5:14; SD ¼ 3:80), and depressive symptoms (M ¼ 3:23; SD ¼ 2:82). Clinically significant levels of anxiety, depression, and melanoma-specific distress were identified in 23%, 9%, and 1% of participants, respectively.

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There were no gender differences in distress levels, however participants previously diagnosed with melanoma displayed significantly more intrusion (Z ¼ 3:06; p50.01) and avoidance (Z ¼ 3:34; p50.01) than unaffected participants. Predictors of distress will be discussed. CONCLUSIONS: Preliminary findings suggest that the majority of individuals at high-risk of developing melanoma are functioning well psychologically, but a significant subset are experiencing elevated levels of distress.

669 Differential Levels in Caregivers of Brain Tumor Patients}Observations from a Pilot Study Keir ST, Guill AB, Carter KE, Boole LC, Gonzales L Surgery, The Preston Robert Tisch Brain Tumor Center at Duke, Durham, USA OBJECTIVE: Caregivers of patients with brain tumors experience elevated levels of stress. Using pilot data, we sought to determine which caregivers are at risk for experiencing elevated levels of stress based on caregiver-demographic and patient-medical information. METHODS: Using a convenience sample of 60 caregivers, participants were asked to complete the Perceived Stress Scale and to provide demographic information. The Perceived Stress Scale is a 10 item scale designed to measure the degree to which situations in life are perceived as stressful. Demographic information was collected using self-reported measures. Medical data concerning tumor grade of patient was obtained from most recent medical note. Data for study was standardized using z-scores and analyzed using SPSS software. RESULTS: Seventy-two percent ðn ¼ 43Þ of caregivers reported experiencing elevated levels of stress within the last 30 days. Thirty-five percent ðn ¼ 21Þ of sample scored at least one standard deviation about the mean. A statistical trend (Fð1; 57Þ ¼ 3:12; p ¼ 0:08) exists between caregiver stress and tumor grade of patients for which they are providing care. CONCLUSIONS: Caregivers of patients with brain tumors experience significant stress. Furthermore, this data provides an indication of the profound levels of stress these caregivers experience. Caregivers of patients with Grade I/II tumors are at increased risk for experiencing stress. Younger caregiver age and higher levels of education were also found to correlate to higher levels of stress.

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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670 Re-weaving the Web: Development of CancerSupportNetwork.ca Keller-Olaman SJa, Fitch MIb, Nicoll IMc a Ontario Breast Cancer Community Research Initiative Centre for Research in Women’s Health, Toronto, Canada; bSunnybrook Health Sciences Centre, Toronto, Canada; cOntario Breast Cancer Information Exchange Partnership, Toronto, Canada PURPOSE: The Ontario Breast Cancer Information Exchange Partnership (OBCIEP) strives to enhance the information and support needs of those with cancer. This website project was instigated by previous work which showed that women affected by breast cancer are increasingly turning to the Internet for information. At the same time, the Internet can be a source of uncertainty and frustration. Participants with cancer and several community partners are involved. METHODS: A needs assessment was first conducted to learn about preferred types of information, when specific information and support is sought, and features and options that make an Internet site ‘work’. Data collection involved surveys and discussions among men and women affected by breast, lung, ovarian, or other cancers in eight locations in Ontario, Canada. Subsequently CancerSupportNetwork.ca. was started. Where possible, the site links to reliable information and support sources that already exist rather than creating a new site. Those with cancer are assisting by reviewing the website developments. Current efforts involve piloting peer-led support groups. SUMMARY OF RESULTS: The needs assessment identified gaps in information, and highlighted Internet features both preferred and frustrating. The results guided the development of CancerSupportNetwork.ca. A wide menu of information and support options are offered, including online emotional support. Priorities and next steps include working with community partners to include different cancers. CONCLUSION: This is a work in progress. The expected result is an innovative accessible website that enables those affected by cancer to tailor information and support that is right for them, at the time it is needed.

671 A Model of Psychiatrist Supervision for General Practitioners in the Psychological Aspects of Palliative Care

Copyright # 2006 John Wiley & Sons, Ltd.

Varghese FTa, Kelly Pb, Kelly BJc, Burnett PCd, Robertson Me a Discipline of Psychiatry, Southern Clinical School, University of Queensland Medical School, Brisbane, Australia; bCentre for Rural and Remote Mental Health, University of Newcastle, Orange, Australia; cCharles Sturt University, Wagga Wagga, Australia; dDiscipline of General Practice, University of Queensland Medical School, Brisbane, Australia; eMt Olivet Hospital, Brisbane, Australia AIMS: General practitioners play an integral role in addressing the psychological needs and responses of palliative care patients and their families. This qualitative study investigated issues faced by GP’s in the care of patients receiving palliative care, and aims to investigate clinical supervision in this setting. METHOD: General practitioners were recruited through the Mt Olivet Palliative Care Services in Brisbane, Australia. Doctors whose patients had been recently referred to the Home Care Services were invited to participate in the study. Semi-structured interviews by a psychiatrist member of the research team were conducted individually with 15 GPs in their private practice, focusing on the care and management of one of their existing palliative patients. Interview questions addressed the doctor/patient relationship, experience of delivering diagnosis and prognosis, doctors’ impression of patient’s adaptation, addressing psychological concerns, approaching death, spiritual issues, relationship with patients’ family, and doctors’ personal experience and responses. Qualitative analysis was conducted on the transcripts of these interviews. RESULTS: The themes which emerged were: clinical and psychological issues (including depression), death (discussing death with patients, prognosis and spiritual issues), doctor/patient relationship (interaction, perception of patient coping, house visits, general experiences caring for patient), GPs personal experience (identification with patient, Drs’ experience working with palliative care patients, perception of role as doctor and Drs’ personal responses). CONCLUSIONS: There were major practical challenges to delivering this model of clinical support to general practitioners reflecting a range of organisational and clinical issues. Although the participants appeared to be a self-selecting group of doctors with a prior interest in palliative care, the interaction with the psychiatrist was perceived as

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valuable in elucidating doctors’ own attitudes and thoughts on palliative care, and also doctors’ attitudes and expectations of their relationships with their palliative care patients.

672 Sense of Coherence Predicts the Experience of Distressing Symptoms in Women with Recurrent Breast Cancer Kenne Sarenmalm Ea,b, O¨hle´n Jb, Jonsson Tb, Gaston-Johansson Fb,c a Research and Development Centre, Skaraborg Hospital, Sko¨vde, Sweden; bUniversity of Gothenburg, Sahlgrenska Academy, Institute of Health and Care Sciences, Gothenburg, Sweden; cUniversity Johns Hopkins, School of Nursing, Baltimore, USA BACKGROUND: The diagnosis of breast cancer recurrence is an extremely stressful event, often accompanied by the experience of distressing symptoms and psychological morbidity that may have a profound effect on the ability to adjust to an incurable phase of the disease. The purpose of this study was to describe the symptom burden, and to identify which actors predict the capacity to cope with distressing symptoms. METHODS: A sample of 56 consecutively enrolled postmenopausal women newly diagnosed with recurrent breast cancer, completed questionnaires measuring the symptom burden (Memorial Symptom Assessment Scale), anxiety and depression (Hospital Anxiety and Depression Scale), and coping capacity (Sense of Coherence). RESULTS: The study illustrate that women with recurrent breast cancer suffer from multiple, concurrent and interrelated symptoms. A majority of patients (65%) reported 10–23 symptoms. Highly prevalent symptoms were lack of energy (67%), difficulty sleeping (61%), pain (59%), worrying (59%), problems with sexual interest and activity (59%), feeling sad (57%), and dry mouth (52%). Patients with lower coping capacity reported higher prevalence of symptoms and experienced higher levels of distress, and reported higher scores of anxiety ðr ¼ 0:59Þ and depression ðr ¼ 0:62Þ: Coping capacity was the only significant predictor of the distress experience. DISCUSSION: To help women manage recurrent breast cancer it is important to use multidimensional measurement to identify, evaluate and treat distressing symptoms. Care must be based upon the awareness of critical factors that exacerbate vulnerability to

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distress, as well as the ability to adapt to a recurrent breast cancer disease.

673 Caring for the Cancer Patient: The Caregiver’s Perspective Kettler P, Baile WF Department of NeuroOncology, Psychiatry Section M.D. Anderson Cancer Center, Houston, USA PURPOSE: Due to the cumulative stress effects of task overload, family caregivers (CG) may develop distress symptoms, including emotional and physical fatigue, depression, and anxiety which often go unrecognized and can hamper CG effectiveness. To address this issue, we produced a video that identifies CG challenges through CG interviews relating their personal experiences. METHODS: We used focus groups of 300+ caregivers over the last 3.5 years to identify seven consistent themes representing caregiver challenges, including understanding personal theories of cancer causation, suffering, spirituality, emotions, control, coping and support. We then constructed a questionnaire to evaluate the impact of this video on a selected sample of CG. RESULTS: Of the 22 caregivers sampled, 90% found the video to be helpful; 91% recommended that it be available to other caregivers; 58% thought it would be helpful for their loved one with cancer to view; 80% thought it was the right length; 32% recommended greater emphasis on ‘hope’ and 7% found insufficient coverage of the topic of ‘loss of control’. CONCLUSION: We produced a video using interviews of cancer CG to illustrate the impact that caregiving has on one’s life. It addresses the expansive scope of responsibilities a CG must assume in caring for their loved one. We piloted the impact that this video had on CG and obtained results that suggested it is a valuable tool in addressing CG distress. Uses will include training staff in recognizing caregivers unmet needs. Video will be played during poster presentation with copies available.

674 Caregivers: Building a Personal Theory of Competency Kettler P, Baile WF Department of NeuroOncology, Psychiatry Section M.D. Anderson Cancer Center, Houston, USA Due to the cumulative stress effects of task overload, family caregivers may develop a con-

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stellation of symptoms which may be missed by medical staff in pursuit of focused medical care for the cancer patient. These caregiver distress symptoms include physical and emotional fatigue, social isolation, conflict, depression and demoralization, anxiety, and loneliness resulting in a slow erosion of the caregiver’s sense of personal competency. Appropriate educational and supportive interventions by the psycho-oncology staff can disrupt a spiral of functional caregiver decline. A model of intervention, which we call ‘developing a theory of personal competency’ can be applied individually and in groups with caregivers to restore coping skills. Over the past 3 years, we have worked with over 200 caregivers in our weekly caregiver support group. We have found a universal need within this population to establish a sense of emotional competency in caring for their loved one. Without a model by which to organize chaotic and escalating fearful thoughts, a caregiver is often left feeling depleted and emotionally fatigued.

675 Caregivers: Understanding the Emotions of Caregiving Kettler P, Baile WF Department of NeuroOncology, Psychiatry Section M.D. Anderson Cancer Center, Houston, USA We offer a weekly, psychotherapeutic group to address the universality of caregiver stress comprised of caregivers with a common denominator}the need for meaningful connection to organize confusing thoughts and feelings. Caregiving themes and reflections are: 1. The ways this experience has been particularly hard on me: ‘My husband is irritable with me and I’m working hard to help him.’ 2. Additional stressors I have are: ‘My mother died and we can’t leave treatment to attend the funeral’. 3. What I have learned about myself: ‘I can’t fix everything.’ 4. The skills that have helped me: ‘I can multi-task with the best of them.’ 5. Ways this cancer has impacted our relationship: ‘We try to take advantage of the good days.’ 6. The thing I am most disappointed about in myself: ‘I let picky things get to me.’ 7. The blessings that have resulted from this experience: ‘My children have seen a marriage in action during a very hard time.’ 8. The spiritual meaning that I have found: ‘Where is God through all of this? He’s not listening.’ 9. What I have learned about ‘control’: ‘Only God knows when

Copyright # 2006 John Wiley & Sons, Ltd.

my family member will die, not me or the doctors.’ 10. What I would recommend to a new caregiver: ‘Focusing on the present decreases fear.’ Evaluations reveal that this discussion impacts the caregiver in unexpected ways. Heretofore, ‘forbidden’ feelings of anger, grief, hopelessness, fear become reinterpreted, normalized and ultimately organized within a strengthening framework of acceptance.

676 Psychosocial Effects of Childhood Cancer on their Families Khatib J, Neamat M, Sundus SA, Salhi R Psychosocialoncology KHCC, Amman, Jordan PURPOSE: Assess the problems to draw strategies. METHODS: A cross sectional random sample of 50 families were interviewed. RESULTS: Forty-one (82%) of responders were mothers. Children have leukemia in 32 (64%) of the cases; 29 were males and 21 were females. Almost all patients (98%) were still on treatment. More than half of children (56%) did not know the nature of their illness. Patients, who knew, as well as families, were less anxious. Most children (90%) exhibited behavioral changes; the commonest, nervousness and irritability (in 39), crying more easily and frequently (in 24), increased demand (in 20). Most of children’s school attendance was disturbed. Worst and most prevalent problem was pain, followed by deterioration of health and appearance. Most of the families were affected negatively by the illness, 27 had deterioration and increased tension in the interpersonal relations, 23 reported increased solidarity. Thirty-six (72%) reported fear of unknown, 23 (46%) expressed sadness and depression, 22 (94%) became nervous and anxious. Changes in life style affected almost all families. CONCLUSION: These results reconfirm the fact that cancer is a family issue not only related to the individual patient. 1. An association or league of families against cancer was started. 2. Effect on schooling is to be studies. 3. The issue of telling the child about high illness is still not settled. 4. Multi disciplinary pain management is crucial.

677 Development of a Computer Game Software as an Aide for Image Therapy in Cancer Patients Kikuchi Ha, Sonoda Nb, Morikawa Sb, Ishiguro Yb

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Mental Care Department, Nikko Memorial Hospital, Muroran, Japan; bSapporo Digital Academy, Sapporo, Japan ‘Protect Life!’ is a tool to facilitate image therapy using a PC for patients with cancer. It consists of a shooting game with three stages and computer graphic (CG) animations. Immune cells (T cells, B cells, macrophage) are the weapons. The software provides the patients with an animated explanation of how these work within one’s body. Patients play by shooting bad cells using the mouse of the computer. For patients not familiar with computer games, there is another way to play. By hitting a stuffed toy cancer, bad cells on the screen disappear one by one. To be able to destroy and exterminate the enemy is exhilarating for the patient. The reasons for making ‘Protect Life!’ are firstly, it is not always easy for patients to visualize the battle scenes against cancer on the cell level. Secondly, the impressive images and active operation of this software are utilized to promote participation in their own care. This software makes it easier to visualize under image therapy. Imprinting is a direct result of this. The images viewed would be available when enduring and overcoming the severe pain of the side effects of chemotherapy. This game makes it possible for patients to be aware of their own army within the body, to restore confidence, and to change pessimistic thinking into optimistic thinking by viewing scenes and drawing imagery in the mind. We feel the most important purpose is to support the patient’s volition to fight against the disease and promote hope.

678 Mirtazapine for the Rapid Control of Nausea and Insomnia in Cancer Patients}Preliminary Results Kim SWa, Shin ISa, Kim JMa, Kim YCb, Yoon JSa a Psychiatry, Chonnam National University, Hwasun Hospital, Hwasun, Republic of Korea; bInternal Medicine, Chonnam National University, Hwasun Hospital, Hwasun, Republic of Korea PURPOSE: The antagonistic effects of mirtazapine on 5-HT2 and 5-HT3 receptors are related to the control of nausea and sleep disturbance. This study evaluated the efficacy of mirtazapine for nausea and insomnia in cancer patents. METHODS: This was a four-week prospective, open-labeled study of cancer patients with nausea

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or insomnia. Assessments were performed at baseline and on days 1, 3, 5, 7, 14, and 28 using the Clinical Global Impression (CGI) for nausea, total amount of night-sleep time, modified-Leeds Sleep Evaluation Questionnaire (m-LSEQ), and Montgomery Asberg Depression Rating Scale (MADRS). RESULTS: Forty-one cancer patients (75%: terminal stage) were enrolled. Those with nausea ðn ¼ 26Þ improved significantly from day 1. At the final evaluation, nausea had resolved completely in 13 patients (50%). The total nightsleep time and each item on the m-LSEQ improved from days 1 to 5. The total MADRS score also improved from the end of the first week. The most frequent side effect was daytime sedation (42%), which improved gradually. At the end of the second week, daytime sedation was exacerbated in only 11% of the patients, and was improved compared to baseline in 39%. CONCLUSION: Mirtazapine rapidly improved nausea, sleep quality, and depression. Mirtazapine induced daytime sedation initially in some patients, but it was tolerated by many of these patients within a few days. Mirtazapine may be useful for rapid control of nausea and sleep disturbance in cancer patients.

679 Psychological and Spiritual Adjustment of Female Caregivers Kim Ya, Wellisch DKb, Spillers RLa a Behavioral Research Center, American Cancer Society, Atlanta, USA; bDavid Geffen School of Medicine, UCLA, Los Angeles, USA This study examined the effects of the survivor’s cancer type (hereditary vs non-hereditary) and the female caregiver’s familial relationship status to the survivor (first-degree relative vs non-firstdegree relative) on the caregiver’s psychological and spiritual adjustment. Cancer caregivers, who were nominated by cancer survivors, participated in a nationwide quality-of-life survey, with 458 caregivers providing valid data for the variables. Breast and ovarian cancer were categorized as hereditary types of cancer (HTC+), whereas kidney, lung, non-Hodgkin’s lymphoma, and skin cancers were HTC. Mothers, sisters, and daughters of the cancer survivors were categorized as first-degree relatives (FDR+), whereas daughterin-laws and friends were FDR. Psychological and spiritual adjustment were measured using the POMS-SF and FACIT-Sp, respectively. Multi-

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variate general linear modelling analyses revealed that the HTC+ group reported less psychological distress than the HTC group; the FDR+ group reported better spiritual adjustment than the FDR group. The interaction effect between HCT and FDR on psychological distress or spiritual adjustment was not significant. Female caregivers of survivors with non-hereditary cancer types may benefit from programs designed to reduce their psychological distress, and caregivers who are the daughter-in-law or friend of the cancer survivor may need help in boosting their spirits in the context of cancer care.

680 Family Genogram Klikovac T Institute for Oncology and Radiology, Belgrade, Serbia In the pediatric oncology Ward at the Institute for oncology and radiology of Serbia, in Belgrade, children from few months to the age of twenty are treated. It has been proved that the family genogram is a very useful and qualitative technique in order to make the first contact with the psychologist, of course taking into account the heterogeneous age of the children and teenagers as well as the different phases of the family life they are in. Genogram is a map; it is a visual image of the family life which represents the integration of visual, verbal and emotional material taken from the members of the family. Genogram: (1) It gives the access to the structure, dynamism and history of the family system during many generations in a vertical and horizontal cross-section. (2) It simply ensures the registration of family patterns and the way it is transmitted through generations. (3) It shows how the past events affect the present and future relations in the family system (for example, how the losses, death, illnesses, divorces, separations and exile affect the life of the family). (4) It enables the therapist and the families to perceive all the phenomena like in one integrated unit. Genogram is one of the original techniques for the family therapy which has a wide use in the family diagnostics, therapy, education and research.

681 Levels of Omega-3 Fatty Acid in Serum Phospholipids and Depression in Patients with Lung Cancer Yamawaki Sa, Kobayakawa Ma,b, Inagaki Mb, Akechi Tc, Hamazaki Kd

Copyright # 2006 John Wiley & Sons, Ltd.

a

Department of Psychiatry and Neurosciences, Graduate School of Biomedical Science, Hiroshima, Japan; bPsycho-Oncology Division, Research Center for Innovative Oncology, National Cancer Center Hospital, East Kashiwa, Japan; cDepartment of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Science, Nagoya, Japan; dLaboratory of Membrane Biochemistry and Biophysics, NIH, Rockville, USA

PURPOSE: Previous studies suggested that omega-3 fatty acids (FAs) have therapeutic effects against depression, but there is no evidence in the oncological setting. Our preliminary study reported the association between lower omega-3 FA intake and occurrence of depression in lung cancer patients. To explore the association further, the present study examined whether depression was associated with lower levels of omega-3 FAs in serum phospholipids. METHOD: A total of 717 subjects in the Lung Cancer Database Project were divided into three groups by two cut-off points of the Hospital Anxiety and Depression Scale depression subscale (HADS-D). In all, 81 subjects of the non-depression and minor-depression groups (HADS-D55 and 55HADS-D510, respectively) were selected to match with 81 subjects of the major depression group (HADS-D > 10) for age, gender, clinical stage, and performance status. Fatty acids were assayed by gas chromatography and compared among the three matched groups. RESULTS: There were no differences between the major depression group and non-depression group in any FAs. The minor depression group had higher mean levels of docosahexaenoic acid (mean/s.d. (%), non-depression: 7.40/1.54; minor-depression: 7.90/1.40; major depression: 7.25/1.52, P ¼ 0:017). CONCLUSION: These results suggested that serum FAs are associated with minor, but not major, depression in lung cancer patients.

682 A Longitudinal Study on Self-esteem and Quality of Life (QOL) in Head and Neck Cancer Patients Kobayashi Ma, Matsushima Ea, Sugimoto Tb, Kishimoto Sb, Tsunoda Ab a Liaison Psychiatry & Palliative Medicine Graduate School of Tokyo, Medical & Dental University, Tokyo, Japan; bOtorhinolaryngology/Head & Neck Surgery Graduate School of Tokyo, Medical & Dental University, Tokyo, Japan

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PURPOSE: The aim of the study was to investigate self-esteem and QOL in head and neck cancer patients longitudinally. METHODS: The subjects were 16 patients (12 males; 4 females) with the mean age of 62.7. They were divided into two groups (eight patients with high and 8 patients with low self-esteem). All were requested to complete the questionnaires before surgery (time1), a week after surgery (time2), and six month after surgery (time3). The evaluation instruments included Rosenberg Self-Esteem (RSE), Hospital Anxiety and Depression Scale (HADS), FACTH&N, and FACT-Sp12. RESULTS AND CONCLUSION: High self-esteem group had significantly lower anxiety and depression scores than low self-esteem group in time 1 and 2. Anxiety and depression scores decreased after surgery in high self-esteem group, but they increased after surgery in low-esteem group. Regarding QOL, high selfesteem group had significantly higher scores in physical, emotional, functional, head and neck, and total QOL items in FACT-H&N than low self-esteem group. Moreover, functional aspects of QOL significantly lowered after surgery, although emotional aspects of increased after surgery. The present study suggested that patients’ self-esteem greatly influenced psychosocial factors and QOL. The study is still in progress and further investigation is necessary to observe the course of QOL and/or mental disturbances such as anxiety and depression. At the same time, we should think about measures to support the patients’ self-esteem.

establishing cohabitations, as a measure of marriage, and subsequent risk for separation, as a measure of divorce. METHODS: In this nationwide, population-based, cohort study in Denmark, we included all childhood cancer survivors, identified through the Danish Cancer Register, who were born in 1965–1980, and diagnosed in 1965–1996 before the age of 20 years (n ¼ 1877). A sex- and age matched population-based control cohort was used for comparison (n ¼ 45 449). Demographic and socioeconomic factors were obtained by linkage to public registers in Statistics Denmark. Survival analyses were performed as discrete time Cox regression analyses. RESULTS: Childhood cancer survivors (all) showed a reduced RR for establishing cohabitations (0.78, 95% confidence interval [CI]: 0.73–0.83), due to reductions among both non-CNS (RR 0.88, 95% CI: 0.83–0.95) and CNS tumor survivors (RR 0.52; 95% CI: 0.45–0.59). Male CNS tumor survivors showed an insignificantly lower RR for cohabitation (0.47; 95% CI: 0.38–0.58) than females (RR 0.5; 95% C: 0.47–0.68). Childhood cancer survivors had no augmented RR for separation compared to controls. CONCLUSIONS: The RR for establishing cohabitations was reduced for all childhood cancer survivors; showing a moderate reduction among non-CNS tumour survivors, while CNS tumour survivors showed a 50% reduction, compared to the control cohort. Difficulties with interpersonal relations and neurocognitive deficits after cranial irradiation are expected to be the major explanatory factors.

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Marriage and Divorce Among Childhood Cancer Survivors Koch SVa,b, Schmiegelow Ka, Johansen Cb, Kejs AMTc, Engholm Gc a Section of Pediatric Hematology and Oncology, Pediatric Clinic II, Juliane Marie Center, University Hospital, H:S Rigshospitalet, Copenhagen, Denmark; bDepartment of Psychosocial Cancer, Research Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark; cDepartment of Cancer Prevention & Documentation, Danish Cancer Society, Copenhagen, Denmark

Somatic Complaints and Mental Exposures in Haematology/Oncology: Is There An Interrelation in Adult Patients Under Cytotoxic Chemotherapy? Koehler Ma, Holzha¨user Ja, Koenigsmann Ma, Fanke Aa, Frommer Jb a Department of Haematology/Oncology, Medical Faculty of the Otto-von-Guericke-University, Magdeburg, Germany; bDepartment of Psychosomatic Medicine and Psychotherapy, Medical Faculty of the Otto-von-Guericke-University, Magdeburg, Germany

PURPOSE: Survival from childhood cancer increases, but childhood cancer survivors may experience psychosocial limitations such as reduced marital rates and higher risk of divorce. The aim was to estimate the relative risk (RR) for

Copyright # 2006 John Wiley & Sons, Ltd.

PURPOSE: Haematological patients are subjected to substantial discomfort during their treatment. The purpose of the study is a psychosomatic analysis. METHODS: The study reports on 23 patients who were assessed at 3 time points: (t1) after diagnosis, but before beginning of treatment;

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(t2) interim staging und (t3) end of treatment. The variables depression, anxiety and quality of life (QOL) were collected using PHQ-D and SF-36. Somatic complaints include clinically documented side effects and general somatic symptoms as collected by PHQ-D (SOMSYM). A methodological innovation is the Somatic Burden Score (SBS). SBS is calculated as ratio between the frequency of side effects according to NCI-CTC (National Cancer Institut-Common Toxicity Criteria) and the interval between 2 time points. RESULTS: Results are demonstrated for (t1) and (t2): There are significant positive correlations between SOMSYM and depression/anxiety. Moreover, there are significant negative correlations between SOMSYM and somatic/mental QOL. There are nearly no correlations between the SBS-side effects and depression/anxiety. Correlations between SBS-side effects and somatic vs mental QOL show a difference: SBS-side effects correlate negative to somatic QOL, but positive to mental QOL. CONCLUSIONS: The Somatic Burden Score is a new tool which allows to include both the duration and the severity of side effects. The analysis revealed a very interesting relationship between general somatic symptoms and mental exposures. To obtain such results requires the inclusion of a Psychological Standard Diagnostic into the established repertoire of QOL measurement for patients receiving cytotoxic chemotherapy.

685 Role of Positive Outlook in the Psychological Recovery of Cancer Patients Kohli N, Upadhay A Department of Psychology, University of Allahabad, Allahabad, India The present study examined the role of positive outlook in the psychological recovery of cancer patients. The sample comprised of sixty male and female cancer patients undergoing treatment at a local hospital in Allahabad, India. Semi-structured interviews were conducted to tap patient’s positive outlook and psychological recovery. Results showed a positive correlation between positive outlook and psychological recovery. As positive outlook increased, patient’s psychological recovery also increased. Happiness emerged as an important predictor of psychological recovery. The findings have important implications for doctors and policy makers. Psychological and

Copyright # 2006 John Wiley & Sons, Ltd.

physical recovery are complementary to each other and to improve the quality of life of patients, it is important that due attention is paid to both.

686 The Application of the Theory of Planned Behaviour and the Trans-theoretical Model to the Use of Complementary and Alternative Medicine in Japanese Cancer Patients Komura Ka, Hirai Kb, Tokoro Ac, Uromaru Td, Hyodo Ie a Graduate School of Human Sciences, Osaka University, Osaka, Japan; bCenter for the Study of Communication Design, Osaka University, Osaka, Japan; cDepartment of Psychosomatic Medicine, National Hospital Organization, Kinkichuo Chest Medical Center, Osaka, Japan; d Department of Palliative Medicine, Hikone Municipal Hospital, Shiga, Japan; eDepartment of Gastroenterology, Graduate School of Medicine, Tsukuba University, Ibaragi, Japan PURPOSE: The safety and effects of complementary and alternative medicine (CAM) have not been empirically confirmed. However, the use of CAM has been rapidly increased in Japanese cancer patients in late years. This work will focus on such behavioural phenomenon and explain ‘why some Japanese cancer patients tend to use CAM although they have limited information about the safety and effects?’. The Theory of Planned Behaviour (TPB) and the Trans-Theoretical Model (TTM) were applied to examine their behaviour of CAM use. METHODS: Participants were 521 cancer patients (59.9  11.9 years old) in three treatment facilities for cancer in Japan. They completed the set of questionnaires with informed consent including 25 newly developed items about the behaviour of CAM use based on the TPB, an item to choose one of the five stages of the behavioural change of CAM use, self-efficacy scale for advanced cancer patients, and the Hospital Anxiety and Depression Scale (HADS). RESULTS: The behavioural stages of CAM use were Precontemplation (15.72%), Contemplation (44.16%), Preparation (6.58%), Maintenance (14.01%), and Acton (19.53%). Multivariable analysis showed that the behaviour of CAM use was explained by positive (b ¼ 0:23; p50:01) and negative (b ¼ 0:20; p50:01) attitudes toward CAM use, and the expectations of family (b ¼ 0:41; p50:01) and physician (b ¼ 0:17; p50:01). CONCLUSION: The TPB and TTM

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were applicable to examine the use of CAM in Japanese cancer patients. ACKNOWLEDGEMENT: This work is funded by Grant-in-Aids for Cancer Research from the Ministry of Health, Labour and Welfare, Japan (Grant nos. 13-20 and 17-14).

p50:001), role impairment due to physical problems (RAND-36 p ¼ 0:024), and perceived health change (RAND-36 p50:001). CONCLUSION: Preliminary analyses showed positive effects of both intervention groups on quality of life indicators in cancer patients.

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Quality of Life after Multidisciplinary Cancer Rehabilitation, Combining Physical Training and Psycho-education Korstjens Ia, May-de Groot Ab,c, van Weert Ed,e, Mesters Ia a Department of Health Education and Promotion, Maastricht University, Maastricht, The Netherlands; bJulius Center for Health Sciences and Primary Care 2, University Medical Centre Utrecht, Utrecht, The Netherlands; cDepartment of Medical Psychology and Psychotherapy, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands; dCentre North-Netherlands, Groningen, The Netherlands; eCentre for Rehabilitation 5, University Medical Center Groningen, Groningen, The Netherlands

Prevalence and Need for Psycho-social Intervention in Japanese Breast Cancer Patients Koyama Aa, Inui Hb, Hirai Kc, Shiozaki Md, Tokoro Ae a Department of Psychosomatic Medicine, Sakai Hospital, Kinki University School of Medicine, Osaka, Japan; bDepartment of Surgery, Kinki University School of Medicine, Osaka, Japan; c Center of the Study for Communication Design, Osaka University, Osaka, Japan; dJapan Society for the Promotion of Science, Osaka, Japan; e Department of Psychosomatic Medicine, National Hospital Organization, Kinki-Chuo Chest Medical Center, Osaka, Japan

PURPOSE: Cancer patients are often facing distressing physical and psychosocial problems resulting from their cancer and its treatment. To address these problems we developed a 12-week multidisciplinary group program for cancer patients (all cancer types, medical treatment>3 months ago), combining physical training (twice a week) and psycho-education (once a week), focusing on self-management. Aim of the present study is to determine the effects of multidisciplinary rehabilitation (MDR), compared to physical training (PT), and to no intervention. METHOD: In this ongoing study participants are randomly assigned to MDR or PT. The non-intervention group consists of waiting list patients. Quality of life is measured by the EORTC-QLQ-C30 and the RAND-36 before and after rehabilitation and at the same time intervals in the non-intervention group. RESULTS: Preliminary analyses on prepost measures of quality of life in 184 participants MDR (n ¼ 75), PT (n ¼ 66) and controls (n ¼ 43) revealed no significant differences between groups at baseline and no differences in effects between MDR and PT. Compared to the control group significant improvements were found in both MDR and PT in global quality of life (EORTC p ¼ 0:022), physical functioning (EORTC p ¼ 0:021; RAND-36 p ¼ 0:003), vitality (RAND-36

Copyright # 2006 John Wiley & Sons, Ltd.

PURPOSE: The purpose of this study is to investigate the prevalence and the need for psycho-social intervention in Japanese breast cancer patients and to analyse the correlation between psychological distress and the psychosocial intervention. METHODS: The total of 112 post-operation patients in the Department of Surgery of Kinki University Hospital participated in this study with an informed consent. A questionnaire which included asking patients their experience and their need for psycho-social intervention was conducted. Hospital Anxiety and Depression Scale (HADS) was used to assess psychological adjustment. The correlation between HADS scores and the need for the intervention was analysed by t-test. RESULTS: The valid data was 108 (96.4%). Majority of the patients, 94 (87.0%) answered that the psychosocial intervention was necessary. However, only eight (7.4%) of them had psycho-social intervention. The patients who had the psycho-social intervention were satisfied with it. The patients who didn’t express the need for the intervention as well as the patients who had the experience of psycho-social supports indicated significantly higher scores in HADS than other patients. CONCLUSIONS: Although many breast cancer patients required psycho-social intervention, only a few of them used it. This result indicated that psycho-oncology services in Japan should be

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established more. The correlation between HADS scores and the intervention suggested that the patients who didn’t express the need for it had a potential need and that the screening of it was necessary.

689 Impact of Psychotherapeutic Support on Patients with Gastrointestinal Cancer Undergoing Surgery: 10-year Survival Results of a Randomized Trial Kuechler Ta, Bestmann Ba, Rappat Sb, HenneBruns Dc, Wood-Dauphinee Sd a Department for General and Thoracic Surgery, Reference Center Quality of Life in Oncology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; bDepartment of Medical Psychology, University of Hamburg, Hamburg, Germany; cDepartment of Visceral- and Transplantation Surgery, University of Ulm, Ulm, Germany; d Department of Epidemiology and Biostatistics, School of Physical and Occupational Therapy, Faculty of Medicine, McGill University Montreal, Montreal, Canada PURPOSE: The impact of psychotherapeutic support on survival in patients with gastrointestinal cancer undergoing surgery was studied. METHODS: A randomized controlled trial was conducted in cooperation with the Departments of General Surgery and Medical Psychology, University Hospital of Hamburg, Germany from 1/ 1991 to 1/1993. Consenting patients (n ¼ 271) with a preliminary diagnosis of cancer of the esophagus, stomach, liver/gallbladder, pancreas or colon/rectum were stratified by sex and randomly assigned to a control group that received standard care as provided on the surgical wards, or to an experimental group that received formal psychotherapeutic support in addition to routine care during the hospital stay. From 6/2003 to 12/2003 the 10-year follow-up was conducted. Survival status of all patients was determined. RESULTS: Kaplan–Meier survival curves demonstrated better survival for the experimental group than the control group. The unadjusted significance level for group differences was 0 ¼ 0:0006 for survival to 10 years. Cox regression models that took TM Staging or the Residual Tumor Classification and site of tumor into account also found significant differences at the 10-year follow-up. Secondary analyses found that differences in favor of the experimental group occurred in patients with stomach, pancreatic, primary liver or colorectal

Copyright # 2006 John Wiley & Sons, Ltd.

cancer. CONCLUSIONS: The results of this study indicate that patients with gastrointestinal cancer, who undergo surgery for stomach, pancreatic, primary liver or colorectal cancer, benefit from a formal program of psychotherapeutic support during the in-hospital stay in terms of long-term survival.

690 Coping and Quality of Life in Couples Affected by Cancer: Individual and Dyadic Measures Diverge Kuenzler Aa,b,c, Zindel Aa, Bargetzi Mb, Znoj HJa a Institute of Psychology, University of Bern, Bern, Switzerland; bDivision of Oncology/Haematology, Kantonsspital, Aarau, Switzerland; cPsychooncology, Krebsliga Aargau, Aarau, Switzerland PURPOSE: Reveal predictors of quality of life in cancer patients and their spouses, including dyadic coping processes. Relationships between individual and dyadic measures of both, coping and quality of life are investigated. METHODS: In an ongoing study, a pilot sample of 51 patients (67% male) with any type and stage of cancer, and their partners, were assessed 2–8 weeks after diagnosis. A pre-tested mailed self-report questionnaire was used (return rate 70%), including standard measures of psychopathology; health-related quality of life (QoL); relationship; and individual and dyadic coping. Medical control variables included ECOG performance, pain, stage of disease, and treatment factors. RESULTS: Individual coping was correlated with individual QoL, but not with dyadic indicators of QoL. On the other hand, dyadic coping was correlated with dyadic QoL, but not with individual measures of QoL. This pattern was true for both, patients and partners, although there were noticeable differences. CONCLUSIONS: Individual and dyadic measures of both, coping and QoL, may reveal distinct and therefore important information, when the area of interest is widened from the individual to the couple level. Results of the ongoing study hint to differential effects concerning the coping process with a recent diagnosis of cancer: What style in what situation is most helpful for both, the patient and his or her partner?

691 Psychological Intervention and Music Psychotherapy of Neurotic Anxiety Disorders in Rehabilitation of Patients after Mastectomy Kui-Beda V

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Department of Rehabilitation, Samara Cancer Center, Samara, Russia Neurotic anxiety disorders often accompany breast cancer. In most studies the disorders are diagnosed with no less than a half of women after mastectomy. In most cases destructive reactions to illness are observed. To tackle with this we have developed and probed The Method of Synaesthetic Associations and Relaxation (SAR). The aim of this investigation was to compare the effectiveness of rehabilitation of patients with anxiety neurotic disorders after mastectomy with- and without the use of the method of SAR. 60 patients suffering from anxiety neurotic disorders from 1 to 6 months after mastectomy participated in the study. Subjects were examined at the beginning and in the end of a rehabilitation course with the help of diagnostic and research criteria of the 10th edition of WHO disease Classification and the range of scales and tests (HARS, HDRS, Bechterev Institute Response to Illness Personal Questionnaire). Being computer-based, the method of SAR made it possible to create a unique music therapy composition with a target effect for each patient and assess its effectiveness during relatively few psychotherapy sessions. Having confirmed the effectiveness of the composition we recorded and gave it to 15 patients for further supportive treatment at home. Analyses of the results of treatment revealed SARincluded scheme of rehabilitation to be more effective in producing significant changes in anxiety and depression, transforming destructive responses to illness types to non-destructive types. The treatment is more effective if the composition is handed to a patient to be audited at home as supporting therapy.

692 Screening for Psychosocial Distress}Cross-cultural issues Kumar TMa, Venkateswaran Ca, Bostock Na, Thekkumpurath Pa, Bennett Mb a Department of Liaison Psychiatry, Becklin Centre, Leeds, UK; bPalliative Medicine, St Gemma’s Hospice, Leeds, UK The poster aims to highlight the cross-cultural validity of screening instruments comparing two studies done in India with a large scale study in the UK. PURPOSE: Over the last few years, there is an increase in interest in screening for psychosocial distress in psycho-oncology populations.

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Most of the published work is from developed nations. There are some reports of screening instruments such as the distress thermometer having validity in various cultures. However, it is unclear whether similar cross cultural validity exists for other screening instruments and also in less developed nations. METHODS: In an attempt to answer some of these issues, we did a pilot study using the distress thermometer and the BSI 18 in a sample of 80 patients who were also seen by a qualified liaison psychiatrist in India. A larger study was then done involving a larger sample, evaluation by more than one psychiatrist and the use of the General Health Questionnaire (GHQ12) in addition to BSI 18 and the distress thermometer. In the last phase of the study, we aim to replicate the same design in Leeds, UK, in a large palliative care population using the same instruments and comparing them with structured psychiatric interviews by two trained psychiatrists. RESULTS: The results from the first study showed that the prevalence of psychiatric diagnosis was around 40% and that the BSI 18 appeared more robust as a screening instrument while the distress thermometer performed poorly in comparison. CONCLUSIONS: It can not be assumed that screening instruments perform similarly across settings and cultures. Validation in any given setting is essential before adaptation into routine practice.

693 Grief Groups for Children at the Age of 7 to 9 Kvist TW, Olsen LZ, Roholm HH The Cancer Counselling Centre, The Danish Cancer Society, Roskilde, Denmark PURPOSE: The Danish Cancer Society has recently created a concept of how young children’s grief can be worked with in a grief group. Children aged 7–9 have different demands than older children if they are to benefit from working with their grief in a group. Young children find it hard to concentrate for more than a short while, especially when the subject is full of disturbing emotions. It is a challenge because the young children need less words and more action. METHOD: A group consists of 6–8 children who have lost a parent or a sibling and it is run by two adults. The loss can be recent or up to 3 years old. The meetings are every fortnight for 212 hours and the number of meetings are restricted to 10. The meetings are followed up by an evening for

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the grown-up relatives. The meetings consist of small units interrupted by frequent breaks filled with physical activity. RESULT: We have experienced that a very well planned mixture of physical activity and talks is essential if we are to meet the children in question in their grief. We use activities as: small breaks used to play, excursions to the graveyards where their relatives lay buried, imaginary trips, meditation, working with modelling wax or other creative activities.

694 An Evaluation of the ‘Good Food at Home’ Program: A Community-based Support for Women Recently Diagnosed with Breast Cancer Labrecque Ma,b, Gould Ja,b, Boucher Bc, Enk Va,d, Frood Jc,e a Ontario Breast Cancer Community Research Initiative Women’s College Hospital, Toronto, Canada; bCentre for Research in Women’s Health, Women’s College Hospital, Toronto, Canada; c Cancer Care Ontario, Toronto, Canada; dRadiation Oncology, University of Toronto, Toronto, Canada; eFoodShare, Toronto, Canada PURPOSE: Though eating patterns are fairly stable throughout one’s life, they can change following a cancer diagnosis. Dietary changes may improve quality of life among survivors by increasing their sense of control and well-being. Interventions encouraging dietary change tend to utilize interactive activities and social support and are focused on an individual’s readiness to change, food preferences/availability. Research is required to understand the experience of dietary change in response to participating in such interventions. The ‘Good Food at Home’ program was created to offer practical support to women newly diagnosed with breast cancer. This program includes the home delivery of fruits and vegetables over a period of six months to women receiving active treatment with the intention to make it easier to eat well during this time. METHOD: The qualitative evaluation focused on quality of life, feelings of support, consumption of fruits/vegetables, and fear/anxiety associated with food pre/ post diagnosis, food preferences/availability, and program satisfaction. Ten women were chosen for their diversity in ethnicity, income, age and treatment modality. In-depth telephone interviews were conducted prior to the delivery of the first box, at program completion and six months later. FINDINGS: Program Expectations: Most parti-

Copyright # 2006 John Wiley & Sons, Ltd.

cipants had already begun to make changes or considered making changes to their diet prior to receiving the box. PROGRAM COMPLETION: The program encouraged women and their families’ to increase their fruits and vegetable consumption as well as encouraged them to eat a wider variety of fruits and vegetables which was also evident at 6 months follow-up.

695 Cognitive Function in Women with Early Breast Cancer Receiving Adjuvant Chemotherapy Lacey RTa, Aimola Davies AMa, Stuart-Harris Rb, Byrne DGa a School of Psychology, The Australian National University, Canberra, Australia; bMedical Oncology, The Canberra Hospital, Canberra, Australia Inconsistent findings have been reported regarding cognitive deficits in women with breast cancer following adjuvant chemotherapy. As confirmed by meta-analyses, reports of the type (diffuse vs focal), duration (long-term vs transient) and domain of chemotherapy-induced cognitive impairment differ, depending on whether group comparisons are done on a cross-sectional or longitudinal (baseline comparison) basis. Effects of chemotherapy on cognition are often difficult to evaluate because they may be subtle, or confounded by cognitive effects of mood alterations resulting from diagnosis of a life-threatening illness, or by practice effects from repeated exposure in prospective designs. In addition, hormone depletion related to chemotherapy may contribute to cognitive changes. The potential impact of factors such as surgery, menopausal symptoms, concurrent toxicities, mood, and fatigue on cognition has not been systematically addressed. Despite the current interest in chemotherapy side-effects, the evidence base remains small and lacks: (1) longitudinal studies with prechemotherapy baseline measures, (2) a detailed cognitive test battery to aid differential diagnosis, and (3) adequate controls. Here we examine why contradictory findings might have occurred in the context of the different types of studies, interpretation of test results, and methodologies adopted. We report on a new study designed to account for a number of previous shortcomings.

696 Quality of Life in Intermediate or High Risk Prostate Cancer Patients Treated by External

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Beam Radiotherapy and Brachytherapy with or without Androgen Deprivation Lacorte-Pi TMa, Guix-Melcior Bb, Guedea-Edo Fb a Psycho-Oncology Unit, IMOR Foundation, Barcelona, Spain; bRadiotherapy Service, IMOR Foundation, Barcelona, Spain; cRadiotherapy Service, IMOR Foundation, Barcelona, Spain PURPOSE: To elucidate long-term changes in health-related quality-of-life (HRQOL) outcomes by prospectively re-evaluating a cohort of intermediate- or high-risk prostate cancer patients. MATERIAL AND METHODS: A cross-sectional survey was administered to 200 consecutive patients with either intermediate (Gleason 7 or PSA 10-20 or T2A-B) or high (Gleason>7 and/or PSA>20 and/or >T2B) - Risk Prostate Adenocarcinoma before treatment and at 6 months interval during 4 years follow-up. The EORTC CLQ-C30 with the PR-25 module was employed. HRQOL was compared among therapy groups. RESULTS: 200 patients completed the measurable questionnaires. Significant changes in HRQOL were found depending of the time after treatment. After a temporal decline in HRQOL, an improvement of it was found during the first 18 months after end of treatment. Significant improvement in the urinary irritative-obstructive performance (p50:006) was found after 6 months post-treatment. Bowel domains worsened after therapies (p50:05) but improved after 18 months follow-up (p50:02). Overall sexual HRQOL deteriorated depending greatly on treatment (p50:008). Patients who were given AD presented a significant lower Sexual Function values after treatment, that were difficult to recover after AD cessation (p50:007). No differences in HRQOL were found between LDR or HDR BT implants. Satisfaction with either treatment was high. CONCLUSION: The instruments QLQC-30 and PR-25 provided a sensitive measure of physical, functional and psychological aspects across treatment groups and indicated that there are important differences between them on different aspects of Health Related Quality of Life.

697 Preferences and Differences in Information, Communication and Distress among Different Types of Cancer Lacorte-Pı´ TMa, Leo´n-Pizarro Cb, Guix-Melcior Bc a Psycho-Oncology Unit, IMOR Foundation, Barcelona, Spain; bPsycho-Oncology Unit, Hospital de

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Terrassa, Barcelona, Spain; cRadiotherapy Service, IMOR Foundation, Barcelona, Spain PURPOSE: To analyse the correlation between levels of distress and preferences for information and communication. MATERIAL AND METHODS: 100 patients completed the Hospital Anxiety and Depression (HAD), Functional Assessment Cancer Therapy (FACT-G) and Cuestionario de Comunicacio´n e Informacio´n in cancer (CCIC). Prostate Cancer Patients: 86% married; 10% single; 3.3% divorced. 73.3% retired; 23% active. 33.3% High School; 80% believe in God or some Superior Being. Breast Cancer Patients: 40% married; 10% single; 20% widow. 45% active; 25% retired. 25% High School. 70% believe in God or some Superior Being. RESULTS: Significant differences were found depending on gender. Women show higher scores in Anxiety and Depression Scale (p ¼ 0:00 and p ¼ 0:019) than men. Health Related Quality of Life does not show a correlation with preferences for information and communication (0.06). DISCUSSION: The instruments HAD, FACT-G and CCIC provided sensitive measures of information and communication aspects and indicated that there are some important differences between men and women in order to obtain information and establish communication about their disease. Gender is a very important variable to take into account when studies about information and communication are made.

698 Monitoring Two Hundred Prostate Cancer Patients Health Related Quality of Life. A Final Study Lacorte-Pı´ TMa, Guix Melcior Bb a Psycho-Oncology Unit, IMOR Foundation, Barcelona, Spain; bOncology Service, IMOR Foundation, Barcelona, Spain PURPOSES of this study are:. To obtain the Health Related Quality of Life (HRQoL) Prostate Cancer Patients Profile. To identify Treatment Related Symptoms that modify Health Related Quality of Life of prostate cancer patients. METHODS: Two hundred consecutive prostate cancer patients treated at IMOR Foundation since December 1999. All patients were treated using Brachytherapy and/or External Radiotherapy and or Androgen Deprivation. Two hundred patients average age of 68 (50–85), PSA average of 16.40 ng/ml (1.04–89.80) and different 1994 AJCC

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Stage T1/T3 tumours, Gleason score 1.04 (0–10) and no perineural invasion. The European Organization for Research and Treatment of Cancer (EORTC) QLQ C-30 Questionnaire with the PR25 module were administered prior to treatment, 3, 6, 12 and 24 months later. RESULTS: SPSS statistics. A standard one way analysis of variance was performed in order to describe differences between treatments groups. Prostate Cancer Patients have a high HRQoL in general, except: Sexual Function depends on treatment (0.008). Patients who were treated with AD or treated with a combination of RT and/or BT and AD presented a significant lower Sexual Function values after treatment. Role Function depends on treatment (0.003). Patients treated with RT presented a significant lower Role Function values. Fatigue depends on treatment (0.006). Patients who were treated with External Radiotherapy presents a significant Higher Fatigue values. CONCLUSIONS: These findings may: Provide health care providers with knowledge about different treatment for prostate cancer. Enable patients to make more informed about treatment decisions.

699 The Observed Versus Estimated Quality of Perception of Patient Symptoms Reported by Healthcare Professionals in Palliative Care Ladinek V, Zloklikovits S, Adritsch E, Samonigg H Department of Oncology, Medical University, Graz, Austria PURPOSE: An effective palliative symptom management requires knowledge of factors influencing the accuracy of assessment by other raters. This study compares symptom severity ratings of patients and their professional caregivers depending on the estimated quality of perception of nurses and physicians. METHODS: Socio-demographic data, different physical, psychological and functional disorders as well as pain were assessed independently by 50 advanced cancer patients themselves and their treating caregivers using a modified standardized Symptom List in Palliative Care (MIDOS) and the psychological subscale of the Memorial Symptom Assessment Scale (MSAS-PSYCH). Additionally, the caregivers filled out a question measuring their estimated quality of perception: ‘How well do you believe to perceive and estimate the patients’ symptoms?’. RESULTS: Statistical analyses were computed on

Copyright # 2006 John Wiley & Sons, Ltd.

sum-scores for pain, physical/functional symptoms and psychological symptoms (ANOVAs, Wilcoxon-test) for the total sample as well as for two subgroups (high vs low estimated quality of perception). The assessment of physicians with a high estimated quality of perception and the patients’ self-assessment showed no significant difference. Physicians with a lower estimated quality of perception significantly overestimated the intensity of patients’ psychological symptoms (p ¼ 0:003). Independent of the quality of perception, nurses scored pain significantly lower than patients (p ¼ 0:002; p ¼ 0:048). Nurses with a high estimated level of quality of perception significantly underestimated the occurrence of physical/ functional symptoms (p ¼ 0:021). CONCLUSION: The findings indicate that factors influencing the level of agreement, like the estimated quality of perception, should be more integrated in further research.

700 Psychological Impact of Genetic Diagnosis in Endocrine Tumors: The Example of Paragangliomas and Pheochromocytomas Lahlou-Laforet Ka, Consoli SMa, Jeunemaitre Xb, Gimenez-Roqueplo APb a C-L Psychiatry Paris 5 University of Medicine, AP-HP, European Georges Pompidou Hospital, Paris, France; bGenetics Paris 5 University of Medicine, AP-HP, European Georges Pompidou Hospital, Paris, France In around 25% of the cases, paragangliomas and/ or pheochromocytomas may reveal an hereditary disease due to a mutation in one of the predisposing SDHD, SDHB, SDHC, VHL, RET or NF1 genes. In index cases, a positive genetic testing allows to trigger the management and the follow-up of the affected subject. In the first relatives, positive presymptomatic genetic testing permits to organize an accurate medical supervision in order to early detect small and easily operable tumors. Thus, the medical benefit of the genetic diagnosis is well recognized but its psychological consequences need to be evaluated. We have created a multidisciplinary oncogenetic consultation which is dedicated to endocrine tumors at European Georges Pompidou Hospital (Paris). This outpatient visit includes a consultation with a psychiatrist before genetic testing and a visit after delivery of the result by the geneticist. In a population of 40 patients, we assessed the

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emotional impact of genetic testing. Before the blood sampling, we evaluated anxiety, depression and the subjective risk to be positive, as estimated by the candidate tested. After the genetic test result we measured again anxiety, depression and the post-traumatic burden of the results (Impact of Event Scale). Data collection is in progress and results will be presented during the IPOS congress.

701 Lessons Learned While Conducting Focus Groups with Individuals with Cancer: Tips to Optimize the Experience Lambert SD, Dubois S, Loiselle CG School of Nursing, McGill University, Montreal, Canada PURPOSE: To present the authors’ experience with and challenges encountered while conducting focus groups with individuals diagnosed with breast, prostate or colorectal cancer. METHOD: As part of a larger study to document individuals’ motives in information seeking about cancer, nine focus groups were conducted between January and June 2006. Participants were recruited from oncology ambulatory clinics of a University teaching hospital in Montreal, Canada. RESULTS: Practical insights gained from our experience with focus groups include. (1) Reliance on well-planned approaches to gain access to clinical settings particularly when no prior investigation has been conducted in such setting (e.g. preparing appealing materials tailored to the multiple stakeholders; ‘publicize’ the study); (2) Adapting the recruitment process to the clinics’ characteristics (e.g. seeking the assistance of volunteers); (3) Using the most appropriate criteria to determine the composition of groups (size; homogeneity vs heterogeneity of participants’ characteristics such as sex, type and stage of cancer); (4) Timing invitations and contact according to participants’ health status and preferences to maximize attendance; (5) Refining the interview guide as the study unfolds; (6) Adjusting the interview according to group composition and dynamics; and (7) Strategizing logistics (e.g. equipment; refreshments). Also discussed are challenges related to moderators’ experience (or lack of) and participants’ preferences for individual interviews vs focus groups. CONCLUSION: Careful attention to pragmatic issues while planning focus groups in psychosocial oncology is likely to optimize the richness of data, mean-

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ingfulness of the experience for both investigator and participant and enhance the overall quality of the inquiry.

702 Exploring the Discipline of Volunteerism in a Multidisciplinary Palliative Care Setting: A Unique Canadian model Lapointe BJa, O’Brien SMb a Palliative Care Division, Sir Mortimer B. Davis Jewish General Hospital, Montreal, Canada; bHope & Cope, Sir Mortimer B. Davis Jewish General Hospital, Montreal, Canada It is the mantra of health care systems that multidisciplinary teams provide the most comprehensive approach to patient care. If volunteers are part of a multidisciplinary team, than what is the discipline associated with volunteerism? The collaboration of Hope & Cope (a community-funded, volunteer-based cancer support program) and the Palliative Care Unit of the Jewish General Hospital has allowed us to develop a unique model integrating community, volunteer and professional support for patients and families which goes well beyond the traditional role of most volunteer programs. This presentation looks at the integration of emerging Canadian standards for best practice and quality in the volunteer component at end of life and the role of the volunteer in the domains of self-esteem and selfworth which we know play a buffer role for patients coping with death anxiety. Case narratives will be used to explore the development of a therapeutic environment which has allowed us to maximize work in multiple languages and with respect to diverse spiritual traditions and to enhance the psychosocial support available to patients and families at end of life and in bereavement.

703 Psychological Online Counselling in Leukaemia Patients Larbig W, David N, Schlenker P, Prudlo U Department of Medical Psychology and Behavioral Neurobiology, University of Tuebingen, Tuebingen, Germany PURPOSE: The aim of this prospective study was to examine the efficacy of online counselling by e-mail in leukemia patients in reducing disease and therapy-related symptoms such as distress,

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anxiety, depression and in improving coping behavior and quality-of-life. Studies focusing on this specific issues are lacking. METHODS: Data were collected from 47 leukemia patients who participated in a web-based online service which lasted for 2 months. Individual counselling consisted of cognitive restructuring, psychoeducation and teaching of various coping strategies. Problem areas treated included interaction with relatives, partners and doctors, real and dysfunctional fears of relapse and employment issues. A single group, pretest–posttest design with 2-month counselling sessions provided assessment of client satisfaction (HAQ), changes in coping with illness (MAC), psychological stress (BSI) and health-related quality-of-life (QLQ-C30 with QLQ-LEU). In addition, emotional state was recorded before and after writing e-mails (PANAS). RESULTS: Patients (n ¼ 47) displayed a high level of unmet therapeutic needs. 82% were not using any conventional online assistance, despite severe psychological stress Pre-posttest comparisons showed significant reductions of depression and anxious preoccupations. Immediately after writing, patients experienced a significantly improved positive emotional state. CONCLUSIONS: Shorttime counselling was effective in improving psychological functioning and quality-of-life and should therefore be considered as an important component in psycho-oncology. ACKNOWLEDGEMENTS: Supported by the Deutsche Jose´ Carreras Leuka¨mie Stiftung e. V. (DJCLS R03/23p).

704 Dyadic Coping and Marital Satisfaction of Couples that are Coping with Cancer Laron A Department of Oncology, Hadassah University Hospital, Jerusalem, Israel Dyadic coping and marital satisfaction of couples which are coping with cancer. PURPOSE: During the last decades, the concept of coping has been broadened to include the dyadic context. Much of the research that has been carried out on dyadic coping is based on models and measures of individual coping. The present study attempts to examine the concept of dyadic coping in the context of couples coping with cancer. The study, based on the model of R. Lyons et al., assumes that there is such a phenomenon as dyadic coping, which is used along with individual coping. This

Copyright # 2006 John Wiley & Sons, Ltd.

model presents a broad theoretical approach to dyadic coping. METHOD: 30 women with breast cancer and their spouses and 30 healthy couples as the control group were administered the Dyadic Coping Scale (G. Bodennman) and the Dyadic Adjustment Scale (G. Spiner). RESULTS: The results support the hypothesis that couples who scored high on dyadic coping report higher satisfaction than couples who scored low on dyadic satisfaction. However, the hypothesis was not confirmed that couples who cope with cancer report lower marital satisfaction. Furthermore, contrary to the hypothesis, couples where one member scored high and the other low on dyadic coping did not report the lowest marital satisfaction. It was found that women were more likely to cope in a dyadic way. CONCLUSION: Dyadic coping is a mode of coping which is central in a couple’s life. When coping with cancer, couples should be qualified for intervention treatment as a relevant technique.

705 Psycho-Oncology: Activities to Prepare Medical Procedures and Hospitalization Zoe´ga Soares, Marinho ML General and Behaviour Analysis Psychology, State University of Londrina, Brazil Hospitals should invest in the overall Human Resource Development to work with children by creating a pleasant environment and specific programs which include playing games during medical care. PURPOSE: To prepare professionals for the use of simulations as intervention alternatives to help children develop adequate behavioral repertoires towards medical procedures and hospitalization. Through game activities, patients can recall experiences involving difficult themes in a more pleasant way. METHODS: Provide miniatures of real hospital; role-play medical procedures; provide information about medical instruments and procedures; motivate free-play and inter-peers play. Population: 12 children aged between 5 and 8 years old, admitted to a children’s hospital ward. The development of this stage consisted of using the material for roleplaying; helping the child to act as the medical procedure agent; providing ‘patient’ reaction models. The Observation Scale of Behavioral Distress was used as a data collection instrument. RESULTS: Statistical analysis and qualitative data analysis made it possible to evaluate the

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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participants’ behavior in hospital context. Expected generalization: The use of games and roleplaying during hospitalization and medical care help children accept treatment and illness by means other than physical and psychological suffering. CONCLUSIONS: During hospitalization, the children were motivated to evaluate and manage their own behavior by taking an active role in the process and by learning from their own experience, thus becoming responsible for the change, changing their passive participation into an active participation.

706 Risk for Cancer, Myocardial Infarction and Psychiatric Disease Among Members of Religious Societies}A Danish Cohort Study Larsen LRa, Hvidt NCb, Hansen HPc, Dalton SOa, Johansen Ca a Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark; bDepartment of Theology, Notre Dame University, Notre Dame, USA; cInstitute of Public Health, University of Southern Denmark, Odense, Denmark PURPOSE: To investigate whether the risk for cancer, cardiovascular disease and psychiatric admissions among members of selected Danish religious communities differs from that of the general Danish population. METHODS: We will establish a cohort of members of religious societies such as the Seventh Day Adventists, the Baptist Church and the Catholic Church. The CPR number, which is a unique personal identification number assigned to all Danish citizens, permits accurate linkage of information between registers (i.e. the Danish Cancer Register, the Hospital Discharge Register and the Danish Psychiatric Central Register). The population-based character of the registers will allow us to generate background rates in order to make age and genderadjusted comparison with the Danish background population. Analyses stratified by length of membership of the community will be performed as well as analyses comparing those who withdraw from the community with those who remained in the community until death. We will also investigate whether the risk for disease differs between the various religious communities in an attempt to estimate if these health risks or benefits could be ascribed to the varying heath habit prescriptions of these communities. RESULTS AND CONCLUSIONS: This prefatory work is intended to

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lead to a variety of research methods (e.g. a case– control study nested within these communities and qualitative studies) in an attempt to obtain a more profound understanding of the meaning of faith and the complex associations between faith, religious practice, lifestyle habits, the social environment and mental and physical heath.

707 The Contents of Individual Consultations between Patients and Health Professionals at the Time of Rehabilitation as Evaluated Separately by Both Sides Larsen S, Tofte J, Nielsen Mogens M, Piester CB, Kristensen T The Dallund Centre for Rehabilitation of Cancer Patients, Danish Cancer Society, Søndersø, Denmark BACKGROUND: Our knowledge of cancer patients’ experience of individual consultation with health professionals is generally based on specialist records and mostly concerns consultations close to treatment. Dallund offers a one week residential course in rehabilitation to cancer patients from all over Denmark. Each year approximately 650 patients visit Dallund on average 8.3 months after their last treatment (range 1–107 months, mode 2 months). All residents are offered individual consultations (45 minutes) with health professionals. During 2006 these consultations are monitored. PURPOSE: To obtain knowledge about the contents of these consultations as these are experienced by both the patients and the professionals. METHOD: A short, structured questionnaire has been developed and is given to both the patient and the professional immediately after the consultation. Both are asked to state the five (maximum) main themes of the consultation, their expectations and the character of the dialogue (knowledge, support, possibilities). The questionnaire can be completed in less than 5 minutes. The data are analysed in a two-way manner in order to identify on which topics both patient and professional are agreed and where they differ. The data may further be collated to Dallunds other information about the individual patients, e.g. the patients’ expectations to their stay at Dallund, the Dallund Scale disclosing the patients’ need of rehabilitation, and the patients’ evaluation of their stay. RESULTS: The data and analysis of approximately 50 consultations between patients and Dallund’s nurse or medical doctor will be presented.

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708 Side Effects at the Time of Rehabilitation as Reported by More than 600 Cancer Patients’ in Response to an Open Question and a Structured, Closed Questionnaire Larsen S, Tofte J, Hjortebjerg U, Piester CB, Kristensen T The Dallund Centre for Rehabilitation of Cancer Patients Danish, Cancer Society, Søndersø, Denmark Our knowledge of side effects after cancer and its treatment is generally based on observations close to treatment. Less is known about late complications months or years after treatment. PURPOSE: 1. To identify and quantify the side effects reported by cancer patients at the time of rehabilitation. 2. To ascertain whether answers prompted by an open question yield results comparable to answers obtained by a structured, closed questionnaire. METHODS: Before their stay at Rehabilitation Centre Dallund, each patient received a set of open questions related to the stay. The patients also received the Dallund Scale, which is a highly structured one page questionnaire qualified to disclose the patients’ need of rehabilitation. The scale contains the possibility of checking 64 different complications. 624 patients attended Dallund during 2005; they attended Dallund 1–107 months after treatment. RESULTS: 1. Both the number of different complications and the frequency of side effects picked up by the ‘open question’ are significantly less than those checked on the Dallund Scale. 2. Approximately 11% of the patients does not respond to the open question, but indicate complications on the Dallund Scale. Their profiles of side effects are similar to the rest of the patients’. 3. Approximately 5% of the patients simply state that they have ‘several complications’ when answering the open question. When investigated by the Dallund Scale, these patients have profiles of side effects similar to the rest of the patients. The profiles of side effects reported by these 624 patients’ will be presented.

709 Fatigue in Cancer Patients at the Time of Rehabilitation Larsen S, Tofte J, Nielsen Mogens M, Piester CB, Kristensen T The Dallund Centre for Rehabilitation of Cancer Patients, Danish Cancer Society, Søndersø, Denmark

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BACKGROUND: Fatigue is one of the most common side-effects during cancer treatment. Reduced quality of life during chemo- and radiation therapy may be due to fatigue. Much less information is available about fatigue and its role after treatment, e.g. at the time of rehabilitation. Dallund offers a one week residential course in rehabilitation to cancer patients from all over Denmark. Each year approximately 650 patients visit Dallund on average 8.3 months after their last treatment (range 1–107 months). 53% of these patients are women with breast cancer. Since 2004 all 1272 patients have completed the Dallund Scale, which is a highly structured one page questionnaire qualified to disclose the patients’ need of rehabilitation. On this scale 68% indicate that they are distressed by tiredness. PURPOSE: 1. To investigate the frequency and the quality of fatigue among Dallund’s patients as measured by the Multidimensional Fatigue Inventory (MFI-20, Danish version). 2. To analyse possible correlations of fatigue to diagnosis and treatment. 3. To identify possible differences in the experience of fatigue between breast cancer patients and the remainder group patients at the rehabilitation centre. METHODS: All patients coming to Dallund between January and May 2006 (estimated 200) are asked to fill in MFI-20. The data are collated to the patients’ diagnoses and treatments and may be further compared to Dallunds other information about the individual patients, e.g. from the Dallund Scale. RESULTS: The results of this investigation will be presented at the congress.

710 The Pedagogy and Didactics of the Dallund Centre for Rehabilitation of Cancer Patients Larsen S, Tofte J, Nielsen A, Piester CB, Kristensen T The Dallund Centre for Rehabilitation of Cancer Patients, Danish Cancer Society, Søndersø, Denmark BACKGROUND: Dallund offers a one week residential course to cancer patients. The American Cancer Society’s rehabilitation programme ‘I can cope’ (1979), the Swedish ‘Starting-Again’ group rehabilitation programme as well as the experience from the cancer schools of the Danish Cancer Society have provided the empirical grounds for the pedagogical contents of the stay at Dallund. The duration and the structure of the present course, the actual contents of the topics,

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their duration and order are the results of practical experiments during the first four years of the project. PURPOSE: To identify and describe factors influencing the learning of the participants concerning rehabilitation after cancer. METHODS: A study of pedagogical literature in general and more specific in relation to people with a cancer disease. A systematic study of the daily practice at Dallund. RESULTS: We present a practical description of the pedagogic factors influencing patient education and rehabilitation after cancer. CONCLUSIONS: It is possible to support the participants’ learning by organizing and carrying through the course in such a way that the participates’ learning conditions are met, e.g. concerning frames, goal, contents, learning processes and evaluation.

711 Physician Designation of Pathological Levels of Psychological Distress in Patients with Advanced Cancer: Frequency, Correlates and Predictors in Patients Admitted to a Tertiary-Level Inpatient Palliative Care Unit Lawlor PGa, Nekolaichuk CNb, Kelly Ac, Fainsinger RLd, Bruera EDe a Palliative Medicine, Our Lady’s Hospice, Dublin, Ireland; bPsychosocial and Spiritual Resources, Cross Cancer Institute, Edmonton, Canada; cCommunity Medicine, Trinity College, Dublin, Ireland; d Oncology, University of Alberta, Edmonton, Canada; ePalliative Care and Rehabilitation Medicine, MD Anderson Center, Houston, USA PURPOSE: To characterize physician designation of pathological levels of psychological distress (PLPD) in advanced cancer by determining its frequency, correlates and predictors in tertiarylevel palliative care unit (TPCU) patients. METHODS: We retrospectively examined TPCU database records to obtain the following: demographics; systematic physician rating of patients’ psychological distress in the Edmonton Staging System (ESS) for cancer pain classification; Edmonton Symptom Assessment System (ESAS) scores; and morphine equivalent daily dose (MEDD) for the day following admission. Consecutive first admission data for patients surviving more than three days were eligible. Independent variables for patients with complete data were entered into a logistic regression model with PLPD as a dependent variable. RESULTS: From 1351 patients meeting initial descriptive analysis

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eligibility criteria 1259 (93.2%) had ESS ratings for PLPD. The PLPD prevalence was 243/1259 (19.3%). In bivariate analysis (N ¼ 879) PLPD was positively associated (p50:05) with female gender, younger age, opioid tolerance, substance abuse, MEDD, patient ESAS scores for pain, anxiety, depression, and the total 9-item ESAS score or global symptom distress. In the regression model (N ¼ 879) ESAS depression score and younger age were the strongest positive predictors of PLPD: OR ¼ 4:2 (1.5–12.2, upper-lower) and 3.4 (1.2–9.3), respectively. Female gender, opioid tolerance, and substance abuse were retained as weaker, positive independent predictors in the model. CONCLUSIONS: Experienced physician designated PLPD is common in advanced cancer and is strongly predicted by younger age and higher patient depression ratings. ACKNOWLEDGEMENTS: We wish to acknowledge support from the Alberta Cancer Board Palliative Care Research Initiative, Canada; Our Lady’s Hospice, Dublin; and the Academic Unit of Clinical and Molecular Oncology, Trinity College, Dublin.

712 Psychosocial Adjustment to Breast Cancer Surgery Leal Ia, Patra˜o Ib, Maroco Jc a Psychology ISPA, Lisboa, Portugal; bPsychology ISPA, Lisboa, Portugal; cEstatistics ISPA, Lisboa, Portugal Dealing with breast cancer surgery can range from being a crisis experience, to a trauma with various negative consequences at psychosocial level. To help women go through this experience it is important to assess the emotional response to breast cancer surgery. A study was conducted to assess the emotional response to cancer surgery and its relation with coping styles, emotional control and social support. In this study 100 women were assessed after surgery for breast cancer, at Dr. Alfredo Costa Maternity (Lisbon). We found that, in women with breast cancer surgery, higher levels of stress, depression and anxiety are associated with a passive coping style, emotional control and lower satisfaction with social support. Data suggests that a psychological intervention with these women should be focus on emotional expression, search for alternative social support that can be more satisfying, enabling a beneficial emotional response to breast cancer diagnosis and prevent a poor adjustment in the

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future, during the disease experience and adjunct treatments.

713 Stigma and the Psychosocial Impact of Head and Neck Cancer Lebel Sa,b, Bezjak Ac, Irish Jd, Devins GMa,b a Psychosocial Oncology and Palliative Care, University Health Network, Toronto, Canada; bPsychiatry, University of Toronto, Toronto, Canada; c Radiation-Oncology, University Health Network, Toronto, Canada; dSurgical Oncology, University Health Network, Toronto, Canada PURPOSE: Stigma can affect all cancer patients. It can exacerbate the stress associated with illness and lead to distress and reduced social life. Individuals whose behavior may have contributed to their cancers and/or who are left visibly disfigured are at greater risk for stigma. These conditions make head and neck cancer patients particularly vulnerable to stigma. Our goal was to investigate the relationship among stigma, distress, and well-being in head and neck cancer patients. We examined disfigurement, self-blame for cancer because of smoking and drinking, gender, and benefit-finding as moderators of this relationship. We hypothesized that the impact of stigma on distress and well-being would be greater among head and neck cancer patients who reported comparatively high disfigurement and self-blame, who were female and who reported comparatively few benefits associated with their illness. METHODS: 85 head and neck cancer patients completed a self-administered questionnaire that included widely used measures of distress, well-being, stigma, self-blame, disfigurement and benefit-finding. All respondents had been surgically treated and were less than three years post-diagnosis. RESULTS: Hierarchical regression analyses, controlling for significant covariates, indicated that stigma correlated significantly and uniquely with distress. Self-blame did not moderate the effects of stigma, but did correlate with increased distress. Disfigurement correlated significantly and uniquely with stigma. Gender did not moderate the effects of stigma. A significant Benefit-Finding  Stigma interaction indicated that highly distressed and stigmatized patients focused significantly more on cancerrelated benefits. CONCLUSIONS: Increased understanding of stigma and its psychosocial impact can inform efforts to facilitate adaptation.

Copyright # 2006 John Wiley & Sons, Ltd.

714 Advantages and Limits of Multidisciplinary Tools Leger I, Bendrihen N, Dauchy S Psycho-Oncology Unit, Institut de Cance´rologie Gustave Roussy, Villejuif, France BACKGROUND: In Gustave Roussy Institute (IGR) a one-day study (Dauchy, 2003) using HADS showed that a strong proportion of hospitalized patients presented high psychological distress: anxiety 33% (HADS-A>11), depression 18% (HADS-D>11). 48% of distressed patients refused to meet a psychologist. Moreover there was no concordance between psychological needs as assessed by the staff and HADS scores, and the patients were arbitrary referred to psychooncology unit. PURPOSE: Improving referral and care of patients’ psychological needs from the staff, implicating them in a screening policy. Actions: a dynamic approach, based on the common tools used by physicians and nurses, has been implemented to better evaluate and take into account patients’ distress. These following tools have been introduced: (a) a brief demand form, filled by the nurses or the physicians to address a patient to the psychologists. It states the motivation and the degree of emergency of this demand. (b) a new structure for the psychological pages of IGR’s intranet. The design proposes easy to access guidelines to detect regular clinical situations (anxiety, depression, etc.). It also describes the common reasons of patient’s skepticism toward a psychological assistance and the possibilities to overcome them}integration of psycho-social data in the computerized patient’s files used by nurses. RESULTS: Better patients access to psychooncology unit (+29.4% consultations from 2003 to 2005), and better motives screening. Nevertheless, the persistence of few maladjusted demands indicate multidisciplinary limits. We present examples of these demands referring to a real institutional need.

715 Psychosocial Distress and Physical Burden: Longterm Effects of Interdisciplinary Cancer Rehabilitation Programs Lehmann Ca, Bergelt Ca, Hagen-Aukamp Cb, Berger Dc, Koch Ua a Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg,

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

ABSTRACTS OF THE 8TH WORLD CONGRESS OF PSYCHO-ONCOLOGY

Germany; bNiederrhein-Klinik, Korschenbroich, Germany; cFight Against Cancer Consortium, Bochum, Germany PURPOSE: Interdisciplinary rehabilitation interventions focus on the improvement of physical and mental impairments caused by cancer and its treatment. In Germany they are performed in an inpatient or outpatient setting for about three weeks. Temporary positive effects on patients’ health were found, long-term effects remain unclear so far. METHODS: The prospective study assesses the outcome of rehabilitation interventions in the long-term. 258 cancer patients receiving an outpatient (52%) or inpatient (48%) rehabilitation program were examined at the beginning (T1), at the end of the rehabilitation (T2) and one year afterwards (T3). Psychosocial burden was obtained by standardized instruments (HADS, SF-12, Distress Thermometer (DT), among others). Additionally, physical impairments were assessed by physicians’ evaluations. RESULTS: Initially younger patients (560 years) reported higher levels of anxiety and depression than older patients, young male patients had the highest depression scores (p50:05). At T2 in both settings patients’ anxiety and depression scores as well as their physical burden improved significantly (p50:001). At T3 38% of the 183 participants (response rate ¼ 70%) had scores >4.5 on the DT, 10% were anxious and 8% were depressed (HADS: scores >11). Following rehabilitation 55% of the distressed patients had consulted the general practitioner, only 10% attended psychosocial services. CONCLUSIONS: The results show positive effects of cancer rehabilitation on patients’ health but a lack of maintenance of these improvements. To meet psychosocial support needs during rehabilitation the early detection of highly distressed patients and provision of psychosocial services have to be more emphasized.

716 Correlation between Hospital Anxiety and Depression Scale (HADS) and an Emotional Problem List Leo´n Ca, Jovell Ea, Barthe Eb, Schro¨der Mc, Lluch Jd a Psycho-Oncology Consorci Sanitari de Terrassa, Terrassa (Barcelona), Spain; bPsycho-Oncology Clinica Teknon, Barcelona, Spain; cPsycho-Oncology Hospital Germans Trias i Pujol, (Can Ruti), Badalona (Barcelona) Spain; dPsycho-Oncology Hospital Josep Trueta, Girona, Spain

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PURPOSE: Emotional distress is a very common symptom among cancer patients. Given the interest in rapid psychosocial screening, the purpose of this study is to find the correlation between Hospital Anxiety and Depression Scale (HADS) and an emotional problem list measured with 0–10 scales METHODS: This is a retrospective descriptive study among 258 cancer patients in three hospitals from Catalonia (Spain). Patients completed HADS testing and a problem list with eight emotional problems, in 0–10 scales. The level of significance for the Pearson’s correlation coefficients analysis were set at 1% (0.01). RESULTS: There is an association between HADS measurements and the emotional problem list in every one of the 8 items (p ¼ 0:000). Concerning the subscale ‘Anxiety’, the correlation was good for ‘nervousness’ (r ¼ 0:660), ‘worry’ (r ¼ 0:532) and ‘sadness’ (r ¼ 0:504); and moderate for ‘fear’ (r ¼ 0:475), ‘depression’ (r ¼ 0:454), ‘lack of illusion’ (r ¼ 0:426), ‘adaptation to the disease’ (r ¼ 0:382) and ‘pain’ (r ¼ 0:341). Concerning the subscale ‘Depression’, the correlation was good for ‘lack of illusion’ (r ¼ 0:587) and ‘sadness’ (r ¼ 0:536); and moderate for ‘depression’ (0.475), ‘worry’ (r ¼ 0:444), ‘adaptation to the disease’ (r ¼ 0:395), ‘nervousness’ (r ¼ 0:393), ‘pain’ (r ¼ 0:322) and ‘fear’ (r ¼ 0:315). CONCLUSION: In our study correlation was significant in the comparison between HADS and a list of emotional problems. In our population, asking about ‘nervousness’, ‘worry’ or ‘sadness’ provide as much information about ‘anxiety’ than information provided from HADS subscale. And asking about ‘lack of illusion’ or ‘sadness’ provides comparable information about ‘depression’ as data obtained by HADS subscale.

717 Meaning and Connection in Life}Understanding the Mediating Effect of Social Support and Global Meaning on Distress in a Cancer Population Lethborg Ca, Kissane Db, Aranda Sc a Department of Oncology, St. Vincent’s Hospital Fitzroy, Australia; bDepartment of Psychiatry & Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, USA; cCancer Nursing Research, Peter MacCallum Cancer Centre and School of Nursing, University of Melbourne, Melbourne, Australia This study builds on previous work exploring the lived experience of meaning in advanced cancer.

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AIMS: To explore the associations of physical symptom burden, existential distress and social support with psychological distress (D) and global meaning (M) among 100 adults attending an Australian metropolitan cancer service. METHODS: The contribution of physical symptom distress, existential distress and social support, to D and M were examined. Multiple regression analyses were conducted to further examine relative contributions to both D and M. RESULTS: Physical symptom distress and existential distress were positively associated with D while high social support and personal meaning were related to lower levels of D. Social support was the strongest correlate of M while high levels of existential distress were related to lower levels of M. There was no association between socio-demographic and illness-related factors to either D or M. On the basis of this study, it is concluded that the factors related to suffering (i.e. physical and existential distress and lack of social support) clearly promote D and the reverse is true for M for those living with cancer. PRACTICE IMPLICATIONS: We need to better understand the impact of physical suffering and personal meaning in the lives of cancer patients and to actively work towards the enhancement of social support an connection with others in order to ameliorate suffering for those living with this serious illness.

718 Activities of Breast Cancer Survivors from Different Age and Ethnic Groups Levine EGa, Aviv Cb, Yoo Gc a Biobehavioral Center, San Francisco State University, San Francisco, USA; bSchool of Arts, Humanities, and Social Sciences Core Curriculum and the Center for Judaic Studies, University of Denver, Denver, USA; cAsian Studies, San Francisco State University, San Francisco, USA PURPOSE: To examine daily activities between women with breast cancer from different ethnic groups and ages. METHODS: 163 survivors (37 African-Americans, 52 Asians, 53 Caucasians, and 22 Latinas) participating in a study of social support and quality of life. RESULTS: Except for Caucasian women most women did the cooking and cleaning before diagnosis but fewer after. Caucasians and Latinas were less likely to care for their children than African-Americans and Asians. All women under age 40 cared for

Copyright # 2006 John Wiley & Sons, Ltd.

their children before diagnosis but only 83% did after. Women between the ages of 40–60 were more likely to take care of their children before and after diagnosis. Most of the women exercised regularly. The most common form of exercise was aerobic although some women did strength and flexibility activities. There were no differences in type or length of exercise between ethnic or age groups. CONCLUSIONS: While overall these women were capable of engaging in exercise and household chores, these results suggest that women under the age of 40 may have more difficulties with household chores. This is consistent with data showing that younger women are more distressed and have poorer quality of life. Since they are more likely to take care of their children, child-care services may be beneficial for them. ACKNOWLEDGEMENTS: Supported by a Research Infrastructure in Minority Institutions (RIMI) Grant 5 P20 MD000544-02 from the National Center for Minority Health and Health Disparities, National Institutes of Health.

719 Age Differences in Psychosocial Status, Social Support, and Quality of Life Among Breast Cancer Survivors from Diverse Ethnic Groups Levine EGa, Yoo Gb, Aviv Cc a BioBehavioral Center, San Francisco State University, San Francisco, USA; bAsian Studies, San Francisco State University, San Francisco, USA; c School of Arts, Humanities, and Social Sciences Core Curriculum and the Center for Judaic Studies, University of Denver, Denver, USA PURPOSE: To examine differences in psychosocial status, social support and quality of life between women in three age groups: under 40, 40–60 and over 60 years of age. METHODS: 163 women (37 African-Americans, 52 Asians, 52 Caucasians and 22 Latinas) answered surveys of mood, quality of life, and social support received before, during, and after treatment for breast cancer. RESULTS: Fourteen women were under 40, 89 women were 40–60, and 60 women were over 60 years of age. Women over 60 years of age had significantly lower levels of depression, anger, anxiety, fatigue, confusion, and total distress. They had significantly higher levels of vigor, physical, emotional, and functional well-being and overall quality of life than those between 40 and 60. Women over 60 had less concerns around

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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body image, worry that others will get breast cancer and the effects of stress on health than women in the other groups. Women over 60 had significantly higher levels of spiritual support before diagnosis than women under age 40. However, women over 60 had significantly lower high contact levels of their social network than the other two groups. CONCLUSIONS: Middle aged women have more distress, less social support and poorer quality of life than younger or older women. Psycho-oncologists might want to pay close attention to the distress in this middle-aged group. ACKNOWLEDGEMENTS: Research Infrastructure in Minority Institutions (RIMI) Grant 5 P20 MD000544-02 (National Center for Minority Health and Health Disparities, NIH, to San Francisco State University.

720 Benefits of Pet Ownership for Women with Breast Cancer Yoo Ga, Aviv Cb a Asian American Studies, San Francisco State University, San Francisco, USA; bSchool of Arts, Humanities, and Social Sciences, University of Denver, Denver, USA PURPOSE: To assess the benefits of pet ownership on breast cancer survivors METHODS: 107 breast cancer survivors (less than 4 years) were asked a variety of questions as part of a long-term study of social support, quality of life, distress and spirituality. RESULTS: Forty-eight women (45%) had pets, 49 (46%) did not. An additional 10 women (9%) did not have pets but liked them. Of the women with pets, 33 (80%) felt the pet was helpful. Caucasian women (n ¼ 27) were more likely to have a pet (57%) than Asian women (n ¼ 11; 39%) and African-American women (n ¼ 2; !2%). Half of the Latinas (n ¼ 8) had pets. The differences were significant (p ¼ 0:008). Married women (31, 54%) were more likely to have a pet than single (7, 41%), divorced (6, 38%) or widows (3, 27%, p ¼ 0:12). There were no significant differences in having children. Employed women (29, 57%) were more likely to have pets than unemployed (15, 33%, p ¼ 0:04). Women with pets were younger (p ¼ 0:01), had higher social/family well-being (p ¼ 0:08), felt connected to God (p ¼ 0:04), connected to others (p ¼ 0:04), felt loved (p ¼ 0:05), and were more thankful

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(p ¼ 0:05). CONCLUSIONS: Pet ownership is related to better social/family well-being, feeling connected to a higher power and others, feeling loved, and thankfulness. Pet ownership seems to be more popular among Caucasian and Latina women. ACKNOWLEDGEMENTS: Supported by Research Infrastructure in Minority Institutions (RIMI) Grant 5 P20 MD000544-02 from the National Center for Minority Health and Health Disparities, National Institutes of Health, to San Francisco State University.

721 Traditional Chinese Medicine and Psychology Li P Department of Traditional Chinese and Western Medicine, Peking University School of Oncology, Beijing Cancer Hospital, Beijing, China China is one of the richest cultured countries in the world with over 5000 years of history. About 2000 years ago, the first famous Traditional Chinese Medicine book}‘Yellow Emperor’s Canon Internal Medicine’ appeared. It discussed the relation of people with nature and society very minutely, and the system theory about how to judge, prevent, treat disease and health recovery. TCM takes patient’s feeling seriously. Beginning with asking patients, to the end of symptom change, care is taken of patient’s subjective symptom at all time. This idea is the same as western medicine about quality of life. The body which loses balance will fall ill. So we should both dispel disease and protect body resistance, especially for end stage cancer patients. Through regulating YIN–YANG, bowel and viscera, we can improve the quality of life and stabilize the tumor. Handling well the contradiction of human and disease is the most important thought of TCM holism conception. TCM still pays attention to the relation of mood and disease. Most patients have same emotional experience either patients hear bad news, or chemotherapy causes pain. TCM emphasizes that mood change would influence the body health. So doctors should care for patient’s feeling, give them help and courage, regulating the body’s function with herbal medicine. Doctor is a sacred occupation, because they face life. We not only should understand evidence medicine, but also should be adept in caring for patients, help them move the anxious. It is the most important

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work and duty in medical policy decision that we confront.

722 Factors Influencing Cancer Patients’ Desire for Psychological Support Merckaert Ia,b, Libert Yc,d, Razavi Da,b a Internal Medicine, Institut Jules Bordet, Brussel, Belgium; bPsychosomatics and Psycho-Oncology, Research Unit Universite´ Libre de Bruxelles, Brussel, Belgium; cHemato-Oncology Unit, Institut Jules Bordet, Brussel, Belgium; dHuman Resources, Institut Jules Bordet, Brussel, Belgium PURPOSE: The aim of this study was to investigate cancer patients’ desire for psychological support and to identify patients’ sociodemographic, disease-related and psychological factors associated with this desire. METHODS: The study is part of a multicenter, cross-sectional study assessing cancer patients’ needs and desire for psychological support. All consecutive inpatients and one consecutive outpatient out of two from ten Belgian hospitals were invited to participate. Patients completed a sociodemographic questionnaire, the HADS, the Ways of Coping Checklist, the Cancer Rehabilitation Evaluation System and reported their desire for psychological support. RESULTS: Among the 381 included patients, 21% reported desiring psychological support. Women (26%) desired psychological support significantly more often than men (11%) (P50.001). Regression analysis showed that women’s desire for psychological support was associated with being younger, not being in radiation therapy, receiving hormone therapy, having a support-seeking coping and experiencing sexual difficulties. Men’s desire for psychological support was associated with being younger, working part or full time, being Frenchspeaking, having a support-seeking coping and experiencing pain. CONCLUSION: One cancer patient out of five desires psychological support. This desire is more present in women than in men. Most importantly, this study shows that desire for psychological support is not associated with patients’ emotional state but rather with their support-seeking coping. These results emphasize the need to organize screening both for cancer patients’ distress and for their desire for psychological support. This will allow organizing psychological interventions according to patient needs.

Copyright # 2006 John Wiley & Sons, Ltd.

723 Factors that Influence Cancer Patients’ Anxiety Following a Medical Consultation. Impact of a Communication Skills Training Program for Physicians Lienard Aa,b, Merckaert Ia,b, Libert Yc,d, Marchal Se, Razavi Da,b a Psychosomatics and Psycho-Oncology Research Unit, Universite´ Libre de Bruxelles, Brussels, Belgium; bInternal Medicine, Institut Jules Bordet, Brussels, Belgium; cHemato-oncology Unit, Institut Jules Bordet, Brussels, Belgium; dHuman Resources, Institut Jules Bordet, Brussels, Belgium; eC.A.M. (Training and Research Group), Brussels, Belgium INTRODUCTION: No study has yet assessed the impact of physicians’ skills acquisition after a communication skills training program on the evolution of patients’ anxiety following a medical consultation. PURPOSE: This study aimed to compare the impact, on patients’ anxiety, of basically a communication skills training program (BT) and the same program consolidated by consolidation workshops (CW), and, to investigate physicians’ communication variables associated with patients’ anxiety. METHODS: Physicians, after attending the BT, were randomly assigned to CW or to a waiting list. So, the control group is not a non-intervention group. Consultations with a cancer patient were recorded. Patients’ anxiety was assessed with the State-Trait Anxiety Inventory before and after a consultation. Communication skills were analyzed according to the Cancer Research Campaign Workshop Evaluation Manual. RESULTS: No statistically significant change over time and between groups was observed. Mixed-effects modeling showed that a decrease in patients’ anxiety was linked with screening questions (p ¼ 0:045), physicians’ satisfaction about support given (p ¼ 0:004) and with patients’ distress (p50.001). An increase in anxiety was linked with breaking bad news (p ¼ 0:050) and with supportive skills (p ¼ 0:013). CONCLUSION: No impact of the training program was observed. This study shows the influence of some communication skills on the evolution of patients’ anxiety. Physicians should be aware of these influences.

724 Parents’ Accounts of Everyday Life after a Child’s Completed Treatment for Medulloblastoma

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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Lindahl Norberg A, Steneby S Childhood Cancer Research Unit, Karolinska Institutet, Stockholm, Sweden Several previous studies have observed stress in parents after successfully completed cancer treatment of a child. It is typically assumed that this distress represents lasting reactions to experiences during active treatment in the form of full-blown post-traumatic stress or less severe crisis reactions. On the other hand, parental reactions to current stressors related to the child’s cancer after completed treatment have attracted less attention. Nevertheless, especially when the child experiences remaining sequelae the family can be supposed to encounter several potential stressors. PURPOSE: The aim of this pilot study was to investigate the post-treatment influence of childhood medulloblastoma, as described by the parents. METHODS: The sample included three families where a child, now about 13 years of age, had successfully completed treatment for medulloblastoma 2–3 years ago. Both the mothers and the fathers took part in individual open-ended face-to-face interviews lasting 60–70 min. Strain and demands in the parents’ everyday lives were derived with inductive thematic method. RESULTS: The various aspects of influence, which parents referred to, were structured in the following themes: Supporting the child; Concerns about the child’s future; Adapting to current conditions; The parenting role. In addition, daily-life influence on the childhood cancer survivor him/herself and on his/her siblings also affected the parents. CONCLUSIONS: A full scale study of parents’ stress, including a larger sample, can contribute with valuable information for the planning of supportive interventions for these children and their families.

725 Fatigue and Aging in Cancer Patients Lissandrello Ga, Tralongo Pb, Respini Da a Psychooncology, Mareluce Onlus, Siracusa, Sicilia; bMedical Oncology, G. Di Maria Hospital, Avola (SR), Italy INTRODUCTION: Fatigue is the most common chronic symptom of cancer and the symptom most likely to disrupt the patient’s activity and cause disability. In older cancer patients fatigue appears to be related to different factors such as anemia, depression and reduced neuromuscular energy production. In the elderly, fatigue may cause

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functional dependence. PURPOSE: In this study we want to valuate the relationship between fatigue and depression in a geriatric group of cancer patients, undergoing in a chemotherapy program. METHODS: A cross-sectional study in a group of 54 patients over 65 years old (range 60– 85), the instruments used were: Geriatric Depression Scale (GDS), the Mini Mental State Examination, and the Fatigue Symptom Inventory. All patients had metastatic cancer. RESULTS: 52 patients reported fatigue in the last week (96%). In 51 patients fatigue had an interference with their daily activity. There was a significant correlation between depression and incidence of fatigue (p50.0007, Rhp 95% confidence limits 0.21: 0.76), depression was also correlated to the severity of fatigue (p5 0.0001, Rho confidence limits 0.27:0.82). CONCLUSIONS: depression and fatigue are correlated. They can have an important incidence in the quality of life of patients in the elderly, and are needed interventions to control depression and to reduce fatigue. This can improve the patient quality of life.

726 Multicenter Study of Emotional Assessment Scales in Oncological Patients Lluch Ja, Parra Ga, Leon Cb, Schroder Mc, Arcusa Ad a Psycho-oncology, Institut Catala` d’Oncologia, Girona, Spain; bPsycho-oncology, Health Center of Terrassa, Mutua of Terrassa and Parc Taulı´ of Sabadell, Sabadell., Spain; cPsycho-oncology, Hospital Trias i Pujol of Barcelona, Barcelona, Spain; d Oncology, Health Center of Terrassa, Mutua of Terrassa and Parc Taulı´ of Sabadell, Sabadell, Spain INTRODUCTION: Although emotional distress is very common in cancer patients, its detection is not a frequent assessment at medical settings. In the last few years, thanks to the success of visual analogue scales for pain detection and the distress thermometer proposed by J. Holland, the use of these types of scales have been generalized. We intend to compare the effectiveness of two different assessment instruments for the detection of psychological distress AIMS: 1. To contribute to improve detection of emotional distress, so incidence distribution and correct referral to treatment units is enhanced. 2. To determine the usefulness of visual–analogue scale to detect anxiety as well as depression levels in oncological patients. 3. To determine the usefulness of oral-numeric scale to detect anxiety as well as

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depression levels in oncological patients. METHOD: Prospective design. The sample was a group of consecutive oncological patients seen in a psycho-oncological ambulatory service. First, we asked patients to define their anxious and depressive signs on the last week, by assigning a number from 0 to 10 to each feeling. Second, patients filled up the HAD questionnaire as the independent variable. Last, we asked patients to mark their anxiety and depression feelings in two continuous lines, being one extreme of the line no distress and the other, maximum distress. This preliminary study tries to establish a research line for the improvement of detection instruments for the measure of psychological distress as an unavoidable part of good psychological and emotional screening of cancer patients.

727 Psychological and Neurological Status in Patients with Acute and Chronic Leucosis Zyrina G Tver State Medical Academy, Tver, Russia Psychological status in patients with malignant blood diseases having central and peripheral neural disorders is not well studied now. The aim of this study was to learn psychopathological disorders in leucosis. MATERIALS AND METHODS: 98 patients with acute (36; 36.7%) and chronic (62; 63.3%) leucosis were investigated (male}37, female}61, mean age}56.4 years). All patients are investigated by neurologist and in all cases reactive anxiety level (RAL) and personal anxiety level (PAL) (test C.D. Spiegelberg) and depression intensity (test W.W. Zung). RESULTS: 39 patients (39.8%) showed peripheral and central neural disorders. Mean RAL in pts with acute and chronic leucosis was 32  0.6 and PAL}48.4  0.5. In chronic leucosis RAL was higher (34  0.93) than in acute leucosis (29.4  1.2), (p50.01). Patients with neural disorders showed tendency to increase of RAL (p50.1). True depression state was observed in 1 case of chronic leucosis, moderate depression}in 4 case of chronic leucosis. Mild situational or neurotic depression (54.8  0.9) was found only in chronic leucosis 23 (37.1%). 13 (56.5%) of these patients had neural disorders. CONCLUSION: Psychopathological disorders in form of increased anxiety level and depression occurred more frequently in chronic leucosis and presence of neural disorders. In acute leucosis depression wasn’t found.

Copyright # 2006 John Wiley & Sons, Ltd.

728 The Role of Interactive Health Communication (IHC) in Softening the Blow of a Cancer Diagnosis and Guiding the Use of Health Care Services: Are Women and Men Reacting to IHC Differently? Loiselle CGa,b,c, Dubois Sa, Edgar La,b,d,e a School of Nursing, McGill University Montreal, Quebec, Canada; bDepartment of Oncology, McGill University, Montreal, Quebec, Canada; c Centre for Nursing Research, SMBD Jewish General Hospital Montreal, Quebec, Canada; d Hope and Cope SMBD Jewish General Hospital, Montreal, Quebec, Canada; eDepartment of Nursing, Brock University, Ontario, Canada PURPOSE: The use of computer-based interactive educational tools are seen as engaging and convenient (Loiselle and Dubois, 2003) and have the potential to enhance psychosocial outcomes in cancer. However, the contribution of interactive health communication (IHC) to psychosocial adjustment to cancer remains understudied. OBJECTIVE: The goal of this secondary analysis was to compare psychosocial adjustment according to IHC use, impact of IHC on health care services utilization, and sex differences on process and outcomes related to IHC. METHOD: A comparative controlled trial with pre-post intervention data collection (Loiselle et al., 2002–2005) included women with breast cancer (N ¼ 205) and men with prostate cancer (N ¼ 45) within eight weeks of diagnosis. Questionnaires were completed at baseline, 1 week post-intervention and at 3 months. The intervention consisted of a 1-hour training on the use of Internet, a CD-ROM (The Oncology Interactive Education Series- OIEST), and reputable Websites. SUMMARY OF RESULTS: Findings highlight enhanced psychosocial adjustment (e.g. quality of life) in the IHC group. However, patterns of service use (e.g. type, frequency, and satisfaction) were similar between experimental and control groups. Observations during IHC training also pointed to sex differences in terms of acceptability with men refusing IHC training more frequently than women. CONCLUSION: Although information needs are particularly high among individuals newly diagnosed with cancer, they also report being dissatisfied by the information provided. IHC may be an important complementary strategy to enhance psychosocial adjustment and outcome in cancer.

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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ACKNOWLEDGEMENT: Funded, in part, by CIHR.

729 School in Hospital: Exploratory Survey on the Situation of the Roman Units of Oncological Pediatrics Lopez Ea, GuarinoAb a Italian Society of Psycho-Oncology, Lazio Section, Rome, Italy; bPsychology School 1, University of Rome ‘La Sapienza’, Rome, Italy The school is the structure better defines the daily life of every child. More than whichever other activity, school represents, for children with oncological disease, a mark of continuity and a sign of acknowledgment as child more than patient. It performs three main tasks: preserving the educational purpose, distracting the child and fostering elaboration of emotional experiences in a pleasant context. Currently in Italy the activities of school in hospital is regulated by numerous circulars of Ministry of Education and some Interdepartmental Understanding Protocols: that is, an organic normative about school in hospital doesn’t still exist, in spite of the numerous bills introduced in Parliament and never approved of. The exploratory survey carried out in the units of oncological pediatrics of Rome has the aim to verify the actual realization of the different provisions of law and the ways in which the scholastic service is effectively organized. This preliminary analysis reveals that the hospital schools aren’t in keeping with the provisions in force. In detail, the problematic nodes are the shortage of: suitable spaces, educational staff with specific training and collaboration between teacher and the forwarding school} essential for the educational process’ continuity }and between teacher and health workers} fundamental for the purpose of a overall taken into care. An appropriate scholastic service could allow the child}in the anonymous and depersonalized hospital environment}both to preserve sense of control of situations and to experience themselves as independent, with positive effects on the medical treatments too.

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a

Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; bDepartment of Gynecology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; cDepartment of Gynecology, Academic Medical Center, Amsterdam, The Netherlands; dDepartment of Oncological Sciences, Mount Sinai School of Medicine, New York, NY, USA Preventive health strategies for women at increased hereditary risk of ovarian cancer include gynecologic screening (GS) and/or prophylactic oophorectomy (PBSO). Hormone replacement therapy (HRT) is often prescribed to compensate for postsurgical endocrine deficiencies. This study examined the impact of HRT use on levels of endocrine symptoms and sexual functioning among premenopausal women who have undergone PBSO. Comparisons were made with similar women undergoing GS. Questionnaire data on endocrine symptoms and sexual functioning were obtained from 450 premenopausal, high-risk women who had participated in this nationwide, cross-sectional, observational study. Thirty-six percent of women had undergone PBSO and 64% had opted for GS. In the PBSO group, 47% of the women were current HRT users. They reported significantly fewer vasomotor symptoms than non-users (p50.05). However, compared to premenopausal women undergoing GS, oophorectomized HRT users were more likely to report vasomotor symptoms (p50.01). HRT users and non-users reported comparable levels of sexual functioning. Compared to women in the GS group, oophorectomized HRT users reported significantly more sexual discomfort due to vaginal dryness and dyspareunia (p50.01). Although HRT has a positive impact on surgically-induced vasomotor symptoms, it may be less effective than is often assumed. Symptom levels remain well above those of premenopausal women undergoing screening, and sexual discomfort is not alleviated by HRT. Physicians need to provide younger high-risk women considering PBSO with realistic information about both benefits and drawbacks of this preventive strategy, including information about premature menopause and HRT.

730 The Impact of Hormone Replacement Therapy on Menopausal Symptoms in Younger High-risk Women Following Prophylactic Ovarian Surgery Madalinska JBa, van Beurden Mb,c, Bleiker EMAa, Valdimarsdottir HBd, Aaronson NKa

Copyright # 2006 John Wiley & Sons, Ltd.

731 Predictors of Prophylactic Oophorectomy versus Gynecological Screening Uptake in BRCA1/2 Mutation Carriers

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Madalinska JBa, van Beurden Mb,c, Bleiker EMAa, Valdimarsdottir HBd, Aaronson NKa a Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; bDepartment of Gynecology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; cDepartment of Gynecology, Academic Medical Center, Amsterdam, The Netherlands; dDepartment of Oncological Sciences, Mount Sinai School of Medicine, New York, NY, USA Women with BRCA1/2 gene mutations who have completed their childbearing are strong candidates for risk-reducing prophylactic bilateral salpingooophorectomy (PBSO). The aim of the current study was to identify baseline predictors of PBSO versus gynecologic screening uptake in this group of high-risk women. Baseline questionnaires were available from 160 BRCA1/2 carriers who participated in a nationwide, longitudinal, observational study of the psychosocial consequences of prophylactic surgery versus periodic screening. Topics addressed by the questionnaire included generic quality of life, cancer-specific distress, risk perception, knowledge of ovarian cancer, and perceived pros and cons of surgery versus screening. PBSO uptake during the 12-month period after the first gynecologic consultation was determined on the basis of medical record data. During the 12 month follow-up, 74% percent of women had undergone PBSO and 26% opted for screening. Statistically significant multivariate predictors of PBSO uptake included education, general health perceptions, perceived incurability of ovarian cancer, and perceived benefits of surgery. Women with lower educational levels, with poorer general health perceptions, those who view ovarian cancer as an incurable disease, or those who believe more strongly in the benefits of surgery are more likely to undergo PBSO. Clinicians should ensure that high-risk women are well-informed about the low predictive value of gynecologic screening techniques and about the lethal threat posed by ovarian cancer due to its limited curability.

732 Does a Program of Pancreatic Screening and Counseling Increase Distress Among Individuals at High-risk of the Disease? Maheu Ca, Esplen MJa, Ardiles Pa, Rothenmund Hb, Smith Kb

Copyright # 2006 John Wiley & Sons, Ltd.

a

Behavioral Sciences and Health, Toronto General Research Institute, University Health Network, Toronto, Canada; bFamilial GI Cancer Registry, Mount Sinai Hospital, Toronto, Canada

Individuals with a family history of pancreatic cancer and those who carry BRCA2 mutations are at increased risk for pancreatic cancer. PURPOSE: To determine if individuals at high-risk experience increased distress by participating in a new pancreatic cancer screening program. METHOD: Individuals with family history of pancreatic cancer (FPC) or having a BRCA2 mutation underwent genetic counseling and clinical screening (e.g. abdominal ultra sound; magnetic resonance imaging). A pre (T1) and post-test (T2) design was used to examine measures of psychological functioning, perceived risk and attitudes on genetic testing. RESULTS: The mean age for the whole sample was 57 years. Forty-three women and 13 males were BRCA2 carriers; 51 women and 31 men had a family history of pancreatic cancer. Among BRCA2 carriers, 47% had a personal cancer diagnosis vs. 18% of the FPC group. Mean levels of lifetime perceived risk for pancreatic cancer at T1 were ¼ 41% (S:D: ¼ 24) vs 18% (S:D: ¼ 17) (p ¼ 0:0001) for the FPC and BRCA2 groups respectively. Baseline predictors of distress were explored (e.g. coping style, gender, perceived risk, cancer worry) with perceived risk and cancer worry being significant. At T2, perceived risk decreased for the FPC group (p ¼ 0:078) while it increased for the BRCA2 group (p ¼ 0:009). Using the IES and BSI, there were no significant differences from T1 to T2 among both groups in distress levels. CONCLUSION: Pancreatic screening/counseling does not appear to cause increase distress for individuals at high-risk. Further examination of the increased perceived risk among BRCA2 carriers warrants further exploration.

733 Onco-hematology and Burnout: An Italian Survey Manenti Sa, Bressi Ca, Lambertenghi-deliliers Gb, Invernizzi Ga a Clinica Psichiatrica Fondazione Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, I.R.C.C.S., Milano, Italy; bDipartimento di Ematologia Fondazione Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, I.R.C.C.S., Milano, Italy PURPOSE: Burnout and psychiatric morbidity among physicians and nurses of 11 onco-hemato-

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logical units all over Italy have been estimated by means of a questionnaire-based survey. The relationship between subjects mental health and their job stress and satisfaction were also examined. METHODS: The components of burnout were assessed using the Maslach Burnout Inventory; psychiatric morbidity was estimated using the 12-item General Health Questionnaire; job stress and satisfaction were valued using studyspecific questions. RESULTS: 121 physicians and 229 nurses participated in the study. The estimated prevalence of High Emotional Exhaustion score was 27% of physicians vs 26% of nurses; High Depersonalisation score was 15% vs 13%; Low Personal Accomplishment score was 50% vs 50%, surely the most valuable result. The prevalence of psychiatric morbidity was 26% in physicians vs 22% in nurses (GHQ cut-off=5) and 36% vs 29% (cut-off=4). 64% of physicians vs 46% of nurses (p ¼ 0:01) perceived high levels of job stress, mainly caused by workload, disorganization and physical fatigue, factors also associated with burnout components. However the subjects are overall very satisfied with their work (89%). The relationship with patients is by far the most important source of job satisfaction (78%). The female gender seemed to be a risk factor for high Emotional Exhaustion. CONCLUSIONS: Prevalence of burnout and psychiatric morbidity was similar to other surveys in England, Canada and United States. It seems that onco-hematological workers in Italy are satisfied with their job but under environmental stress.

734 Home Care (HC) for Terminally Ill Children with Cancer: An Italian Centre Experience Miano M, Garaventa A, Tanasini R, Fieramosca S, Leimer M, Manfredini L Department of Paediatric Hematology-oncology, Giannina Gaslini Children Hospital, Genoa, Italy In literature there are no data reporting on quality of life of Italian terminally ill children. This Haematology Oncology HC Unit started its activity at Gaslini Children’s Hospital (Genoa) on April 2000 with two objectives: to improve the quality of life of terminally ill children with cancer and reduce assistance costs. From April 2000 to December 2004 232 children suffering from cancer or haematological pathologies have been cured at home: 24 of those 232 (aged 1–21 years, with an average age of 7 years and 10 months) had

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progression of disease. The average duration of assistance per child was of 80 days (it ranges 9– 1222 days). It is evident how this kind of assistance can reduce costs since an average of 43 home accesses per patient. Seventeen children died at home while 7 children, due to psychosocial problems, have been transferred to the Department of Oncology and died there. During this period both patients and their families, both physicians and nurses have been giving a positive feedback. One of the most important aspect of this activity is the possibility for the family to reduce the frequency and duration of hospitalization keeping to manage their daily life as usual. Families requesting this kind of assistance can experience their children’s suffering and separation in a private environment, free to show their feelings and their own coping capacity by respecting their privacy. Actually we are working to increase assistance quality and to improve children’s palliative are.

735 ‘Pain, no thank you’. A Experimental Project for Diagnosis, Treatment and Monitoring of Pain in the Haemato-Oncology Department (HOD) of Gaslini Institute in Genoa Derosas La, Monte Pa, Emanueli Tb, Massone MLc, Manfredini La a Department of Paediatric Hematology-oncology, Giannina Gaslini Children Hospital, Genoa, Italy; b Pharmacy Service, Giannina Gaslini Children Hospital, Genoa, Italy; cIntensive Care Department, Giannina Gaslini Children Hospital, Genoa, Italy Pain is a common symptom by children affected of cancer or leukaemia. It’s a diagnosis signal (50% of cases); it can highlight disease evolution; children display it at every diagnostic–therapeutic procedures; it can be a manifestation of anxiety and fear; it appears in 80% of patients with cancer terminal disease. Aware of the importance that pain has in this context, the Gaslini Hospital’s HOD decided to create a multiprofessional–multidisciplinary team with physicians, nurses, psychologists, physiotherapists, pharmacists and anesthetists. The team has drawn the project ‘Pain, no thank you !’, whose goal is to awaken and motivate the medical staff to prevent, diagnose and treat the pain. The project is articulated in four steps: (1) adopting a questionnaire, evaluation of attitude and knowledge of

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pain by the medical staff of HOD and Surgery Department of this Institution. After collecting data, the team creates a widening program taking care of clinical aspects of pain; (2) providing the prevalence evaluation (in a specific day), the intensity (with behavioral or self-report scales) and the treatment of pain in a large sample of HOD children; (3) training course for HOD medical staff and an adequate informative campaign for patients and parents; (4) the drawing up of procedural guidelines for pain control will have to provide the cooperation of several professional advisers (physicians, nurses and anesthetists). A good pain control for all HOD staff with the use of such procedural guidelines is the main goal of this widening programme.

736 ‘Punto a Campo’: Therapeutic Recreation for Italian Children Affected by Oncological and Haematological Diseases Spanevello Ma, Goldstein Da, Terenzani Lb, Manfredini Lc a Punto a Campo Project, Fondazione Alberto Rangoni, Trento, Italy; bMicrocitemia Centre, Galliera Hospital, Genoa, Italy; cDepartment of Paediatric Hematology-oncology, Giannina Gaslini Children Hospital, Genoa, Italy Through Punto a Campo, every year the Fondazione Alberto Rangoni allows many children from all over Italy who suffer from serious oncological and haematological diseases to participate in special summer camps located abroad that are specifically structured to the requirements of the children’s pathologies and therapies. At these camps children participate in a varied range of activities, develop their skills and share exciting moments with other children of the same age. From early morning walks to bonfires in the evening, the young participants turn into naturalists and fishermen, athletes and actors, equestrians and writers, sculptors and painters, poets and photographers, singers and outdoorsmen, canoeists, clowns and musicians. The camps are safe environments thanks to continuous and personalized supervision of children by qualified staff, an ever present and specially trained medical team and a studied program of therapeutic recreation. Not only do the children have a fun holiday, but they are also supported to consider their disease from a different point of view, one which highlights their potentialities rather than their limits.

Copyright # 2006 John Wiley & Sons, Ltd.

Camp represents a crucial moment in their life: the memory of it encourages and supports them, strengthening their self-assurance and determination, necessary to fight against disease throughout the whole year. In the last 3 years 152 Italian Cancer ill children (39 patients with acute leukemia, 44 cancer ill children, 58 male with hemophilia and 8 patients with beta-thalassemia) participated in international special summer camp in United States, Ireland and Germany.

737 Cancer and Suffering: How We Can Help to Alleviate and Transform the Suffering Mann B Psychology, Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada As professionals, we ‘know’ our patients suffer but all too often we do not focus on suffering as part of the healing process. We emphasize the specific techniques or strategies we as professionals can use to help the patients move on past the suffering. In my view, we sometimes forget that persons naturally suffer as part of the healing process and we are too eager to skip past it partly because it is so very wretching. Also, we perhaps unconsciously want the person to move on from his/her suffering as it is easier to work with that which is more visible. For sure moving forward is significant but when a person with cancer is experiencing grief, agony, and despair, telling them that they should be forward thinking is not a very helpful thing to say at that moment. On the other hand, focussing and acknowledging their suffering will be empowering and alleviate feelings of despair. At least, one can now feel some emotional relief and validation of themselves so that he/she can move forward with a little more hope. This paper focusses on the psychological role of suffering. How we can help a person suffering with cancer understand their feelings. And secondly, how we can help an individual with cancer use the emotional pain and suffering as a catalyst to move forward and move authentically from one’s old identity (before the diagnosis) to one’s new identity (during the process of treatment and afterwards).

738 The Language of Hope: Alleviating the Suffering of Patients with Malignant Spinal Cord tumors and Metastatic Spinal Disease through a Multidisciplinary Team Approach

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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Mann B Psychology, Glenrose Edmonton, Canada

Rehabilitation

Hospital,

The Adult Spinal Cord Injury Program at the Glenrose Rehabilitation Hospital in Edmonton, Canada is a 15-bed inpatient rehabilitation program for traumatic spinal cord injury, primary spinal cord tumors, and metastatic spinal disease. Rehabilitation is offered by a multidisciplinary team of professionals that include physiatrists, nurses, occupational therapists, social workers, recreational therapists, psychologists and rehabilitation counsellors from the Canadian Paraplegic Association. This paper focuses on the complex topic of language and communication and how our program attempts to create a positive rehabilitation experience for our patients through the language of hope and its effective communication. The purpose of this paper is to describe our multidisciplinary program and biopsychosocial framework of treatment as a channel of hope to those persons diagnosed with spinal cord metastases and tumors. And secondly, to describe how the language and communication of hope from the entire team can enhance a positive experience and alleviate suffering felt by our patients. Underlying this is the assumption that if professionals working on a team are hopeful, this is transferred verbally and nonverbally to our patients. Our program emphasizes a goal-oriented approach in which hope is communicated to our patients when each step towards patient goals are accomplished. Hope and the communication of hope by the entire team is seen as essential to the quality of our rehabilitation treatment, collaboration, and success.

739 Fatigue: An Interface Between Psyche and Burden Colombo Ac, Marino Ca, Sciacchitano Tb a Psycho-oncology, House of Care ‘Macchiarella’, Palermo, Italy; bOncology Medical, House of Care ‘Macchiarella’, Palermo, Italy; cHaematology, House of Care ‘Macchiarella’, Palermo, Italy PURPOSE: The cancer-correlated Fatigue is an increasing priority in the assistance to the patients. The syndrome is a lot more than a consequence of the tumour, in fact, besides burdening on the physical comfort and on the quality of life, it can invalidate the result of the treatments and it is for such reason that we speak of interface between

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psyche and burden. METHODS: The progress in oncology sustain that the anaemia can contribute, in fact, to the development of resistance to the therapies through mechanisms due to the scarce tissues oxygenation causing some mechanisms: the detoxification that can reduce the effectiveness of the treatments; the angiogenesis that also contributes to the tumour growth and the appearance of anti-apoptotic mechanisms them implicated in the tumour proliferation (Curt, 2001). The haemoglobinaemia can be considered a predictive parameter of answer to the therapy, of recidivist and survival in patients with tumours solid. We hold that to correct the anaemia could influence aggressiveness state of the illness and accordingly reduce physical and emotional exhaustion sense that compromise the quality of life. CONCLUSIONS: An important objective is therefore to promote and to facilitate the so-called ‘self-care’ (Bellani et al., 2002) so that patients and relatives can be polite to develop specific techniques for the asthenia management (Cella, 1998). We remember the tendency to underestimate the syndrome can be, partly, due to the fact that the sick does not often know how to clearly express the nature of his uneasiness. We conclude in accord with the model of multidisciplinary care that imposes the necessity to observe syndromes as the Fatigue along the continuum psyche-burden to make inseparable the care of the illness from the care of the sick.

740 Who Care the Caregiver? Experience of a Preoperating Mourning Colombo Ac, Marino Ca, Sciacchitano Tb a Psycho-oncology, House of Care ‘Macchiarella’, Palermo, Italy; bOncology medical, House of Care ‘Macchiarella’, Palermo, Italy; cHaematology, House of Care ‘Macchiarella’, Palermo, Italy PURPOSE: The present contribution tells an experience of support, still in action, about a young single woman (36 years) with an anticipation of mourning for the mother (77 years), with cancer pathology. METHODS: The couple mother-daughter has been signaled by the physicians of department following repeated episodes of mistrust and disconfirm for some members of the medical team and for the place of care. Through interviews we know the couple and observe the following polarities, that appear us interesting to understand the time of the pre-

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operating mourning of the daughter (caregiver) and the time lived by mother (patient). 1. Anguish of death of caregiver VS patient’s awareness to have a chronic-degenerative illness with inauspicious prognosis; 2. Inversion roles mother-daughter in the patient with a passage from the independence to the dependence and construction of the role of severe and punitive mother for the caregiver; 3. Semantic register clash. Words as way of living time and continuity for the mother vs absence and loneliness for the daughter. CONCLUSIONS: Through this meeting-clash of words, among them never said, we build the theory about theirs different lived of illness and the relationship of total symbioses and dependence. We believe that the emerged elements point out the direction in which to work to the construction of a relationship of help that can make to meet words of life and words of death on a same plan relation so that the time of the preoperating mourning can become an useful way and introductory that makes ‘more prepared’ (Cazzaniga, 2003) to the real mourning.

741 A One Day Communication Workshop for Breast Cancer Patients and Their Partners}Design and First Results Marme´ Aa, Koerting Ab, Verres Rc, Stammer Hb a Gynecology, University of Tuebingen, Tuebingen, Germany; bGynecology, University of Heidelberg, Heidelberg, Germany; cClinical Psychology, University of Heidelberg, Heidelberg, Germany The quality of life for patients with cancer depends not only on the quality of the medical care but also on the psychological and social support provided by the people around them. One of the major sources of social support is a functioning communication between the patient and her partner. Patients who experience a high level of psychosocial support show better coping, less anxiety and depression. At the University of Heidelberg a one day workshop for patients and partners has been developed to help cancer patients discuss their condition with their partner. A music therapy session was integrated into the workshop to let patients and partners experience the power of nonverbal communication. Until know we have performed 6 workshops with 30 couples. The acceptance of the communication programme was high. Both patients and partners said that the workshop was a valuable experience.

Copyright # 2006 John Wiley & Sons, Ltd.

The effects on Quality of life and coping, which were assessed with standardized psychological measures (SF 12 and TSK) will be presented.

742 Use of Antidepressant Duloxetine in Depressed Patients with Cancer Martı´ n Va´zquez MJ Department of Psychiatry, Hospital Son Lla`tzer, Palma de Mallorca, Spain PURPOSE: Duloxetine is a new antidepressant agent that has a dual activity (upon serotonin and noradrenalin) and it is supposed to have a good antidepressant profile and an effect upon neuropathic diabetic pain. We want to confirm its antidepressant profile and tolerability in patients with depression and cancer, with physical pain. METHODS: We developed a naturalistic study with a group of ten patients with a medical diagnosis of cancer and a psychiatric diagnosis of major depressive disorder, with duloxetine as an antidepressant. We study changes in depressive items, anxiety, pain and tolerability. RESULTS: The most important secondary effect referred by the patients is gastric pain. In one of the patients the treatment was interrupted due to secondary effects, mainly anxiety and insomnia. In six of the patients, remission of depressive disorder was found after three months of treatment, with a significant reduction in pain perception also. In two patients there were a reduction in pain and in depressive symptoms, but not remission and in two patients we observed no changes in depressive nor pain perception. CONCLUSION: We found useful duloxetine as an antidepressant, well tolerated, in patients with cancer and depression. It has effect upon pain, though it’s unclear, in our study, if this is independent or not of depressive disorder. Pain perception improves when the affect is better, and pain could cause depressive symptoms by itself, which makes difficult to look for an independent effect for the two items.

743 A Psycho-oncological Rehabilitative Model Maruelli APA, Katz M, Bulli F Oncology Rehabilitation, Centre of Study and Research in Oncology (CSPO), Florence, Italy PURPOSE: Introduction of an organisational model of the Psycho-Oncologic Service at the Ce.Ri.On. (Oncologic Rehabilitation Center) in

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Florence. METHODS: The rehabilitation pathway starts with the Psychological Distress Inventory (PDI) at the first outpatient consultancy. If the questionnaire shows a score >35, a psychodiagnostic consultation is proposed. If the score is 535, no contact with the psychologist is activated, unless the physician or the patient expressly require it. The psychologist, after the assessment, indicates the most appropriate support treatment: Introspective verbal works: individual conversations or encounter groups. Introspective nonverbal works: music-therapy, colors and collage groups. Body awareness techniques: relaxation groups, guided visualizations and yoga. Psychiatric consultancy. The patient, after the treatment, has a consultation with the psychologist to check its efficacy. RESULTS: From April 2005 to April 2006, 778 patients filled the PDI. Out of the total number, 198 patients (25.4%) reached a score >35: 81 (40.9%) had a psychological consultation; the remaining 117 (59.1%) did not. 187 patients had at least one consultation with the psychologists: 55 (29.4%) of them acceded without having previously completed the PDI. All the other 132 patients filled the questionnaire. 51 (27.3%) decided to have however a psychological consultation, in spite of a score 535. Besides, 103 patients joined the support groups. CONCLUSIONS: Owing to this rehabilitative model among 778 patients, 187 were psychologically supported: 132 (70.6%) patients were selected through the PDI, which can be useful as a screening instrument for psychological consultation.

‘When to suspect of cancer in children and adolescents’ idealized by Boldrini’s Children Hospital, Campinas, Brazil. In 2005/2006, in a partnership with a private institute, has offered the same program}tuition-free}via the internet, for pediatricians from the public health system nationwide. Justification: Disseminate the importance of identifying possible symptoms and signs of childhood cancer, contributing to early diagnosis, improving prognosis, survival rates and orienting pediatricians. OBJECTIVE: Stimulate early diagnosis, minimizing regional contrasts of knowledge accessibility in different regions of Brazil, via the internet. METHOD: A free software, created by the State University of Campinas. The course is comprised of 20 classes recorded in video, power-point presentations, reading material in Portuguese, bibliographical references, discussion and chat-rooms, tests and one supervisor per each 50-student group. The classes are made available on a weekly-basis. RESULTS: A total of 221 students enrolled, from 19 different states of Brazil. 49% of the applicants came from the state of Sao Paulo}95% of which came from other cities than the capital, which contributed to the other 5%. 81% of the participants were doctors from the public health system and 19% were other professionals. The possibility of creating joint programs with other health institutions that works with pediatric oncology.

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The Global Approach to Breast Cancer: Our Experience Mastrogiacomo Russo F, Cocozza A, Ponta M, Sica A, Fiore M Centro di Oncologia Azienda Sanitaria Locale NA 1, Naples, Italy

When to Suspect of Cancer in Children and Adolescents Mastellaro MJa, Cappellaro KMCb, Perina EMc, Bettega PBd, Brandalise SRe a Continuous Education Department, Boldrini’s Children Center, Campinas, Brazil; bOdontology, Boldrini’s Children Center, Campinas, Brazil; c Mental Health Department, Boldrini’s Children Center, Campinas, Brazil; dBoldrini’s Research Institute Research, Boldrini’s Research Institute, Campinas, Brazil; eDepartment of Oncology, Boldrini’s Children Center, Campinas, Brazil BACKGROUND: Distance learning widens health education practices. It helps to shorten geographic barriers, creating new health-related networks, gathering generalists and specialists. The e-course was based on the in-class course

Copyright # 2006 John Wiley & Sons, Ltd.

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PURPOSE: The exhaustive communication and a psychological intervention in the different steps of breast cancer bring to a better quality of life and better compliance with treatment, even in a population economically undeveloped. This pilot study has been worked out by a multidisciplinary team at the Health District 46 of Naples, addressed to such a population. The team is composed of medical oncologist, psychologist, radiologist, general practitioners, physiatrist, physiotherapists, nurses and volunteers. The team offered information, outcome patients service for early diagnosis, treatment, follow up, rehabilita-

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tion, psychosocial intervention in association with University and Cancer Institute. METHODS: The team treated 790 patients, between January 2002 and December 2005. Support and counselling intervention has been foreseen to ensure the holding of suffering and promote the compliance with the treatment. In order to verify the value of the communication and information among the health workers of the team has been given a questionnaire to 151 women. RESULT AND CONCLUSIONS: The 84% of the patients joined the complete treatment, obtaining high level curative intervention. The 72% of the patients has performed psychotherapy. Of the 151 women that answered the questionnaire: the 86.8% consider exhaustive the communicative aspects of the information given, the 78.8% consider satisfying the organization of the centre. The care of the patient has been considered the best aspect of the service, we’re expecting to evaluate the quality of life of the patients that join this project, in a first check it seems to aim to an improvement.

746 Project Waiting Room Zemel GS, Diz MDPE, Afonso AA Oncology Department of the Radiology Institute, Hospital das Clı´nicas of the Medicine College of the University of Sa˜o Paulo, Sa˜o Paulo, Brazil INTRODUCTION: The extensive waiting period at the outpatient oncology clinic is a major stress factor for patients, caretakers and staff. Patients chat about the illness and are often scared about what they hear of the side effects of chemotherapy, radiotherapy, and death due to cancer. Therefore, we sought to lessen the stress level in the waiting room. OBJECTIVE: To offer several activities to decrease the anxiety level of patients and caretakers while at the waiting room in our hospital, and also lessen the complaints about the long waiting time. METHODS: A partnership with the group of artists ‘Mestres-Salas’ was undertaken, who performed daily in the waiting room. A specific topic related to the various regional cultures of Brazil was presented each month of the project. In addition, in each day of the week a different art form, such as, music, dance, circus, theater or plastic arts, was presented. RESULTS: The psychologist and the social worker acknowledged the participation of most patients. Many would interact with the actors and also among themselves. Nevertheless, some kept apart from

Copyright # 2006 John Wiley & Sons, Ltd.

the activity, apparently disturbed, and left the room. A significant participation of the staff of the InRAD was also observed. CONCLUSION: Due to the high level of participation, we concluded that there is a demand for such a project. The objective of offering differentiated activities is being achieved. Additional strategies to involve those who did not respond to these activities should be implemented, as well as an objective measurement of patient stress.

747 Biomedical and Psychosocial Determinants of Intrusive Recollections in Women with Breast Cancer Matsuoka Ya,b, Inagaki Mb, Sugawara Yb, Akechi Tb,c, Uchitomi Yb a Division of Adult Mental Health, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan; bPsycho-Oncology, Division Research Center for Innovative Oncology, National Cancer Center Hospital, East Kashiawa, Japan; cDepartment of Psychiatry, Nagoya City University Medical School, Nagoya, Japan BACKGROUND: Being diagnosed as having cancer is a traumatic event for any individual. Intrusive recollections, i.e. one of the representative symptoms of posttraumatic stress disorder, are frequently observed in cancer survivors. The study aim was to identify determinants of intrusive recollections in women after cancer treatment. METHODS: A consecutive series of breast cancer patients at 3–15 months after surgery, consisting of subjects with (N ¼ 63) and without (N ¼ 92) intrusive recollections was examined. They filled out self-report questionnaires, Eysenck Personality Questionnaire revised and State Trait Anxiety Inventory, and were evaluated using the Structured Clinical Interview for DSM-IV and structured interview for demographic, sociological, and biomedical characteristics. RESULTS: Logistic regression analysis revealed that neuroticism (odds ratio ½OR ¼ 1:27; 95% confidence interval ½CI ¼ 1:1021:47; p ¼ 0:01), precancer intrusive recollections (OR ¼ 4:15; 95% CI ¼ 1:57210:76; p50.01), and the number of cancer patients in relatives by marriage (OR ¼ 1:64; 95% CI ¼ 1:15 22:34; p50.01) were final significant determinants, and receiving radiotherapy (OR ¼ 0:43; 95% CI ¼ 0:1920:94; p ¼ 0:04) was an associated factor. CONCLUSION: These results suggest that biopsychosocial factors contribute to intrusive

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recollections and have clinical implications for the use of these characteristics in screening and early intervention.

748 A Survey of Physicians’ Attitudes for Cancer Disclosure in Japan Matsushita Ta,b, Noguchi Wa, Kobayashi Ma, Matsuda Aa, Matsushima Ea a Section of Liaison Psychiatry & Palliative Medicine, Graduate School of Tokyo, Medical & Dental University, Tokyo, Japan; bSection of Health and Welfare, Graduate School of International University of Health and Welfare, Tokyo, Japan

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The Netherlands; bDepartment of Medical Psychology and Psychotherapy, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands, cComprehensive Cancer Centre, North-Netherlands, Groningen, The Netherlands; dDepartment of Health Education and Promotion, Maastricht University, Maastricht, The Netherlands

PURPOSE: The aim of the present study was to understand actual situations of physicians’ attitudes on cancer disclosure to their patients in Japan. METHODS: The questionnaires had been mailed to physicians on 2397 randomly sampled hospitals with 50–300 beds to ask about their attitudes for truth-telling about cancer. RESULT AND CONCLUSIONS: Five hundreds and thirteen physicians answered questionnaires (21.4%), and 62.7% of them had cancer patients with less than 20%. While 31.5% physicians made initial disclosure of cancer diagnosis to more than 70% of their cancer patients, 28.5% physicians made first cancer disclosure to less than 10% of their cancer patients. About 50% physicians answered that there were less than 10% of the patients who were not told about their cancer. The rate of cancer disclosure increased as physicians who treated more cancer patients. On the other hand, initial disclosure of cancer diagnosis was held to patients’ families rather than patients themselves. Moreover, the initial cancer disclosure was often held to the patients themselves when the physicians’ rates of cancer disclosure were high. There were routine manuals of the effective way of cancer disclosure; however, follow-up after the disclosure was not enough. Furthermore, each practitioner had their original consistent way of cancer disclosure and follow-up after the disclosure.

PURPOSE: Cancer and its treatment often produce significant persistent comorbidities that reduce physical fitness in survivors. Research indicates that post-treatment oncological rehabilitation enhances physical fitness. We studied the effects of a 12-week multidisciplinary rehabilitation program that combines physical training (two hours twice a week) with psycho-education (two hours once a week). The aim of the present four-center RCT was to determine the effect of rehabilitation on physical fitness in survivors (medical treatment minimally three months ago). Patients were randomized to multidisciplinary rehabilitation (MDR), physical training (PT) alone or a waiting-list group (WLG). METHODS: 108 cancer survivors (MDR, n ¼ 56; PT, n ¼ 39; WLG, n ¼ 13) completed maximal cycle ergometer and muscle force testing before and after rehabilitation. Control subjects performed measurements at the same time intervals. Effectiveness of MDR and PT was determined by analysing changes between groups from baseline to postintervention. RESULTS: Groups did not differ on outcome variables at baseline. Physical fitness, including peak oxygen consumption (V02peak), peak work load (Wpeak) and muscle force (MF) improved significantly but not differently in both, the MDR and PT group. Therefore, these two groups were combined and changes were compared to WLG. In the exercise groups Wpeak increased by 12%, whereas it remained unchanged in the WLG (p ¼ 0:004). MF of lower and upper extremities improved in the intervention groups when compared to WLG (p ¼ 0:01 and 0.05, respectively). CONCLUSIONS: MDR and PT had beneficial effects on physical fitness in cancer survivors.

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Effect of an Oncological Rehabilitation Program on Physical Fitness in Cancer Survivors May-de Groot AMa,b, van Weert Ec, Korstjens Id, Trijsburg RWb, Ros Wynand JGa a Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht,

Smoking Relapse Prevention Programs and Factors which Predict Abstinence: A Controlled Study Comparing the Efficacy of Workplace Group Counselling and Proactive Phone Counselling Mayer Ca,b, Slachmuylder JLa, Vandecasteele Hb, Bodo Mb, Razavi Da,b,c

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a

Unit of Psycosomatic and Psycho-oncology, University Libre of Bruxelles, Bruxelles Belgium; b Center of Traitment of Tobacco Dependence Institut Jules Bordet, Bruxelles, Belgium; cClinic of Psycho-oncology and Supportif Care Institut, Jules Bordet, Bruxelles, Belgium BACKGROUND: Efficacy of workplace relapse prevention programs for former smokers has been poorly studied. PURPOSE: The aim of this study was to assess 2 relapse prevention programs for former smokers who achieved abstinence after 3 months workplace smoking cessation program and to assess predictors of abstinence 9 months later. METHODS: 275 healthy adults who reported to be abstinent were randomised in two 9 months relapse prevention programs: 10 sessions of Workplace Group Counselling (WGC) or 10 Proactive Phone Counselling (PPC). Assessment included questionnaires (Brief Symptom Inventory (BSI), Dutch Eating Behaviour Questionnaire (DEBQ), Life Event Scale, socio-demographic and workplace characteristics), expired monoxide level and urinary cotinine concentration rate. RESULTS: Quit rate at 9 months was respectively 57.5% in the PPC arm and 61.7% in the WGC arm (p ¼ 0:552). Regression analysis indicate that baseline urinary cotinine concentration levels inferior or equal to 317 ng/ml was associate with more abstinence (OR ¼ 4:75; 95% CI ¼ 1:23218: 30; p ¼ 0:024). Moreover being supported financially by the company to join the program (OR ¼ 0:46; 95% CI ¼ 0:2220:99; p ¼ 0:048), having higher baselines BSI global severity index (R ¼ 0:36; 95% CI ¼ 0:1520:83; p ¼ 0:017) and DEBQ external eating scores (OR ¼ 0:67; 95% CI ¼ 0:4521:00; p ¼ 0:050) were associated with less abstinence. CONCLUSIONS: Efficacy was similar between the 2 programs. In order to achieve better outcomes, future relapse prevention programs should focus more intensively and specifically on psychological factors (motivation, subjective distress and eating behaviours).

Royal Marsden NHS Trust Sutton, Surrey, UK; c University of California, San Francisco, San Francisco, USA; dDepartment of Psychological Medicine, The Royal Marsden NHS Foundation Trust Sutton, Surrey, UK PURPOSE: Few international studies have examined the associations between family history of prostate cancer, individual risk perception, and prostate-specific antigen (PSA) screening behavior. This study compared PSA screening behaviors and risk perceptions of US and UK men with a family history of prostate cancer. METHODS: This study combined survey responses of 150 US and 122 British white males, aged 35–74. Multivariate logistic regression was used to examine associations between screening behavior and components of the health belief model, adjusted for socio-demographic and family history variables. RESULTS: College educated men and those with more family members with prostate cancer were more likely to rate their prostate cancer risk as being ‘greater than average’. Health anxiety was positively related with prostate cancer worry. Men were more likely to have had a PSA test if they were older, married, perceived benefits to PSA screening, and rated their personal risk as greater. US men were more likely than UK men to have had a PSA test and, on average, reported higher perceived risk of prostate cancer and perceived benefit of PSA testing. Screening was associated with both perceived risk and perceived benefit. Perceived benefit was associated with perceived risk. CONCLUSIONS: Although findings concerning screening behavior were consistent with previous research examining US or UK populations, this study found differences when comparing US and UK men. This variation could be associated with health system differences including incentives for US providers to conduct screenings and UK patient education efforts instituted by the NHS.

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Prostate Cancer Risk, Screening Attitudes and Behavior: A Comparison of US and UK White Males with a Family History of Prostate Cancer McCurdy RKa, Monahan Cb, Stewart Susan Lc, Watson Md, Bloom JLa a School of Public Health, University of California, Berkeley, Berkeley, USA; bAcademic Department of Radiotherapy, Institute of Cancer Research and

The Use of Participatory Action Research in an Oncology Setting Keck Ja, MacEwan La, Hammell Nb, Hyatt Alb, Mayer Cc a School of Social Work, Laurentian University, Sudbury, Ontario, Canada; bCircle of Strength, Sudbury Breast Cancer Support Group, Sudbury, Ontario, Canada; cSupportive Care Program,

Copyright # 2006 John Wiley & Sons, Ltd.

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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Regional Cancer Program, HRSRH, Sudbury, Ontario, Canada PURPOSE: ‘Taking Care: Women’s Experience with a Breast Cancer Support Group’ is a collaborative study designed to explore the experiences of women who have participated in a breast cancer peer-led support group. Participatory Action Research was chosen to address their concerns and to address a gap in the scholarly literature dealing with women’s health and cancer peer-led support groups. METHODS: Participatory Action Research was used with qualitative methods of data collection. A Research Advisory Group included members of a breast cancer peerled support group and participated directly in the management of the project. RESULTS: The findings of this study suggest the potential of a collaborative project between breast cancer survivors, university researchers, and a health care researcher to identify community health care issues and suggest action strategies. This study recognized how breast cancer survivors addressed health care needs in their lives and, in the process, generated knowledge; the importance of collaborative conversations with the Research Advisory Group as a mean of modifying the research design; and the significance of research reflexivity especially during unplanned events. CONCLUSIONS: Participatory Action Research was successful in a research collaboration of breast cancer survivors, academic researchers, and a health care researcher to identify a community health care concern with findings useful to the participants and made contributions to health care knowledge. ACKNOWLEDGEMENTS: This study was funded by the Laurentian University Research Fund and the Canadian Breast Cancer Foundation-Ontario Chapter.

753 Examining Findings from the Time to Adjust Programme: Utilising a Mixed-method Design to Determine for the First Time the Acceptability, Feasibility and Effectiveness of Providing Structured Psychological Support for Irish Cancer Patients Mc Kiernan Aa, Carr Aa, Steggles Sb a Department of Psychology, UCD, Dublin, Ireland; b Psycho-oncology Services, St. Luke’s Hospital, Dublin, Ireland PURPOSE: The purpose of this presentation is to discuss methodology and findings from an

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ongoing evaluation of a psychoeducational group intervention for breast cancer patients in Ireland. METHOD: A comparative-group design is being utilised to compare the efficacy of a group cognitive–behavioural clinical intervention pre, post and at 6-months follow-up. Outcome variables include patients’ psychological adjustment, coping, Health Related Quality of Life. In addition, changes in participants’ expectations and goals are being examined. A cost–offset analysis has also been incorporated. RESULTS: Findings indicate that standardised measures alone may lack the sensitivity required for a comprehensive assessment of psychosocial gains in cancer patients post intervention. Qualitative results suggest that Irish breast cancer patients perceive beneficial effects from participating in the Time to Adjust programme. CONCLUSIONS: Preliminary results are promising data collection for the study is ongoing. ACKNOWLEDGEMENTS: The financial support of Saint Luke’s Institute of Cancer Research and Irish Cancer Society is gratefully acknowledged.

754 A Prospective Pilot Study of Emotionally Focused Therapy for Couples Facing Advanced Cancer McLean LMa,b, Rodin GMa,b, Zimmermann Ca,c,d, Esplen MJb,e, Jones JMa,b,e a Department of Psychosocial Oncology and Palliative Care, UHN-Princess Margaret Hospital, Toronto, Canada; bDepartment of Psychiatry, University of Toronto, Toronto, Canada; cPalliative Care Services, University Health Network, Toronto, Canada; dDepartment of Medicine, University of Toronto, Toronto, Canada; eBehavioral Sciences & Heath Research Division, Toronto General Hospital, Toronto, Canada PURPOSE: This pilot study is continuing to prospectively evaluate effectiveness of emotionally focused couples’ therapy (EFT) in improving marital functioning and alleviating couples’ distress where one is diagnosed with advanced cancer. As many as 50% of cancer patients and their spouses experience significant psychological distress, which can threaten the stability of the marital relationship. There are few couples’-based interventions and the suffering of distressed couples remains largely under-recognized and under-treated. METHODS: Ten patients (female

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n ¼ 5; male n ¼ 5) facing end of life and their spouse caregivers were recruited from Princess Margaret Hospital (PMH) in Toronto and offered 4 8 couples’ sessions by EFT therapists at PMH. Participants’ marital functioning, depression, hopelessness, attachment security and benefit from the intervention were assessed through selfreport measures at baseline, after sessions 4, 8 and 3 months post treatment. RESULTS: Preliminary results measuring self report at 4, 8 sessions, and 3 months post-treatment will be reported on. Providing support to couples at this challenging time may result in improved marital functioning and a reduction of psychological distress, and provide an opportunity for relational growth during the last stage of life. CONCLUSION: This prospective study serves as the first step in the development of an empirically validated marital intervention for couples facing advance cancer, that will influence the development of a future randomized controlled clinical trial.

755 Presence of Prostate Cancer Related Anxiety and Psychosocial Distress in Patients During Rehabilitative Follow-up Care Mehnert Aa, Lehmann Ca, Koch Ua, Schulte Tb a Institute of Medical Psychology, University Medical Center, Hamburg, Germany; bKlinik Bad Oexen, Bad Oeynhausen, Germany PURPOSE: Prostate cancer is the most frequently diagnosed male cancer in Germany with 48.650 new cases every year. Given the high incidence of prostate cancer and frequent treatment consequences such as pain, fatigue, incontinence and impotence, empirical studies focussing on psychological symptoms and psychosocial distress during the course of the disease are relatively rare so far in comparison to other cancer types. METHODS: 208 prostate cancer patients were recruited at the beginning of a oncological rehabilitation measure (88.3% participation rate). Participants completed the German versions of the Memorial Anxiety Scale for Prostate Cancer (MAX-PC), the NCCN Distress thermometer and subscales of the EORTC QLQ-C30. RESULTS: 52% of the patients have a score over 4.5 on the Distress thermometer (M ¼ 4:4; SD ¼ 2:55). Most frequently reported problems were sexual problems (56%), changes in urination (56%), problems getting around (41), pain (41%), fatigue (38%),

Copyright # 2006 John Wiley & Sons, Ltd.

sleep (33%); followed by nervousness (32%), worries (31%) and fears (28%). Patients with high levels of distress report higher levels of prostate cancer anxiety (P50.001; ES ¼ 0:71); anxiety related to prostate specific antigen (PSA) levels (P ¼ 0:012; ES ¼ 0:73); and fear of cancer recurrence (P50.001; ES ¼ 0:65). Patients who remembered their last PSA test result were found to have higher general distress (P ¼ 0:3; ES ¼ 0:48), but no higher levels of prostate cancer related anxiety (P>0.45). CONCLUSION: Results indicate a substantial percentage of men with prostate cancer experience high levels of distress and prostate cancer related anxiety and therefore need for psychosocial support.

756 The Art of Feeding: Humanizing the Nutritional Assistance for the Hospitalized Child with Cancer Meira WVAa, Perina EMb, Aguiar Sc a Nutrition Department, Boldrini’s Children Hospital and State University of Campinas, Campinas, Brazil; bMental Health Department, Boldrini’s Children Hospital and State University of Campinas, Campinas, Brazil; cOncology, Division Boldrini’s Children Hospital, Campinas, Brazil INTRODUCTION: Lack of appetite and change in taste are acute effects of the antineoplasic therapy in childhood, causing difficulty in accepting and ingesting food and therefore leading to weight loss. OBJECTIVE: Encourage the ingestion of food making use of alternative measures in the nutritional approach to inpatients. METHOD: Elaboration of an alternative menu according to age group, presenting the visual image of the food which values the eating preference and thereby allowing an interaction between the nutritionist and the patient. The criterion used to choose the items of the alternative menu is linked to the need for acceptance of a routine menu. RESULTS: The application of an interactive menu which respects the desire of the patient for choosing the food, contributed for a better adherence and acceptance to the proposed nutritional approach. CONCLUSION: This strategic resource favored the patients with refusal ingestion through careful use of the menu and without abusive consumption of alternative food. Even though the suggested menu did not provide all daily nutritional needs, this measure guarantees the maintenance of food ingestion, demystifying the preconceptions related to the hospital nutrition.

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Impact of Familial Adenomatous Polyposis (FAP) on Young Adults: Attitudes to Genetic Testing, Support and Information Needs Meiser Ba, Mireskandari Sb, Jessen Jc, Thewes Bd, Solomon Me a Psychosocial Research Group, Prince of Wales Hospital, Sydney, Australia; bSchool of Psychiatry, University of New South Wales, Sydney, Australia; c Prince of Wales, Clinical School University of New SouthWales, Sydney, Australia; dSchool of Biomedical Science, Faculty of Medicine, University of Newcastle, Newcastle, Australia; eDepartment of Surgery, Royal Prince Alfred Hospital, Sydney, Australia

Impact of Life-threatening Risk Information on the Evolution of Patients’ Anxiety and Risk Recall: The Specific Context of Informed Consent for Experimental Stem Cell Transplant Merckaert Ia,b, Libert Yc,d, Bron Da,c, Jaienois MFc, Razavi Da,b a Internal Medicine, Institut Jules Bordet, Brussel, Belgium; bPsychosomatics and Psycho-Oncology, Research Unit, Universite´ Libre de Bruxelles, Brussel, Belgium; cHemato-Oncology Unit, Institut Jules Bordet, Brussel, Belgium; dHuman Resources Institut Jules Bordet, Brussel, Belgium

PURPOSE: This study utilized a novel FAPspecific questionnaire to explore views concerning genetic testing, information and support needs, and document possible experiences of discrimination amongst young adults aged 18–35 years old with a diagnosis of, or at risk of developing, Familial Adenomatous Polyposis (FAP). METHODS: Eighty-eight participants (25 males, 63 females) were recruited through four Australian Hereditary Bowel Cancer Registries. RESULTS: The average age of participants was 28 years and the average age of these participants at the time of their last genetic consultation was 23 years. Seventy-one participants had clinical FAP with 57 of them having undergone either ileorectal anastamosis (IRA) or ileum-pouch-anal anastamosis (IPAA). Participants’ highest areas of unmet support needs were with regards to anxiety about their children having FAP (39%) and fear of developing cancer (28%). Although 75% would consider prenatal genetic testing, only 21% would consider termination of an affected pregnancy. Two-thirds (61%) selected at birth or early childhood as the preferred age for genetic testing of offspring. CONCLUSIONS: These findings demonstrate that FAP may significantly impact young adults, with many having unmet support needs. The length of time since the last genetic consultation, and the young age at which these consultations took place, suggests that clinics should consider a means of regular follow up to address these unmet needs, particularly in those only counseled as adolescents. The parental desire to test children before it is clinically indicated may be a source of distress for parents and create conflict with genetic services.

Copyright # 2006 John Wiley & Sons, Ltd.

PURPOSE: This study aims to investigate the evolution of patients’ anxiety and risk recall after transmission of life-threatening risk information in an informed consent procedure for experimental stem cell transplantation and related factors. MEASURES: Patients completed the HADS and the Ways of Coping Checklist. Immediately before and after the interviews, patients completed Spielberger’s STAI-State. Interviews were audiorecorded. Physicians’ CS were rated according to the CRCWEM. Patients were asked to recall risks in a semi-directive interview that was audiorecorded and compared with the information provided in the informed consent interview. RESULTS: Twenty interviews were recorded and analyzed. Patients on average recalled 44% of risks (SD ¼ 15:5). There was on average no evolution of patients’ anxiety (Mean ¼ 0:4; SD ¼ 9:1). There was no significant correlation between the evolution of patients’ anxiety and risk recall following the informed consent interview. Linear regression analysis showed that the evolution of anxiety was predicted positively by the number of times benefits were transmitted and negatively by the level of anxiety before the interview. Risk recall was predicted positively by the number of different risk transmitted and by patients’ problem-focused coping. CONCLUSION: Physicians’ CS do not influence the evolution of patients’ anxiety and risk recall. Our results show the necessity of adapting information transmission to every patient’s needs in order to avoid increasing patients’ anxiety and optimize risk recall.

759 Matching of Need and Provision Optimizes Types of Actual Social Support for Persons with Cancer Merluzzi TV, Heitzmann CA

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Department of Psychology, University of Notre Dame, Notre Dame, USA PURPOSE: Consistent with Optimal Matching Theory (OMT; Cutrona, 1990) matching actual (received) support with the needs of persons with cancer resulted in better psychosocial adjustment than the mismatched condition (Merluzzi and Heitzmann, 2006). This study explored the subtypes of actual support that optimize adjustment. METHOD: 144 adults with cancer (M ¼ 57 years; breast cancer, 38.9%; lymphoma, 17.4%) completed measures of actual support (Inventory of Socially Supportive Behaviors; ISSB), physical debilitation (Sickness Impact Inventory; SIP), and adjustment (Psychosocial Adjustment to Illness Scale; PAIS). RESULTS: Regression analyses included subtypes of actual support (factors from the ISSB), physical debilitation (SIP), and interaction terms (Factors of the ISSB  SIP) as predictors and psychosocial adjustment (PAIS) as the criterion. Significant interaction terms were obtained for: Information/Problem Solving (B ¼ 0:20; p ¼ 0:02) Esteem/Competency (B ¼ 0:16; p ¼ 0:05) and Tangible Non-monetary (B ¼ 0:18; p ¼ 0:03) but not for Monetary and Emotional/Affection support. Thus, those who need those types of support (i.e. highly debilitated) and have not received them (i.e. low actual support) are more poorly adjusted than those who need them and received them. Those who do not need actual support (i.e. not debilitated) but received it (i.e. high actual support) are more poorly adjusted than those low in disease impact who do not receive high levels of actual support. CONCLUSIONS: The results indicate that certain types of actual support may optimize the relation between physical debilitation and adjustment to cancer. Supported by NCI Grant CA94914.

760 Congruence of Caregivers’ and Social Workers’ Perspectives on Caregivers’ Self-Efficacy for Caregiving Merluzzi TVa, Heitzmann CAa, Vachon DOb a Department of Psychology, University of Notre Dame, Notre Dame, USA; bFamily Medicine Residency, Program St. Joseph, Regional Medical Center, South Bend, USA PURPOSE: Provision of services may be enhanced by an accurate understanding of the caregiver. This study investigated the congruence

Copyright # 2006 John Wiley & Sons, Ltd.

of perceptions of caregiving by primary caregivers (CGs) and Hospice social workers (SWs). METHOD: Participants were 42 primary CGs (M age ¼ 63:5) and 8 Hospice SWs, who provided services to the CGs. Most CGs were females, married, European American. On the second home visit Hospice SWs provided the CGs with (a) the 21-item Caregiver Inventory CI; Merluzzi et al., 2004), which assesses self-efficacy for caregiving, and (b) a measure of frequency of performing 10 caregiving tasks (i.e. ADLs, feeding, dressing, etc.). SWs rated the CGs on (a) the CI and (b) the frequency of performing 10 caregiver tasks. RESULTS: Correlation of CGs’ and SWs’ ratings of the frequency of caregiver tasks (ADLs) was 0.61 (p50.001), indicating highly congruent perceptions of the frequency of caregiver tasks. CGs’ CI ratings (i.e. self-efficacy) were not correlated with their ratings of the frequency of caregiving tasks; whereas, SWs’ CI ratings (i.e. perceived self-efficacy of CGs) were correlated with the CGs’ ratings of the frequency of caregiver tasks (r ¼ 0:30; p50.05). Thus, for CGs, self-efficacy for caregiving is independent of caregiver burden (ADLs); whereas, for SWs, selfefficacy for caregiving and caregiver burden are significantly related. CONCLUSIONS: This study shows the resilience of caregivers, whose efficacy is undeterred by the burden of caregiver tasks; whereas, SWs may use caregiver tasks to index caregiver efficacy.

761 Self-Efficacy and Coping with Cancer: Confirmatory Factor Analysis and Psychometric Analysis of the Cancer Behavior Inventory (Brief Form) Heitzmann CAa, Merluzzi TVa, Roscoe Jb, Lord Rb, Kirs Kc a Department of Psychology, University of Notre Dame, Notre Dame, IN, USA; bCancer Center, University of Rochester, Rochester, NY, USA; c Markey Cancer Center, University of Kentucky, Lexington, KY, USA PURPOSE: The Cancer Behavior Inventory (CBIB), a new 14-item measure of self-efficacy for coping with cancer derived from the 33-item CBIL (Merluzzi et al., 2001), was subjected to Confirmatory Factor Analysis (CFA) and psychometric analyses. METHOD: Participants were 735 patients from an eastern US city and two samples (N ¼ 199 and N ¼ 40) from mid-west US cities. Patients completed the CBI-B and other measures.

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RESULTS: Exploratory factor analysis (N ¼ 735) and CFA (N ¼ 199) confirmed the structure of the CBI-B. The factors include: (1) Maintaining Independence and Positive Attitude; (2) Participating in Medical Care; (3) Coping and Stress Management; and (4) Managing Affect. CFA fit indices indicated adequate fit for the 4-factor model (RMSEA ¼ 0:07; CFI ¼ 0:95; SRMR ¼ 0:04) The internal consistency of the CBI-B was 0.82 (N ¼ 898). The CBI-B was also correlated with the (1) total FACT quality-of-life score (r ¼ 0:43; p50.001; N ¼ 898); (2) the Fatigue Scale of the FACT (r ¼ 0:39; p50.001; N ¼ 199); and (3) the Physical Impairment scales of the Sickness Impact Profile (r ¼ 0:59; p50.001; N ¼ 40). CONCLUSIONS: As a brief measure of coping self-efficacy the CBI-B is reliable, valid, and has a reliable factor structure that relates to the major coping tasks of cancer patients. It can be used in clinical assessment, as a screening tool, and in clinical trials. Supported by National Cancer Institute (NCI CA94914).

revealed that wives’ self efficacy (CBI) was the best predictor of adjustment (MHI, B ¼ 0:49; p50.005). Husbands’ efficacy judgments (HCBI) contributed to wives’ adjustment over and above wives’ efficacy (B ¼ 0:28; p50.05), after controlling for marital adjustment and sickness impact. Interestingly, the HCBI was correlated with the LWMAT (r ¼ 0:36; p50.005), stage (r ¼ 0:38; p50.01), and presence of metastatic disease (r ¼ 0:42; p50.01), whereas, the CBI was not. CONCLUSIONS: Wives may rely on internal information and functional status to gauge coping efficacy, whereas, husbands’ rating of wives’ efficacy may be tied to marital adjustment, functional status, and objective medical markers. The unique perspectives of husbands and wives contribute independently to wives’ adjustment to cancer. Clinically, these findings highlight the importance of partners to women’s adjustment to breast cancer.

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Psychological Profile in Early or Advanced Cancer Patients by the Rorschach’s Test: Correlation with Tumor Histotype Messina G, Colombo E, Manenti S, Ferri F, Curti R Psychological Service, Maggiore Hospital, Milan, Italy

Husbands’ and Wives’ Judgments of Self-Efficacy for Coping Affect Wives’ Adjustment to Breast Cancer Merluzzi TVa, Harper FWKb, Graves KDc, Heitzmann CAa, Martinez Sanchez MAd a Department of Psychology, University of Notre Dame, Notre Dame, IN, USA; bKarmanos Cancer Center, Wayne State University, Detroit, MI, USA; cLombardi Cancer Center, Georgetown University, Washington, DC, USA; dSocial Sciences, Pima Community College, Tucson, AR, USA PURPOSE: Adjustment to breast cancer is likely influenced by a woman’s self-efficacy for coping and her husband’s judgments of her coping efficacy. This study focused on the relationship of husbands’ and wives’ judgments of wives’ selfefficacy for coping to wives’ adjustment. METHOD: 72 women completed measures of coping selfefficacy (Cancer Behavior Inventory; CBI), disease impact (Sickness Impact Profile; SIP), adjustment (Mental Health Index; MHI), and marital adjustment (Locke-Wallace Marital Adjustment Test; LWMAT). Medical staff rated wives’ functional status (Karnofsky Performance Status; KPS). Husbands rated wives’ self-efficacy using a modified version of the Cancer Behavior Inventory (HCBI). RESULTS: The CBI and HCBI were modestly related (r ¼ 0:21; p50.05). Regression

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PURPOSE: Recent advances in the psychoneuroimmunological sciences demonstrate that every psychological or spiritual state is mediated by a well-defined neurochemical status. As far as the psycho-oncology is concerned several psychoneuroendocrine alterations have been demonstrated in cancer patients, it would be interesting to correlate cancer-related neuroendocrine anomalies with the psychological status of patients using the Rorschach’s test. The few studies with the Rorschach’s test are generally limited to the investigation of the only breast cancer. METHODS: A study was planned to investigate the psychological response to Rorschach’s test in 138 cancer patients: we evaluated the anxiety, depression, psychic and somatic identity integrity, sexual repression and spirituality in cancer patients. RESULTS: The anxiety was very high in all cancer patients, as well the lack of identity integrity; the percent of depression observed in non-small cell lung and renal cancer patients was significantly higher than in those affected by breast cancer and prostate cancer. The percent of suppression of sexuality

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observed in breast and colorectal cancer patients was significantly higher than in those affected by renal cancer; the spirituality was absent in most patients. No statistically significant differences occurred between the groups of patients with locally limited disease or with metastatic disease. CONCLUSIONS: This study confirms the efficacy of the Rorschach’s test in investigating the psychological status of cancer patients. The correlation of the responses to the Rorschach’s test to cancer-related psychoneuroendocrine alterations will be the aim of future investigations.

764 Teaching Communication and Stress Management Skills to Junior Physicians Dealing with Cancer Patients: the Belgian Interuniversity Project Meunier Ja, Merckaert Ib, Reynaert Ca, Etienne AMc, Razavi Db a Psychosomatic, Catholic University of Louvain, Louvain-la-Neuve, Belgium; bJules Bordet Institute, Cancer Center, Free Brussels University, Brussels, Belgium; cHealth Psychology, University of Lie`ge, Lie`ge, Belgium INTRODUCTION: Communicating with cancer patients and their family is an important source of stress for physicians. Although communication skills training programs have shown their usefulness, few empirical data are available about their impact on physicians’ level of stress. PURPOSE: This is a randomised controlled intervention study assessing the impact of training in communication skills and in management of job stress on physicians’ communication skills, physicians’ biological and psychological measures of stress and physicians’ recognition of patients’ distress and patients’ satisfaction with the consultation and the information given. METHODS: Eighty-eight postgraduate physicians will be randomly assigned to 40 hours of training or to a waiting list. The training is distributed on 5 months and organised in small groups of 8 physicians. It will involve theoretical information and small group roleplaying training sessions. Techniques will be skills-focused and practice-oriented to promote changes and facilitate transfer of acquisitions to the clinical setting. PROCEDURE: Assessments are scheduled for physicians at baseline and after training for the training group and approximately 6 months after baseline for the waiting list group. The assessment procedure includes at each assessment time, two simulated interviews. Psychologi-

Copyright # 2006 John Wiley & Sons, Ltd.

cal and biological variables are measured throughout the interviews which are videotaped. The comparison between experimental and control group will permit to evaluate the impact of the training on biological and psychological measures of physicians. CONCLUSIONS: The methodology and the assessment used will be presented and discussed.

765 Examining the Psychosocial Impact of Childhood Cancers on Irish Families and the Role of a Therapeutic Recreation Programme in Mitigating this Impact Meyler Ea, Guerin Sa, Kiernan Gb, Breatnach Fc a Psychology, University College Dublin, Dublin, Ireland; bNursing, Dublin City University, Dublin, Ireland; cOncology/Haematology, Crumlin Childrens Hospital, Dublin, Ireland PURPOSE: The primary objective of this research is to evaluate the role of a therapeutic recreation programme in reducing the psychosocial impact of childhood cancers on Irish families. METHODS: Participants to date are 14 families who have had a child diagnosed with cancer and who have attended a family-based therapeutic recreation programme. Parent’s perceived impact of the illness on the family and perceived social support, have been assessed one month before (Time 1), on month after (Time 2) and four months after (Time 3) participation in the programme. In addition, nine families to date have completed semi-structured interviews exploring their experiences of illness, their views of the programme and their perceptions of the impact of the programme on the family. RESULTS: Preliminary analysis of the qualitative data indicate beneficial effects for families relating to family functioning, where parents describe the positive impact of spending time as a family ‘away from the illness’ and a growing awareness of their own strengths as a family. In relation to the quantitative data, while no significant changes over time have been observed, the direction of mean scores indicate positive effects for families in key areas. CONCLUSIONS: The preliminary findings are encouraging and data collection for the study is ongoing. A comparison group of 50 families who have not attended the therapeutic recreation programme is also currently being sourced through a local children’s hospital.

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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ACKNOWLEDGEMENTS: The financial support of Cancer Research Ireland is gratefully acknowledged.

766 The Rehabilitation Service For Breast Cancer Patients Offered by the Lega Tumori, Florence 1986–2005 Mirante Na, Miccinesi Ga, Ciani Lb, Martinelli Fa, Ciurekgian Rb a Epidemiology CSPO, Florence, Italy; bLega Italiana per la Lotta contro i Tumori-Sezione di Firenze, Florence, Italy PURPOSE: To describe the rehabilitation service offered by the Italian Lega Tumori since 1986 in the provinces of Florence and Prato (Tuscany). METHODS: The characteristics of 1143 women who required this service have been gathered prospectively from 1986 to 2005. Oncological disease and life status information were gathered from the Tuscan Cancer Registry. RESULTS: 7.2% of breast cancer incident cases in the area accessed the service. The mean age was 54.6 years, 72% were married, 21% without children, 42% housewives, and 22% had their cancer detected through screening. The median interval after the operation was 91 days. Compared with all the other women that had breast cancer in the same area and period they were younger (for each additional year, OR: 0.95; 95% CI: 0.95–0.96), more often resident in Florence (OR: 4.1; CI: 3.6– 4.8), and had a lower risk of death (HR: 0.71; CI: 0.55–0.91; Cox model adjusted for age, period of incidence, cancer stage, screen-detection, interval to rehabilitation). In 1986–1990 4% of those who accessed the service requested psychological support and 19% felt that their relationship with others had improved after the illness, whereas in 2001–2005 they were 30 and 29%, respectively. CONCLUSIONS: Women who accessed the Lega service in 1986–2005 were 7.2% of incident cases in the area; they were younger and more often resident in Florence. The request for psychological support increased from 4 to 30%.

767 Regaining a Sense of Agency and Shared Selfreliance: The Experience of Advanced Disease Cancer Patients Participating in a Multidimensional Exercise Intervention While Undergoing Chemotherapy}Analysis of Patient Diaries Midtgaard Ja, Stelter Rb, Rrth Mc, Adamsen La

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a

Body & Cancer (UCSF), Copenhagen University Hospital, Copenhagen, Denmark; bInstitute of Exercise and Sport Sciences, University of Copenhagen, Copenhagen, Denmark; cDepartment of Oncology, Copenhagen University Hospital, Copenhagen, Denmark It has been suggested that physicians should prescribe exercise to cancer patients because it is enjoyable, builds confidence, develops new skills, and incorporates social interaction. However, no qualitative studies could be found that provided in-depth descriptions and understanding of the psychological impact of exercise interventions in patients with advanced cancer. The present study aimed to qualitatively explore the experiences of advanced disease cancer patients participating in a 6-week, 9-hours weekly, structured, group-based multidimensional exercise intervention while undergoing chemotherapy. Unstructured diaries from a purposive sample of three females and two males (28–52 years old) who participated in the programme served as the database. Data were analyzed using a phenomenological, narrative method. The analysis yielded three themes: shifting position, self-surveillance, and negotiated strength. The intervention highlighted situations making it possible for the participants to negate psychological and physical constraints. The intervention was an intrusive element that invited the individual to assess his/her own situation in order to increase purpose, autonomy and responsibility. the intervention The concept of structured exercise can be seen as a behavioural strategy that stimulates patients to construe their situation as an encounter that calls for self-action, leaving the individual with a sense of increased agency. Exercise during advanced disease may contain viable psychotherapeutic potentials by allowing the development of alternative bodily and mental realities complying with cancer patients’ demands and abilities to regain autonomy and commitment to discover and adopt a sense of agency and shared self-reliance.

768 Parent–Child Communication About Childhood Cancer Miller KSa, Robinson KEb, Gerhardt CAb, Vannatta Kb a Psychology, The Ohio State University, Columbus, USA; bPsychology, Columbus Children’s Hospital, Columbus, USA

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PURPOSE: To pilot an observational protocol describing the process and content of parent–child communication about pediatric cancer and to examine how medical and demographic variables influence communication. METHOD: Participants will include 30 children (ages 5–17) and their parents recruited 2–3 months post-diagnosis or relapse. Parents and children are videotaped discussing the child’s diagnosis and treatment. Questions about the content, timing, and success of their communication are provided as prompts. Transcriptions are double-coded for cancer content. Medical information and physician perceptions of prognosis are obtained. RESULTS: Eighteen observations have been coded, and 30 will be available for the final presentation. Most parents and children (72–89%) spoke directly about the diagnosis, treatment, and side effects. They were less likely to discuss prognosis (67– 78%). Parents were more likely than children to say the word ‘cancer’ (Pparent ¼ 0:50; Pchild ¼ 0:22) or the specific diagnosis name (Pparent ¼ 0:22; Pchild ¼ 0:17), but the reverse was true for direct reference to ‘death/dying’ (Pparent ¼ 0:17; Pchild ¼ 0:33). Prognosis demonstrated small to medium associations with different aspects of communication. Girls were more likely to mention ‘cancer’ or ‘death/dying,’ and older children talked more about treatment. CONCLUSIONS: Many families communicate openly; however, medical and demographic variables may influence parentchild conversations. Observation protocols represent a novel way to examine how families communicate about cancer and may help inform clinical care.

769 Quality of Life in Context: Women’s Proffered Comments on their QoL Issues in Early Stage Breast Cancer Mills Ja,e, Moynihan Cb,e, Bliss JMa,e, Hopwood Pd,e a Clinical Trials & Statistics Unit, The Institute of Cancer Research, Sutton, UK; bClinical Academic Radiotherapy, The Institute of Cancer Research, Sutton, UK; cClinical Trials & Statistics Unit, The Institute of Cancer Research, Sutton, UK; dPsychoOncology Service, Christie Hospital NHS Trust, Manchester, UK; eOn behalf of the START TMG PURPOSE: To assess the impact of co-morbidity and life events on patients’ quality of life from a large number of spontaneously proffered comments and letters which were submitted by women

Copyright # 2006 John Wiley & Sons, Ltd.

in a QoL sub study of a UK randomised trial of adjuvant radiotherapy for early breast cancer. METHODS: Themes were identified and 9 categories created: mobility; chronic medical conditions; breast cancer related problems; treatment side-effects; additional surgery; acute medical conditions, psychological difficulties, life events/ bereavements and job problems. The influence on contextual factors was examined for Role (RF), Social (SF) and Physical Functioning (PF), and HADS Anxiety (A) and Depression (D); these were compared for those patients who made comments and those who did not. RESULTS: Over 25% submitted comments over 2 years of follow up. A range of 4–69 comments were written per category per time-point. Patients reporting problems relating to mobility, chronic medical and breast related problems had lower levels of RF, SF and PF than the remaining trial patients (t-test, all p50:01). The prevalence of HADS A and D borderline/cases (score > 8) was significantly increased in the majority of comparisons in those reporting psychological or job problems and life events. Breast related problems were associated with significantly higher HADS A compared with other trial patients ðp > 0:002Þ at 1 and 2 years. CONCLUSION: Exploratory analysis suggests that contextual factors are relevant to the interpretation of QL data, with significant effects on patients’ emotional and functional status.

770 5-year Follow-up of Sexual Functioning and Sexual Enjoyment after Radiotherapy for Early Stage Breast Cancer in The START Trial Mills Ja,c, Sumo Ga,c, Bliss JMa,c, Hopwood Pb,c a Clinical Trials & Statistics Unit, The Institute of Cancer Research, Sutton, UK; bPsycho-Oncology Service, Christie Hospital NHS Trust, Manchester, UK; cOn Behalf of the START TMG PURPOSE: To examine self-reported sexual functioning (SEF) and sexual enjoyment (SEE) as part of 5 years follow-up QL for women with early breast cancer following surgery +/ chemotherapy, and after radiotherapy (RT). METHODS: QL was evaluated in 2181 patients (mean age 56.5, range 26–87) using EORTC BR23, Body Image Scale (BIS) and HADS prior to and 6, 12, 24 and 60 months after RT. Three BR23 items assessed SEF/SEE. Predictors of change over time including age, clinical and psychological factors, were examined using multiple regression and the

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population average GEE model. RESULTS: At baseline, 2087 women completed the SEF items, of whom 56% reported that they lacked interest in sex, and 40.6% women were sexually active. Proportions of women reporting ‘quite a bit’ or ‘very much’ SEE were 39% and 22%, respectively. Older age, CT and HADS anxiety and depression were significantly associated with worse baseline SEF/SEE with no effect of type of surgery, time since surgery, or body image (BI). SEF improved significantly from baseline to 6 months ðp50:001Þ but thereafter declined over time ðP50001Þ towards baseline levels. Predictors affecting decreased SEF were older age, poorer body image and increased HADS depression and anxiety. CONCLUSION: Although CT has an initial adverse effect, sexual functioning and enjoyment appear to be mainly affected by age and psychological variables over time. The observed associations with depression and body image warrant further investigation and results will be reported. Women should be informed of likely treatment effects and offered appropriate advice and support.

771 The Experience of Family Support Among Women with Breast Cancer in the USA and Romania Mirsu-Paun Aa, Mirsu-Paun Cb a Psychology, University of Florida, Gainesville, USA; bDepartment of Psycho-Oncology, Institute of Oncology ‘Alexandru Trestioreanu’, Bucharest, Romania This study explored differences in levels of (a) perceived family support and (b) satisfaction with family support, in association with patterns of family functioning (i.e. cohesion, expressiveness, and conflict levels) among women with breast cancer in the USA and Romania. Three types of family support were studied: informational, tangible, and emotional. A total of 194 women diagnosed with breast cancer (91 American and 103 Romanian) participated in this study. They were recruited at their health care clinics or at support group meetings and indicated their agreement to participate by completing the study questionnaires (i.e. the Family Relationship Index and the Index of Socially Supportive Behaviors). We expect the statistical analyses to be conducted to reveal significant associations between levels of perceived family support and levels of satisfaction with family support, and various patterns of family functioning (i.e. cohesion, expressiveness, and

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conflict). We also anticipate that different types of family support (e.g. informational but not emotional, etc.) will show to be significant for American compared with Romanian women. The data from this study can be used in working with women with breast cancer to assess the patterns of family functioning associated with their levels of satisfaction with family support. Additionally, any found differences in levels of perceived family support among women with breast cancer from the USA versus Romania provide evidence for studying cultural differences associated with different levels of perceived family support available to women with breast cancer in these two countries.

772 Clinicians Willingness to Screen for Distress} Survey of Cancer Professionals Mitchell AJa, Coggan Ca, Herdman Jb a Psycho-oncology, Leicester General Hospital, Leicester, UK; bHealth Psychology, Leicester General Hospital, Leicester, UK INTRODUCTION: Screening tools have been used to improve the detection rates, but their value remains unclear often due to problems with implementation. A significant issue is also whether health professionals are willing to formally screen for distress and if so, what length of tool is preferred? Recent recommendations from NICE advocate screening for distress and short practical tools have also been validated (Jacobsen et al., 2005). We aimed to examine clinicians readiness to use any such tool. METHODS: An initial literature review revealed little has been published on this topic before. We designed a new questionnaire of clinicians attitudes to distress screening and conducted a survey of health professionals working in cancer care. We distributed 150 questionnaires and received 90. Typical questions were ‘Do you routinely screen for psychological distress in your patients?’ and ‘How much time would you be willing & able to allocate to DETECTING distress per appointment?’. RESULTS: Almost all clinicians were aware of the need to detect distress but many relied on their own clinical abilities (without special training). Of the clinicians that were willing to formally screen for distress, most preferred a short questionnaire. If given the choice, one that required as little time as possible. Clinicians were generally not aware of the issue of low accuracy or false positives with some tools. A subset of clinicians want to refer all

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distressed patients to a nurse specialist or dedicated psycho-oncology team if distressed. Reference: Jacobsen et al. 2005. Cancer 103: 1494–1502.

773 Who Believes Psychological Factors Influence Onset or Course of Cancer: Comparative Survey of Psychiatrists, Surgeons and Oncologists Mitchell AJa, Friedman Tb a Psycho-oncology, Leicester General Hospital, Leicester, bLeicestershire, UK; Liaison Psychiatry, Leicester General Hospital, Leicester, Leicestershire, UK INTRODUCTION: The question of whether psychological factors influence the onset or outcome (survival) of patients with cancer is highly debated. In a pilot we previously surveyed the beliefs of health professionals (see Mitchell and Friedman, 2004). Here we provide the complete analysis with additional data from general surgery. METHODS: We designed a questionnaire to examine the degree of agreement with a number of statements exploring this link. Degree of agreement was rated on a Likert scale from ‘totally disagree’ to ‘totally agree’. We then conducted a face-to-face survey of attitudes amongst health professionals working in the cancer field and compared results to psychiatrists working independently. We received 216 replies from health professionals working in cancer care [C] 94 from surgeons [S] and 77 responses from psychiatrists [P]. RESULTS: 72% of cancer staff and 81% of psychiatrists felt psychological factors influenced survival ðp50:01Þ: 63% [C] vs 68% [P] said that patients should be helped to ‘think positively’. 75% [C] vs 86% [P] thought that coping style could be altered ðp50:01Þ: 94% of Psychiatrists but 78% of cancer professionals thought that antidepressants should be avoided after receiving ‘bad news’ ðp50:001Þ: Psychiatrists and oncologists were undecided whether bad news was disclosed in a sensitive manner but surgeons believed this to be the case. CONCLUSIONS: Different health professions appear to hold somewhat different views on whether psychological factors influence the onset or course of cancer. References Mitchell AJ, Friedman T (2004) 7th IPOS.

774 Accuracy of Very Short Screening Tests for Distress in Physical Disease: Meta-analysis

Copyright # 2006 John Wiley & Sons, Ltd.

Mitchell AJ Psycho-oncology, Leicester Leicester, Leicestershire, UK

General

Hospital,

INTRODUCTION: A number of long casefinding instruments with robust psychometric properties have been validated in primary care (Mulrow et al., 1995). However, these questionnaires take more than five minutes to complete and may be impractical in busy clinics. In order to improve on acceptability, a number of short tools have been developed with less than 15 items. Examples include the 5 item WHO Well-Being Index Questionnaire and Patient Health Questionnaire. Recently, even shorter (ultra-short) questionnaires consisting of three, two or even a single detection question/linear scale have been developed. Most well known in oncology is the distress thermometer. METHODS: We conducted a literature review, critical appraisal and pooled/ meta-analysis of ultra-short instruments used in those with physical disease. RESULTS: We found 12 studies including 5 in cancer settings. We compared the pooled sensitivity, specificity and positive predictive values with existing data on similar questionnaires in primary care. 22 previous studies of five different instruments in primary care (sensitivity 73.7%, specificity 74.7%, PPV of 38.3% and NPV of 93%) (Mitchell and Coyne, 2006). Results from this new analysis suggest that one or two item test perform comparably in physical health settings but with a low positive predictive value compared with a high negative predictive value. CONCLUSIONS: Very short screening methods appear to work optimally to ‘rule out’ distress/depression. References: Mulrow CD et al. 1995. Ann Int Med 122: 913– 921. Mitchell AJ, Coyne J. 2006 Br J Gen Pract (in press).

775 Personality Differences Between Married and Nonmarried Colon Cancer Patients Mivtach Ra, Pyshniak Lb, Figer Ab a Psychotherapy, Center Ron Institute Kvutzat, Kineret, Israel; bOncology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel PURPOSE: The purpose of the study was to test personality differences in colon cancer patients by means of the Rorschach test. The personality differences were expected between patients who are married and those who are not. METHOD:

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The participants were 44 colon cancer patients of both genders. 28 were married at the time of the diagnosis and 16 were not. All were in the age range of 36 to 45 years old. The patients were administered the Rorschach personality test. It was considered adequate because it assesses personality on a subconscious level. RESULTS: The groups of married and nonmarried patients were compared on 39 different variables of the Rorschach. Only two yielded significant findings: the variables of F þ % and the variable of M. Married patients were higher on F þ % and lower on M. CONCLUSIONS: The Rorschach test reveals only two personality differences between married and nonmarried cancer patients. Other tools need to be applied for further exploring the differences between married and nonmarried cancer patients.

776 Four Years Experience of An Integrated Psychooncologist Modolell Ea, Sanz-Ortiz Jb a Oncologı´a Me´dica, Hospital Universitario Marque´s de Valdecilla, Santander, Spain; bOncologı´a Me´dica, Hospital Universitario Marque´s de Valdecilla, Santander, Spain The experience tries to demonstrate that the integration of psycho-oncologists in Oncology Units is possible, useful and even necessary. Through the true four years experience of a psycho-oncologist integrated in an oncology unit of a Spanish hospital we try to point out an organisation way. Integration concept implicates taking part as a psychologist in all the activities of the Oncology Medical Unit of the hospital. Attending the clinical and bibliographical sessions. Sharing with the sanitary team the emotional burden of cancer patents and their relatives. Receiving the admitted patients together with nurses, doctors and psychologist. Paying special attention to relatives. Moreover, there are the psychology consultations for the cancer patients and their relatives. During this four years an average of 18 patients and relatives have been visited on the consultation. All admitted patients and their families have met the psychologist and have the chance of demanding professional support. Approximately five bibliographical sessions a year have been given. Burnout prevention is another stand out subject. The integrated psychologist experience provides some news regarding to

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the traditional position of psychologist on hospitals. Integrated psycho-oncologist doesn’t need to appear, because he is actually when and where problems emerge. The integrated psychologist does a prevention task of the appearance of conflicts. Detection of early problems becomes possible because of the presence of the psychologist in the same moment of his gestation Patients and colleagues evaluate as satisfactory the integration of a psycho-oncologist on their work teams.

777 Patients Perspectives on Clinically and Psychosocially Implications of Central Venous Catheter Selfcare versus Professional Controlled Central Venous Catheter Care Moeller Ta, Adamsen Lb a Hematology, Rigshospitalet, Copenhagen, Denmark; bUCSF, The University Hospital’s Centre for Nursing and Care Research, Copenhagen, Denmark OBJECTIVE: We previously demonstrated a significant decrease of catheter-related infections in patients with haematological malignancies providing their own central venous catheter (CVC) care. This abstract addresses the patient perspective of CVC self-care versus CVC professional controlled care. Setting: A specialised haematological unit with outpatient and bone marrow transplantation capacities. DESIGN: A phenomenological-hermeneutic analysis of qualitative data gathered as part of a randomized controlled intervention study. METHODS: 82 patients with CVCs were enrolled from May 2000 to September 2002. The intervention group (IG) ðn ¼ 42Þ receiving the patient-education program was individually supervised by the clinical nurse. The control group (CG) ðn ¼ 40Þ followed standard CVC procedures carried out by nurses in and outside the hospital. Nine intervention and nine control patients were selected by strategic sampling to semi-structured interviews focusing on the patient’s experiences with the working methods as well as psychosocial and body aspects by having a catheter. Transcripts were analysed using a phenomenological-hermeneutic approach. Thematic analysis was carried out based on a template method. RESULTS: The contextual situation in terms of treatment and non-treatment was essential for the patients’ perception by having a catheter. The two working

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methods influenced differently on both clinically and psychosocial implications. The IG experienced increased feeling of control, independency ad safety. The CVC influenced the patients’ experience of sexual problems, social isolation and altered body image in both study groups. CONCLUSION: Compliance orientated patient education can empower patients with a CVC to better control, independency and may generate active, problem solving coping strategies.

778 OVER (Olive oil Vaginal Exercises and Replens) Come Mok Ka, Mireskandari Sa, Juraskova Ib, Jarvis Sc, Friedlander Ma a Psychosocial Research Group, Department of Medical Oncology, Prince of Wales Hospital, Sydney, Australia; bPsychosocial Research Group, University of Sydney, Sydney, Australia; cDepartment of Endo-Gynaecology, Royal Hospital for Women, Sydney, Australia Vaginal dryness, dyspareunia (pain during sex) and/or vaginismus (painful tightening of the vagina) are reported in up to 50% of breast cancer survivors. Poor vaginal lubrication results in dyspareunia, and there is often avoidance and anticipatory fear, along with involuntary pelvic floor muscle (PFM) contraction. Most women are advised to use a vaginal lubricant during intercourse, but this is often inadequate. PURPOSE: This pilot intervention study aims to prospectively evaluate the efficacy of an intervention using PFM relaxation exercises to prevent vaginismus, a vaginal moisturizer (Replens) to alleviate vaginal dryness, and olive oil as a lubricant during intercourse, to decrease sexual difficulties experienced following adjuvant treatment for breast cancer. METHOD: Women with a diagnosis of breast cancer who have completed adjuvant chemotherapy, and have had amenorrhea for the past 6 months or are currently on aromatase inhibitors are recruited. This will be a 26-week intervention study, with interventions by a trained physiotherapist at weeks 0 and 4 and follow-ups at weeks 12 and 26. Fifty eligible women will be recruited and data will be collected at each time point, using self-administered questionnaires with validated measures of sexual functioning, quality of life, and emotional outcomes. Readings of PFM functioning will also be recorded by the physiotherapist at each time point.

Copyright # 2006 John Wiley & Sons, Ltd.

RESULTS AND CONCLUSIONS: It is anticipated that sexual functioning and quality of life will substantially improve post-intervention. If proven effective, this intervention has the potential to revolutionize the treatment of women with sexual problems following breast cancer treatment.

779 Pediatric Melanoma: A Call for Research Mollen Ea, Johnson Tb, Riba Mc, Rabe Mb a Pediatrics, University of Michigan, Ann Arbor, MI, USA; bDermatology, University of Michigan, Ann Arbor, MI, USA; cPsychiatry, University of Michigan, Ann Arbor, MI, USA PURPOSE: Children with malignant melanoma are a small but growing segment of the pediatric oncology population. The incidence in children under age 20 clusters into two diagnostic age groups: pre-puberty and adolescents. While the incidence of the younger group is reported to remain stable, that of the adolescent group (14–19) is increasing. The aims are to present incidence data from the University of Michigan Comprehensive Cancer Center (UMCCC), as well as a literature review of childhood melanoma to demonstrate a need for psychosocial research. METHODS: A comprehensive literature review was conducted to identify psychosocial research. A chart review was conducted to document the incidence of pediatric melanoma at UMCCC. RESULTS: An extensive medical and psychological literature review of English articles uncovered no research studies or psychosocial case reviews for children with malignant melanoma. UMCCC patients reflect the incidence and bimodal presentation of melanoma in children as described in the literature. CONCLUSIONS: There is a paucity of research evaluating the psychosocial characteristics and needs of the pediatric population with melanoma. Children with other types of cancers have been well-studied and research indicates that they are often psychologically impacted by the diagnosis, treatment and long term sequelae of cancer. Due to the often atypical initial presentation of melanoma in children, and the need for frequent ongoing surveillance after treatment, children may exhibit increased anxiety and coping difficulties, in addition to the adjustment issues that are held in common with other childhood cancer experiences that may persist past treatment.

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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780 The Place of Death of Teenagers and Young Adults Cancer Patients in a French Population Montel SREa, Flahault Ca, Pacquement Hb, Copel Lc, Laurence Vd a Psycho-Oncology Institut Curie, Paris, France; b Pediatric Oncology Institut Curie, Paris, France; c Supportive Care Institut Curie, Paris, France; d Medical Oncology Institut Curie, Paris, France BACKGROUND: Research on the distribution of cancer deaths by setting}hospital, home, other}in TYA cancer patients has never been investigated in France. However, it is an essential question in order to respond to the needs of these patients and their families at the end of life. PURPOSE: In order to help for planning of a palliative care program, we reviewed the place of death of young patients who were registered in our cancer center, and explored factors that predicted place of death. METHODS: We interviewed parents or partners of teenagers and young adults (TYA) cancer patients who died between 2000 and 2003. Parents/partners were considered eligible if they lived in France, their child/partner aged between 15 and 25 years at time of death were cared at Curie, if their child’s/partner’s former physician allowed us to contact them. A semistructured interview was conducted at Curie by a psychologist. The main issues were: place of death, wishes of TYA patients and their families regarding the place of death, and factors determining the place of death choice. RESULTS: We completed 21 interviews between October 2005 and April 2006, for an overall rate of response of 21 percent (21 of 81 eligible). Preliminary results will be presented. CONCLUSIONS: These qualitative data should not only confirm and enrich understanding of known factors, but also bring new factors. We hope to improve quality of care of TYA dying patients and their families in order to respect their wishes. ACKNOWLEDGEMENTS: La Fondation de France supported this research.

781 How to Cope Relapse Fears: Acceptance and Commitment Therapy (ACT) for Cancer Patients Montesinos Fa, Luciano Cb, Pa´ez Mc, Remedios Md a Spanish Cancer Association (aecc), Madrid, Spain; bUniversity of Almerı´a, Almerı´a, Spain; c Spanish Cancer Association (aecc), Almerı´a,

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Spain; dSpanish Cancer Association (AECC), Granada, Spain PURPOSE: Cancer patients are often involved in fighting against worries and memories related to their illness. Our intention was valuing therapeutic usefulness for cancer patients of an ACT-based procedure centered in values clarification and exposure to private events associated to relapse fear. The aim was to learn about the efficacy of procedures which pursue changes at the contextual level, in contrast to the aims of usual procedures in this field, more oriented towards seeking changes in contents (modification or suppression of thoughts) and the impact of such contextual changes on valued actions of patients. METHODS: A brief (one session) ACT-based protocol was applied in treatment of relapse fears in eight I-II stage breast cancer patients with different degrees of psychological impact after diagnosis. Measures coming from questionnaires and custom-made scales are showed. Measures from 4 subjects in a waiting list are showed. RESULTS: Results showed intervention was effective in 7 out of 8 subjects following ACT brief protocol considering decreasing in interference of relapse fear. Significant drops in intensity and interference of relapse fear were found. Clinically significant drops in emotional distress, hypochondria and anxious worrying were also found. All subjects showed changes related to a less negative meaning of cancer. CONCLUSIONS: Although more investigation is needed including a greater number of subjects, results constitute a new evidence of ACT efficacy and its possibilities of application in psycho-oncology field. Benefits for patients were achieved without necessarily getting changes in topography or frequency of such thoughts.

782 Burnout Prevention in Cancer Volunteers through Acceptance Techniques Montesinos Fa, Pa´ez Mb, Luciano Cc a Spanish Cancer Association, Madrid, Spain; b Spanish Cancer Association, Almerı´a, Spain; c University of Almerı´a, Almerı´a, Spain PURPOSE: Burnout is a risk in volunteers working next to cancer patients. Their work needs extremely complex communication and emotional management skills. This paper is intended to explore possibilities of Acceptance and Commit-

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ment Therapy (ACT) in voluntary work field, when coping with difficult situations which trigger psychological barriers. This new therapy is directed towards providing skills to manage frustration, helplessness, anger and other possible feelings associated to voluntary work. METHODS: An exploratory work is presented with pre and post measures and follow-up after 3 months. Measures were taken through questionnaires and custom-made scales. Group intervention followed an ACT-based protocol. The core of intervention included acceptance methods and exposure to private events and was provided in an only session. Participants were volunteers attending a telephone information service for cancer patients and families provided by Spanish Cancer Association (AECC). RESULTS: Results related to observed changes in burnout reduction, satisfaction with voluntary work, intensity and interference of barriers, and qualitative appraisals of the impact of intervention are presented. Individual change is emphasized. CONCLUSIONS: Acceptance and Commitment Therapy appears as an effective approach for facilitating voluntary work in cancer and burnout prevention. Although additional studies are needed, data are showing this promising intervention focussed in acceptance of feelings which are associated to voluntary work, can help to improve quality of help and preventing burnout.

783 Hospital Doctor’s Reactions to a Memorable Patient Death: Survey of Responses and Needs Moores TSa, Castle KLa, Shaw KLb, Stockton MRc, Bennett MIc a School Of Medicine, The University of Leeds, Leeds, UK; bObstetrics & Gynaecology, York District Hospital, York, UK; cPalliative Medicine, St Gemma’s Hospice, Leeds, UK PURPOSE: To investigate reactions experienced by hospital doctors following a recent memorable patient death, coping strategies employed, impact of training and need for support in future situations. METHODS: Questionnaire survey of 188 hospital doctors of all grades attending 12 educational meetings at two teaching hospitals and one district general hospital in West Yorkshire, UK. Questionnaire measured the relationship between the intensity of doctors’ emotional and physical reactions following a recent memorable patient death (using categorical rating scales),

Copyright # 2006 John Wiley & Sons, Ltd.

exposure to previous training, gender, seniority and medical speciality. RESULTS: Response rate was 79%. Between 5 and 12% of doctors experienced moderate to severe intensity reactions to a patient death, regardless of gender, seniority or medical specialty. Perceived need for both training and increased support from team members was significantly associated with more intense reactions. Common coping strategies included talking, having time alone, socialising, exercise and religious guidance. Previous training was not associated with less intense responses or different coping strategies. CONCLUSIONS: Many doctors perceive that they deal with death well. In a minority of doctors more supportive approaches are necessary, that may include both proactive and reactive measures. This is especially important for doctors in palliative care and oncology who are exposed to significantly more patient deaths. Examples include raising awareness of support services, establishing formal training programmes, and a greater awareness by leaders of clinical teams of their own needs and the need to support some team members after a patient’s death, which may include timely access to a counsellor.

784 Emotional and Physical Problems in Relation to Psychological Distress in Breast Cancer Patients Undergoing Chemotherapy Zainal NZ, Ting JH, Koh OH Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia The PURPOSE of the study was (i) to describe the rate of emotional and physical problems experienced by breast cancer patients undergoing chemotherapy; and (ii) to determine the significant problems associated with psychological distress. METHODS: 82 newly diagnosed women with breast cancer who underwent chemotherapy at daycare outpatient oncology clinic were included in the study. Their mean age was 48.3+9.1 years, 74% were married; and about half were Chinese, 25% Malays and 15% Indians. Patients were asked to identify their emotional and physical problems in a prepared checklist form; and to report their distress level using Hospital Anxiety and Depression Scale (HADS). RESULTS: Worry was the most common emotional problems followed by fearful, sadness, feeling depressed, nervousness and loss of interest in usual activities. The common physical problems were fatigue,

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difficulty sleeping, skin problems, difficulty eating, memory and concentration difficulties, appearance, tingling sensation of hands and feet, nausea, pain and constipation. Using the HADS scores, 45% of them were ‘cases’ of psychologically distressed. All the listed emotional problems were significantly associated with psychological distress. Having eating difficulty, memory and concentration problems, appearance problems, tingling sensation, constipation, problems with urine, breathing and indigestion were significantly associated with psychological distress. CONCLUSIONS: Emotional problem should be recognized by professionals who deal with breast cancer care as it indicates the person is having distress. The physical problems which commonly are the side effects of chemotherapy drugs can be the source of psychological distress in breast cancer patients.

785 Psychosocial Aspects of Cancer in Movies. A Survey Oriented to Medical Didactics Morelli ACa, Gatti Ma, Marmai Lb, Grassi La,b a Section of Psychiatry, Psycho-Oncology Unit, University of Ferrara, Ferrara, Italy; bDepartment of Mental Health, Ferrara, Italy INRODUCTION: The need for training cancer care professionals on psychosocial issues in oncology has been reported as a relevant area. The use of movies has been repeatedly showed to be a powerful didactic instrument in psychiatry. The aim of this study was to examine the use of movies dealing with cancer subjects as a possible further tool in training cancer care professionals. METHODS: The study, as a part of a more general one concerning cancer and the media, examined the most important movies produced over the last 50 years which explicitly contained cancer themes. The Morandini Movie Dictionary, the web sites (e.g. Cinema and Disabilities), with the addition of movie reviews from specialized magazines, were employed for the survey. RESULTS: 137 titles were selected and classified according to time of production. A full descriptive analysis of the story was performed in order to classify the movies by main themes (e.g. doctor– patient relationship, family issues, death and dying) and the main psychosocial implication (e.g. emotional reactions and coping, social support, spirituality). A series of short video-clips were created to be used in Psychosocial Aspects of

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Cancer Care workshops for cancer care professionals. DISCUSSION: The study showed that significant didactic material deriving from cancer movies can be easily and flexibly inserted in different formats of psycho-oncology workshops in order to favour awareness, introspection and discussion (in small and in large groups) of participants.

786 Psychological Adjustment to Breast Cancer: Involved Variables Moreno Bas P, Almonacid Guinot V, Queipo Peirats S, Lluch Herna´ndez A Servicio De Hematologı´a Y Oncologı´a Me´dica/ Unidad De Psicooncologia Hospital Clı´nico Universitario/Junta Asociada Provincial De Valencia De La Asociacio´n Espan˜ola Contra El Ca´ncer, Valencia, Espan˜a In this study we evaluated a sample of 44 patients treated at the Service of Hematology and Medical Oncology of the University Clinical Hospital of Valencia (Spain), between 1999 and 2000. All patients had been diagnosed with breast cancer and were initiating adjuvant chemotherapy treatment. Our objective was centred on discriminating those variables that may help to prevent emotional suffering throughout the process of the disease. For this purpose we evaluated, by means of semistructured interview, the five moments in the disease process that we consider to be especially problematic, requiring greater effort in facing up to the disease. We also attempt to analyze the importance of the possible relationship between some medical and psychological variables and facing up to the disease, the perception of the passage of time in the patients and the perceived family/social support. We found significant differences between different instances of evaluation. We can conclude that the period from the diagnosis, the passage through surgery (radical or conservative) and before initiating chemotherapy, are the most difficult moments, when more specialized attention is needed. At the first revision the patients have been able to adapt themselves, assimilating the situation and have overcome the consequences of the chemotherapy treatments, this improvement is maintained at the 2nd revision. However, this is not the case with regard to the adverse effects of surgery nor with those patients who have a previous history of psychological issues.

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787 Evaluation of the Psychological Distress after the Surgery of Breast Cancer Moreno Bas Pa, Buch Villa Eb, Puig Herna`ndez MAc, Garce´s Furio` Rd, Galan Brotons Ae a Unidad de Psicooncolog"ıa del Hospital de Sagunto Junta Asociada Provincial de la Asociacio`n Espanola Contra el Ca`ncer de Valencia, Hospital de Sagunto, Valencia, Spain; bServicio de Cirug"ıa General y Aparato Digestivo, Unidad Funcional de Ca`ncer de Mama Hospital de Sagunto, Valencia, Spain; cUnidad de Hospitalizacio`n a Domicilio Hospital de Sagunto, Valencia, Spain; dHospital de Dia de Oncohematolog"ıa Hospital de Sagunto, Valencia, Spain; eServicio de Oncolog"ıa Hospital de Sagunto, Valencia, Spain This work values the psychological distress that takes place after the surgery of breast cancer in a sample of 36 women diagnosed with breast cancer, that after to be operated in the Sagunto’s Hospital, they are attended for the Unit of Hospitalization to Residence. This work is based on the multidisciplinary experience in which participate professionals with different specialties from the Functional Unit of Breast Cancer, in order to optimizing and to improve the patients quality of life. The evaluation was carried out in two moments; the first is the fourth day after the surgery, when the patients are discharged from hospital and once in their residence they pass to be attended by the Unit of Hospitalization to Residence (UHD) of the Hospital. The second moment is in 3-4 weeks after the surgery when they respond to Hospital during the day (HD) to initiate processing of chemotherapy. The evaluation valued by an interview structured with psychological, medical, and demographic data, the psychological distress valued by means of Scale of Anxiety and Hospital Depression (HAD) of Zimond and Snaith (1983) that 14 is comprised of ı´ tems (7 for Anxiety and 7 for depression). And finally, an interview was carried out semi-structured with 4 Visual Analogue Scales (EVA), in which was asked to the patients on adjustment, quality of life and satisfaction.

788 Olfactory and Memory Changes in Post-treatment Breast Cancer Survivors Morgan Aa, Metzger RLa, Burns Pb, Shapiro JLa, Lewis Pb

Copyright # 2006 John Wiley & Sons, Ltd.

a

Psychology University of Tennessee at Chattanooga, Chattanooga, USA; bSurgery University of Tennessee, Memphis, USA

Women undergoing chemotherapy for breast cancer often report feelings of mental slowness, memory problems, and difficulties with attention. It is becoming increasingly important to understand both the range of changes that occur. Previous research has demonstrated changes in verbal memory. The primary focus of this study was to examine the long-term changes in olfactory performance, as well as confirming previous research on the impact on attention and verbal memory. We report the results of 50 breast cancer survivors (average age ¼ 67) from 1 to 18 years (average of 4 years) following the completion of treatment. These women were given measures of olfactory identification (University of Pennsylvania Smell Identification Test), attention (digit span) and verbal memory (n-back lag task). Preliminary findings reveal that performance on each of these measures was significantly different than comparable age matched groups, based on published norms. The olfactory performance was in the 33%. Digit span was 1 digit below the comparable age groups typical performance. Verbal memory was better than age matched peers, a result seen in other research. Approximately 30% of the sample did not receive chemotherapy, only surgery and radiation. There was no difference in the performance of the chemotherapy versus the non-chemotherapy group, suggesting that at least some cognitive difference may be the outcome of other treatment or the disease itself.

789 Elderly Cancer Patients: Illness Experiences Morgana F, D’Accordi S, Vigorelli SM, Capovilla ED Oncologia Medica, Istituto Oncologico Veneto I.R.C.C.S., Padova, Italia PURPOSE: Psycho-affective assessment and emotional experiences analysis in a population of 190 older cancer patients (aged limits: 70–92 years; 125 females 65 males). Patients taken into care in the Medical Oncology department from April 2004 to January 2006. METHODS: Used tools: semi-structured acceptance interview and Geriatric Depression Scale (GDS), as reported in Multidimensional Geriatric Assessment (MGA).

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RESULTS: The GDS results demonstrated that 32.1% (61) of the patients had light or serious depression. In the acceptance interview 62.1% (118) of the patients reported psychological suffering, in particular 49% anxiety, death fear and fear, 26% a specific way to face the disease (coping style). CONCLUSIONS: These results confirm the importance of the acceptance interview such as an opportunity of discussion, to a deeper level, about patients illness experiences, in order to obtain a more precise assessment and a better treatment for these patients needs.

affected needs regarding symptom control; treatment intent (palliative vs curative) influenced informational, emotional, and symptom control needs; gender influenced informational, emotional, experiential and practical needs. Whilst most needs were stable over time, in regression analyses unmet need was prospectively associated with distress and QoL. CONCLUSIONS: The CaNAT has potential clinical utility if these findings are replicated to longer term. A full-scale trial platform study is underway.

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Assessing Psychosocial Needs of Cancer Patients with a Patient-held Tool: Do Unmet Needs Predict QoL and Mood? Morrison VLa, Zinovieff Fa, Russell ITb, Gollins Sc, Davies Gc a School of Psychology, University of Wales Bangor, Bangor, Wales, UK; bInstitute of Medical & Social Care Research, University of Wales Bangor, Bangor, Wales, UK; cNorth Wales Cancer Treatment Centre Conwy & Denbighshire NHS Trust Rhyl, Wales, UK

Psychic and Cultural Aspects: Relation with Clinical Oncology Mosquera JA Department of Psychiatry, SOLCA, Quito, Ecuador

PURPOSE: Living ‘well’ with cancer and its’ treatment is fundamental to a persons’ well-being. Care should, wherever possible, fit the needs of individual patients as unmet needs is associated with higher symptom distress/reduced quality of life. Health professional’s assessments of patient needs may differ from those identified by patients themselves. Our study assesses the nature and salience of needs using a patient-completed needs assessment tool (CaNAT) and examines the predictive utility of unmet needs in terms of quality of life and mood 1 month after commencing treatment. METHODS: 166 adults attending an oncology clinic (28% breast; 19% urology; 14% colorectal; 10% head and neck; 10% haematology; 6% gynaecological; 5% lung; 8% other) were recruited. Participants completed demographic and treatment questions, the FACT-G (QoL), the POMS (mood) and the 52item CaNAT (assesses need frequency, saliency and degree to which that need is met; 8 domains: emotional, interpersonal, experiential, practical, informational, treatment/care, symptom control, broader service need). 108 participants completed a 4-week follow-up. RESULTS: The most frequent and salient needs related to information, emotions, and symptom control. Cancer site

Copyright # 2006 John Wiley & Sons, Ltd.

TREATMENTS: Chemotherapy and Hormonal therapy are elements related to ‘cultural perception and consequences’ in oncologic patients. Disease or treatment cause in physical area: nausea and emesis, alteration of appetite, smell/ taste; weakness. In the psychological area patients develop adaptation, depression/anxiety disorders, or delirium. Uncertainty and afraid to unknown situations, reiterative thoughts related to sickness, economic or work situation, afraid reactions to hospital, also ‘irritability and lack of collaboration’, ‘unspecific somatic complaints’, ‘inadequate or atypical evolution with the expectations’, and sleep alterations. NEEDS: The oncology patient need a ‘bio-psycho-social approach’ to the patient and his/her family. Cultural (popular) believes needs to be individualized and noticed in patients, especially in Ecuador, we have a perception of ‘short time and mortal evolution’, and ‘significant and catastrophic effects related to chemotherapy, equal in all types of oncologic disease or treatments’. Get an adequate relationship with the patient/family with an understandable language promote a lesser frequency and intensity of ‘secondary effects in treatments’. RECOMMENDATIONS: Emotional stability in treatment helps for optimal management. We get good results in Ecuador managing the chemotherapy treatment period with anxiolytics in adequate doses and short time use. Prescribing anxiolytics 2 or 3 days before chemotherapy reception, until 2–5 days after it, with suspension of it in the intermediate period, BZD of rapid or medium absorption rate, medium acting life, could be given

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twice a day, with night administration to enhance sleep. In Ecuador people have fear and a generalized believe that the use of anxiolytics will lead to drug dependency. This scheme must be associated with psychotherapy. You observe a frequency and intensity diminution of the ‘physical and psychic effects’ in chemotherapy.

792 Psychiatric Co-morbidity in Cancer Patients Mota M, Costa A, Fonseca S, Sousa V, Grangeia R Psychiatry, Hospital Sa˜o Joa˜o, Porto, Portugal There have been many studies reporting prevalence of psychiatric co-morbidity in cancer patients. The authors collected retrospective data on clinical features gathered from the psychiatric evaluation of 100 patients, occurred in the last 4 years and present the preliminary results. This is an ongoing study and the authors are planning to enlarge sample size. The main purpose of the request for psychiatric evaluation was depressive and anxious symptoms. Also important the growing number of complaints involving concern about self-image and sexual functioning. The most frequent psychological reactions to cancer were anxious worry, stoical acceptance and abandonment. One concluded about the higher prevalence of adjustment disorders with depressive/anxious reaction, which corroborates the results of most other researches.

793 Relevance of a Multidisciplinary Approach to Establish a Community Based Network of Palliative Care in a Population of Children with Cancer Moura MJ, Lacerda A, Ribeiro MJ, Pedroso E, Pava M, Chagas M Department of Pediatrics, Portuguese Institute of Oncology, Lisbon, Portugal PURPOSE: The Portuguese Institute of Oncology, Lisbon (PIOL) admits 150 new patients/y. To date, the ?25% of non-curable children and their families have no support program to improve their quality of life. We received a 2y grant to develop a community based network of palliative care (PC). METHODS: 1st phase (Oct05/Mar06)}a multidisciplinary questionnaire was applied to all the Hospitals (H) and Community Centers (CC) of our area, to know their skills, needs and structures. We prepared a Manual for health-care professionals and another for families. We per-

Copyright # 2006 John Wiley & Sons, Ltd.

formed a 16h training, mainly focused on psychosocial areas. 2nd phase (Apr06/Sep07)}children and families will enter this PC program, in a close interaction with the local Health Services. At the end we will apply another questionnaire to those involved. RESULTS: 92% of the 25 H and 70% of the 128 CC answered the questionnaire. Doctors and nurses at the H gave more importance to PC than at the CC; motivation and experience with grief were similar. Experience with procedures and pain is higher at H. All H have a SW, compared to 66% CC; their motivation is high but experience with CP is low. 86% of H have a psychologist, many experienced in PsychoOncology. 48% of CC have a psychologist, almost none experienced in Psychoncology. CONCLUSIONS: Health care professionals widely recognize the importance of PC and are motivated to locally support the families, through a multidisciplinary interactive dialogue guided by the experts at PIOL. ACKNOWLEDGMENT: work supported by Fundac¸a˜o Calouste Gulbenkian.

794 Making Treatment Decisions for Cancer: What do Patients Consider? Moxey AJa, Adams CAb, McGettigan Pa a School of Medicine & Public Health, University of Newcastle, Callaghan, Australia; bPsychoOncology Service, Mater Misericordiae Hospital, Waratah, Australia PURPOSE: To explore the factors that patients with cancer considered when faced with their prior treatment decisions. METHODS: Consecutive patients attending medical oncology and radiation oncology outpatient clinics from January to April 2005 were asked to complete a 10-minute computer-administered questionnaire. Patients chose from a list of possible reasons for opting to have treatment. These items were generated through discussions with clinical staff and patients with cancer. Qualitative data analyses were performed on other considerations listed by respondents. RESULTS: Of 246 patients who agreed to participate, 240 completed this section of the survey. Overall, 65% of respondents based their treatment decision on the information the doctor provided. However, only 40% of the sample considered the numerical data (e.g. percent chance of survival) when making their decision. Other factors taken into account were: peace of mind knowing that they had tried treatment (55%); the

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perception that it would improve their quality of life (42%); the belief that their family wanted them to have treatment (37%); and their intuition or ‘gut feeling’ (22%). Few patients incorporated information from the media (e.g. television, newspapers) or internet into their decision making (3 and 8%, respectively). Qualitative analysis of information provided by 82 patients corroborated the contribution of doctors’ advice and emotional and family consideration. CONCLUSIONS: Although advice from doctors and emotional and family considerations were equally important, numerical data were considered only by a minority of patients. ACKNOWLEDGEMENTS: Margaret Mitchell Research Grant Scheme.

795 The Forgotten Index Case: Recruitment Problems in the Context of Familial Prostate Screening in a Research Programme Moynihan Ca, Sweetman Jb, Watson Mc, Eeles Rd, Dearnaley De a Academic Department of Radiotherapy, Institute of Cancer Research Sutton, Surrey, UK; bInstitute of Psychiatry, King’s College, London, UK; c Department of Psychological Medicine, Royal Marsden NHS Trust Sutton, Surrey, UK; dCancer Genetics, Royal Marsden NHS Trust & The Institute of Cancer Research, Sutton & London, UK; eAcademic Department of Radiotherapy, Royal Marsden NHS Trust & The Institute of Cancer Research, Sutton & London, UK PURPOSE: To investigate the reasons why men with a family history of prostate cancer, failed to be screened in one phase of a research project. (Melia et al., 2006). METHODS: A qualitative study used Grounded Theory to analyse 28 recorded interviews with probands, transcribed verbatim. Eligible men were asked to describe the possible reasons for non participation or participation into a hypothetical study that mimicked the cited study. RESULTS: 2234 notes were ‘sifted’ for eligibility. 135 (6%) men fitted inclusion criteria. 61 (45%) showed interest and 30 (49%) consented to be interviewed. 28 (46%) participated. Three overarching themes were related to possible barriers to familial screening: Relationships, Masculinity and The Research Process. Two separate ways of responding emerged, however. One group of men were overwhelmingly eager that their relations should attend screening, the other

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sceptical, questioning the scientific base of this resource although familial screening was perceived to be beneficial. One set of responses rested on altruism and familial cohesion where disclosure was possible but temporal; the other on difficult relationships within families where communicating patterns were not easy. Barriers such as homophobia ran through one set of responses; the side effects of treatment that might jeopardise a sense of masculinity, the other. Both groups indicated that the research process itself might help to exclude men from participation. CONCLUSIONS: The giving of information to men, even after they have received a diagnosis, is required if Index Cases are to disclose knowledge that will help in the recruitment process. ACKNOWLEDGEMENTS: We would like to acknowledge and thank Professor Roger Kirby and Dr. Vincent Khoo, and all those working in the Urological Oncology Department of St George’s Hospital, Tooting, London. A special thanks goes to the participatns who gave their time and thoughts to us.

796 Survive and Thrive: Development of a Cancer Survivors Clinic in Rural New England Mulrooney TJ, Schaal AD, Scott MR, Smith EML, Meyer L Department of Nursing, Hematology Oncology, Clinic, Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center Lebanon, NH, USA The oncology community has become successful at curing many forms of cancer, as evidenced by the over 10 million cancer survivors in the United States. However, cancer treatment can create chronic sequelae that negatively affect quality of life of cancer survivors years after treatment ends. Unfortunately, there are no clear guidelines to direct long term survivor care and many chronic problems that occur as a result of cancer therapy may go untreated. In addition, support and education for preventative health behaviours is often not addressed in this population. The advance practice nurses (APNs) of a National Cancer Institute designated comprehensive cancer center in rural Northeastern United States have recognized the need for a more holistic approach in the care of cancer survivors and are developing a clinic specifically for this population. For example, many cancer survivors have requested assistance with smoking cessation. Therefore, one

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APN has become a certified tobacco treatment educator and will be offering evidence based treatment for tobacco addiction in this clinic. Some of the problems that will likely be addressed include hot flashes, peripheral neuropathy, sleep disturbance, cognitive impairment and sexual dysfunction. It is anticipated that enrollment in APN led clinical trials will be offered to cancer survivors in an effort to develop more evidence based interventions for chronic problems of cancer therapy. The poster will discuss he results of a needsassessment survey of cancer survivors as well as the evolution of the clinic which will be called ‘Survive and Thrive: The APN Cares Clinic.’

797 CN Needs, Transfer and Counter-transfer: A Methodological Suggestion Musso Ma, Aggero Ia, Spiota Ea, Duglio Ea, Varese Pb a Polo Oncologico, Azienda Ospedaliera Santi Antonio e Biagioe C. Arrigo, Alessandria, Italy; b UO Medicina e DH Oncologico, Presidio di Ovada ASL 22, Ovada, Italy INTRODUCTION: By the answers given to questions like ‘Who is the patient, what he fears, what’s his priority, the family role, what he desires, what he asks for, what he gets’ we obtain data on patients needs and on the e´quipe members transfer and counter-transfer. The characteristic of this methodology will be shown by CN story. OBJECTIVE: Our goal is to help oncological e´quipe to consider and better understand the different ways that patients used to approach them and so ensure more efficient medical treatments. Sample: The sample is constituted of those different e´quipe suggestions that all care providers have experienced during their activity. MATERIALS AND METHODS: Data of the questionnaire are used into clinical meeting. They allowed to rebuild patients fragmentation: most patients project their angst of feelings on e´quipe that unaware carried the function of emotional includer. Eight health worker has filled up the questionnaire of CN. RESULT AND CONCLUSION: This study represents a methodological suggestion to create around the patients an emotionally hot and involving setting. Who is CN? She was a young, silent, kind, cool, humble, strong 53 woman affected by NSCLC scared of suffering and with the need of being reassured about her treatment. An involving setting is an important chance of

Copyright # 2006 John Wiley & Sons, Ltd.

treatment: if doctors are the patients first medicine (Balint,1960), then a full e´quipe represent an integrated care system. The awareness of transfer and counter-transfer is the prerequisite to transform health workers from technician of medicine into catalyst of patients’ resources.

798 Psychosocial Ward Round-addressing the Imbalance in Palliative Care Myhill K, Swetenham K Southern Adelaide Palliative Services Repatriation General Hospital, Adelaide, South Australia PURPOSE: Concerns have been expressed that the specialist medical focus of palliative medicine has resulted in an emphasis on the management of physical symptoms and pharmacological interventions at the expense of an holistic focus which includes psychosociocultural and spiritual understanding of the patient as an individual and his/her current circumstances in the context of their whole life. This has the potential to interfere with provider satisfaction with respect to their role in the management of the dying patient. PARTICIPANTS AND METHODS: In response to increasing concerns regarding provider dissatisfaction at the perceived lack of attention to psychosocial issues an audit of case notes was conducted. The audit revealed a strong focus on physical symptoms and a lack of attention to psychosocial issues within medical and nursing documentation, despite there being quite a focus on psychosocial care within the initial nursing assessment document on admission to a specialised palliative care unit. The intervention of a psychosocial ward round is being implemented to restore the balance to providing total care for our patients. The ward round is to be conducted on a weekly basis under the direction of the unit’s senior consultant psychiatrist and the unit nurse manager who has specialised in the study of psycho-oncology. Case notes will be audited at completion of the trial phase in August 2006 to assess the benefit of such an intervention. This intervention will focus on restoring the holistic balance to all members of the interdisciplinary team, as well as benefiting patients and families as they face the complexity of end of life care. RESULTS: The results will be determined by a case note audit and a health provider satisfaction questionnaire at the completion of the trial phase in August 2006.

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799 Psychological Support and Knowledge of Cancer Diagnosis in Oncological Patients of Radiotherapy Department of Verona Hospital Nadalini La, Rigobello Fa, Martini MCa, Marciai Nb, Boran Fa, D’Amico Ab, Maluta Sb a Psycho-Oncology Unit; bRadiotherapy Department AIMS: To test how oncological radiotherapy patients demand psychological support only when they are acquainted with their diagnosis. In this study we want to point out the relation between diagnosis knowledge and psychological support demand about oncological patients of radiotherapy department. SAMPLE: 30 patients constantly evaluated during 3 months. The maximum number of patients admitted in the department is 210 patients for year 2005 (290 DRG). They were diagnosed as having cancer between 15 years (thymoma and sarcoma) and 2 months previously, with an average of 3 years from the beginning of illness. The illness of some of them is in an advanced stage. Average age: 51 years old (media deviation þ21=  31). Education: Secondary school. Kind of cancer: brain, colon, uterus, lung, pancreas, stomach, breast, rectal, etc. Males: 14 Females: 16. METHODS: Semistructured interview. RESULTS: 4 patients didn’t know their diagnosis either prognosis, 14 patients had a partial knowledge of their diagnosis but they didn’t know the prognosis, they thought their illness was cured. Other 12 knew their diagnosis and prognosis. Patients who knew their diagnosis and prognosis (2 pancreas, breast, brain, lung) demanded psychological support which lasted more than 3 months; other 4 patients who knew their diagnosis and prognosis (2 brain, rectum, lung) demanded psychological support which lasted between 1 and 2 months. Finally, 6 relatives of patients who knew their diagnosis and prognosis, of patients with a partial knowledge of diagnosis and of patients who did not know anything, demanded psychological support. Patients who had no knowledge of their diagnosis and prognosis did not request any help.

800 Quality of Life Analysis in Oncology Survivors Narvaez A, Cortes-Funes F, Garcia Valverde A, Abian L Psycho-Oncology Unit, Hospital 12 De Octubre, Madrid, Spain

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The actual definition of survivor is a person who has been living without treatment or illness evidence for at least one year, and a long term survivor not having received treatment for 5 or more years. The number of oncology survivors has grown considerably in the past years due to advances in treatments and early detection, thus making more interesting the analysis of this population. In our study we analyze the Quality of Life that is affected in several of its dimensions as a result of the illness and the treatment. Many of these disturbances stay in the long term. The sample we analyze includes 80 long-term survivors who attended the Oncology Unit in the Hospital 12 de Octubre in Madrid, Spain. The Quality of Life variables we consider are: psychological adjustment, physical symptoms and performance status. We also measure sociodemographic, medical and treatment variables and their relations with Quality of Life dimensions. Among the sociodemographic we include: age, sex, marital status, number of children, number of people who coexist, employment status, while in the medical and treatment variables we consider: oncology diagnosis, number of previous treatments and other illnesses. Finally we include SF-36 (Ware, 1993), Rotterdam Symptoms Inventory (DeHaes, 1986), STAI (Spielberger et al., 1970), BDI (Beck and Cols, 1979), Visual Analogue Scale for fear of recurrence and two items measuring post traumatic stress disorder symptoms.

801 Using Adjuvant Analgesics in the Management of Cancer Pain: Three Cases Report Minciotti E, Mattioli S, Nataloni G, Catanzaro P Department of Oncology, Hematology and Biological Science, Silvestrini Hospital Perugia, Italy PURPOSE: Chronic pain is extremely prevalent among patients with cancer. The incidence of chronic pain after primary treatment of breast cancer (surgery, radiotherapy, chemotherapy) varies from 9 to 73% (Thompson, 1995). There is substantial evidence that antidepressant drugs have analgesic effects in diverse type of chronic non-malignant pain. There is limited evidence for analgesic effects in cancer pain. The strongest indication for the use the antidepressants of s an adjuvant analgesic in the cancer population occurs in the patient with neuropathic pain whose response to opioids has been inadequate, taking into account of the established benefit of the

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antidepressants in patients with different types of neuropathic pain (Lussier, 2004). Early use of antidepressants as adjuvant analgesics is also justified when pain is accompanied by depression. METHODS: Three cases of patients affected by depression coupled with breast cancer and chronic pain are presented. Patients were treated with Venlafaxine (75 mg). Depression was asked about with Beck’s Depression Inventory (Beck and Steer, 1993). RESULTS: Venlafaxine has shown the analgesic effect in our patients, in accordance with several studies (Lussier, 2004). No significant side effects are occurred. Dry mouth was the only symptom that seemed to increase during Venlafaxine treatment. CONCLUSIONS: In the cases that were analysed, the Venlafaxine has shown analgesic efficacy. In addition, antihistaminegic or anticholinergic effects were not present. It can be concluded that Venlafaxine alleviated pain intensity in women suffering from symptoms related to treatment of breast cancer.

cancer. METHOD: Fifty patients diagnosed with colorectal cancer were tested pre surgery for CEA, and social support and loneliness on an implicit and a number explicit self-report measures. Immunohistochemical analyses for determining VEGF, TNF-a, and OT in tumor tissues were conducted post surgery, in addition to determining the stage and size of tumor. RESULTS: This study is currently in progress. Statistical analyses will control for treatment patient delay, socioeconomic status, diet and exercise, and family history of colorectal cancer. The findings of this study may contribute to the scientific basis for planning targeted immunotherapeutic interventions in socially-isolated cancer patients. ACKNOWLEDGEMENTS: We thank Miss Karen Nugent, Mary Judd, Alex Baker, and Dr Rona Moss-Morris. This project is funded by the University of Southampton, and Universities-UK.

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Resisting Dominant Frameworks in Breast Cancer Information Resources Nelson JJa, Macias Ta,b, Norville La a CRWH/PBRU Women’s College Hospital, Toronto, Canada; bOntario Institute for Studies in Education University of Toronto, Toronto, Canada

The Relationship Between Social Support and Disease Markers in Colorectal Cancer Nausheen Ba, Gidron Yb, Peveler Rc, Bruce Ld, Verrill Cd a School of Psychology, University of Southampton, Southampton, UK; bDepartment of Psychology and Health, Tilburg University, Tilburg, The Netherlands; cSchool of Medicine, University of Southampton, Southampton, UK; dDepartment of Cellular Pathology, Southampton University Hospitals NHS Trust, Southampton, UK PURPOSE: Studies done on humans and animals demonstrate that social isolation may predict tumor progression. Animal models causally link social isolation with increased angiogenic response and expression of tumor necrosis factor-alpha (TNF-a) and vascular endothelial growth factor (VEGF) in tumors. These angiogenic factors impact on tumor severity. Social wellbeing has been inversely associated with VEGF in cancer patients. Oxytocin (OT) has antiproliferative effects on tumors and is related to interpersonal trust. The levels of these biomarkers in tumor tissues have not been associated with social support in cancer patients. The present study examines whether a lack of social support and higher levels of loneliness are associated with size and stage of tumor, carcinoembryonic antigen (CEA), VEGF, TNF-a, and OT in colorectal

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PURPOSE: While many breast cancer information resources exist in Canada, women from nondominant groups often report that these do not meet their needs. This poster will present the results of a research study that examined the breast cancer information needs of immigrant women and women from marginalized racial and cultural communities. METHODS: This qualitative study consisted of focus groups with forty women from a variety of racialized and immigrant groups in the City of Toronto. Participants, all of whom had experienced a breast cancer diagnosis, participated in a half-day workshop in which they reviewed several different sources of breast cancer information (i.e. pamphlets, articles) and engaged in a facilitated group discussion to critically analyze the relevance, quality and accessibility of the materials from their own perspectives. RESULTS: Materials often did not reflect different levels of literacy, and images rarely reflected women of colour or the realities of life for women of low socioeconomic status. Many women noted a Eurocentric focus on foods and exercises that were recommended, as well as in assumptions about their lifestyles and available resources.

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CONCLUSIONS: Most Canadian information materials are geared toward a ‘model’}white, middle class}patient, who is well-educated and fluent in English. It is crucial that this framework be critiqued and decentred to reflect the needs and realities of the large number of women who are not members of dominant communities. ACKNOWLEDGEMENTS: This study was funded by the Canadian Beast Cancer Research Alliance.

804 Using Knowledge Exchange to Address Social Inequities in Breast Cancer Care Nelson JJa, Gould Ja, Keller-Olaman Sa, Fitch Mb a CRWH/PBRU Women’s College Hospital, Toronto, Canada; bPBRU Sunnybrook Health Sciences Centre, Toronto, Canada PURPOSE: This poster will provide an overview of current knowledge exchange work from the Ontario Breast Cancer Community Research Initiative (OBCCRI), and delineate our process for facilitating the uptake of new research within cancer care. Our mandate, since our inception in 2001, has been to generate knowledge into the psychosocial impacts of breast cancer, and to work with the cancer community to improve health services, information and support. OBCCRI is beginning a year-long focus on knowledge exchange, drawing from our first five years of research. METHODS: The aim of this project is to translate research results and evaluate our knowledge exchange activities. To this end, we have undertaken a social mapping exercise, drawing on social network analysis, to outline effective connections and determine the best pathways for moving research knowledge. In this process, we are communicating work from various research studies, on socioeconomic issues, racial and cultural marginality, stage of life, and other areas within supportive care. RESULTS: This poster will illuminate our progress, to date, on the preparation and implementation of effective knowledge exchange strategies for content focused on ‘Social Inequities in Breast Cancer Care’. We expect to have results from various community and practitioner consultations concerning strategies for change in the cancer system, and hope to engage with conference participants around this highly relevant area of practice and research in psychosocial oncology. As this is a work in progress, conclusions are forthcoming.

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ACKNOWLEDGEMENTS: OBCCRI is funded by the Canadian Breast Cancer Foundation, Ontario Chapter.

805 Well-being and the Use of Complementary Therapies by Residential Hospice Patients Nelson JP Beth-El College of Nursing and Health Sciences, University of Colorado at Colorado Springs, Colorado Springs, CO, USA Complementary therapies are increasingly being used by the public in palliative and hospice care settings for symptom management; however, little research is available on their effect on patient wellbeing. Well-being or the individual’s subjective experience is an important focus in hospice settings when the focus of care is on comfort and palliation, rather than cure. The purpose of this study was to explore patterns and experiences of 15 residential hospice patients who received complementary therapies. Ethnography was used to guide data collection and uncover themes. Data were collected by participant observations, formal and informal interviews, and complementary therapy charts in a residential hospice over 9 months. Rigor was enhanced from prolonged engagement, member checking, and data triangulation (Lincoln and Guba, 1985). Three themes, ‘Experiencing Complementary Therapies’, ‘Reconnecting to Life through Caring’, and ‘Presence in Relationship’, were uncovered during data analysis. The result of this study demonstrated that a caring presence between the complementary therapist and the patient may be more important to the patient’s well-being than the patient’s physical responses to the complementary therapy. A key implication for nursing from this study rests in the need to create a culture of caring, which influences patients’ wellbeing. Furthermore, the caring environment may also positively influence nurses’ retention and job satisfaction.

806 Tobacco Use Patterns and Experiences in Army Soldiers Nelson JP, LaSala K, Pederson LL, Lewis J Beth-El College of Nursing and Health Sciences, University of Colorado at Colorado Springs, Colorado Springs, CO, USA

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Tobacco is commonly used throughout the United States and it is one of the leading causes of preventable death. Tobacco use is shaped by culture (Unger et al., 2003). Culture is a common set of norms that help groups organize themselves, and provide individuals with a sense of continuity and community (Nichter, 2003). The military is a culture within itself, ascribing to a set of norms. Historically, military members use tobacco to relieve the ‘tedium of war’. PURPOSE: The study purpose was to explore experiences and patterns of tobacco use in soldiers. DESIGN: To fully examine how culture influenced tobacco use, an ethnographic study was conducted examining patterns, practices, and experiences of soldiers who used tobacco, quit using tobacco, returned to tobacco use, and abstained from tobacco. Data were purposively collected from 72 soldiers through formal and informal interviews, and participant observations over one year. FINDINGS: Data were analyzed using thematic analysis and five themes were uncovered: Experiences of Tobacco and Tobacco Use in the Army, Tobacco Use: Experiences of Starting and Restarting, Balancing Health Risk with Tobacco Use, and Tobacco Use Policies and Regulations. Army culture and tobacco use experiences influenced soldiers’ tobacco-use patterns. Also, findings suggest that modifying tobacco regulations may provide an aggregate intervention to deter tobacco use. This study provides insight and understanding to developing an cultural intervention that may reduce tobacco use in soldiers, and in turn, reduce cancers and other tobacco related diseases, and the personnel and economic costs associated with tobacco use.

807 Randomized Controlled Trial Testing Methylphenidate as Treatment for Fatigue in Men with Prostate Cancer Roth AJa, Nelson CJa, Rosenfeld Bb, O’Shea Na, Slovin Sc a Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, USA; b Psychology Fordham University, New York, USA; c Medicine, Memorial Sloan-Kettering Cancer Center, New York, USA PURPOSE: Fatigue is a highly prevalent and clinically significant symptom of advanced cancer, associated with poor quality of life. To date, no published controlled trials of interventions for

Copyright # 2006 John Wiley & Sons, Ltd.

fatigue in individuals with prostate cancer exist. METHODS: We are in the final stages of an USNIH sponsored project that incorporates a sixweek, randomized, double-blind, placebo-controlled design, evaluating the benefits of methylphenidate as treatment for fatigue in ambulatory prostate cancer patients. Recruitment has been difficult, and we currently have 13 subjects in the placebo group and 11 subjects in the methylphenidate group. RESULTS: The average age of the subjects is 71.2 years old. 86% are Caucasian, 71% are married, and 70% have a college education. Despite the small number of study subjects, the methylphenidate group reports a reduction in fatigue ðp50:05Þ and there is a trend toward the methylphenidate group reporting a significantly greater reduction in fatigue as compared to the placebo group ðp50:10Þ: 73% of the methylphenidate group reports a clinically significant reduction in fatigue as compared to 23% in the placebo group. Important in these results is that 35% (6/17) of men who started receiving methylphenidate dropped out due to cardiovascular side effects. CONCLUSIONS: Psychostimulants are effective in treating fatigue in men with prostate cancer; however, oncologists need to monitor these men for possible pulse and blood pressure elevations. This study was funded by a Grant from the NIH (Grant #5R01-CA85229) and ongoing support from the PepsiCo Foundation.

808 Toward a Theoretical Model Explaining the Relationship between Religiosity, Spirituality, and Depression Nelson CJa, Breitbart Wa, Roth AJa, Jacobson CMb, Rosenfeld Bb a Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, USA; bPsychology, Fordham University, New York, USA PURPOSE: 58% of cancer patients experience depressive symptoms. Religiosity may help manage depression; however meta-analyses reveal an extremely weak relationship between religiosity and depression. The relationship between spirituality (a distinct construct from religiosity) and depression has received little attention. This study set out to develop a theoretical framework to explain the relationship between religiosity, spirituality, and depression. METHODS: In this

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cross-sectional study, prostate cancer patients ðn ¼ 367Þ completed questionnaires including measures of religiosity (extrinsic/intrinsic), spirituality (FACIT Spiritual Well-Being Scale), and depression (Hospital Anxiety and Depression Scale). RESULTS: The average age of the sample was 66 þ 9 years. There was an association between religiosity and spirituality (r ¼ 0:50; p50:01), however it was stronger between religiosity and the spirituality measure’s Faith subscale (r ¼ 0:70; p50:01) than between religiosity and the spirituality measure’s Meaning/Peace subscale (r ¼ 0:21; p50:05). There was a moderate relationship between intrinsic religiosity and depression (r ¼ 0:23; p50:05) while there was a strong association between spirituality and depression (r ¼ 0:58; p50:01). The Meaning/Peace subscale of the spirituality measure mediated the relationship between intrinsic religiosity and depression. CONCLUSIONS: These results suggest that the main component that may help reduce depression is meaning and peace. Those who identify themselves as religious may or may not develop a sense of meaning and peace. This supports a theoretical framework that may explain the weak association between religiosity and depression.

809 Living with Lymphedema McMahon Ea, Cormier Jb a Psychiatry Kaser Permanente Fremont, California, USA; bSurgical Oncology & Center on Outcomes, Research & Education MD Anderson & Northwestern Healthcare Houston, Texas & Chicago, IL, USA As advances in therapeutic modalities are developed and utilized, there is a spectrum of late complications that are associated with these treatments. This program targets a relevant need in breast cancer survivorship. Agenda: (1) Review the clinical and evidence-based knowledge of lymphedema in women who were treated for breast cancer. (2) Present strategies for reducing the risks. (3) Discuss the effects of lymphedema on the physical self and psychological well-being. (4) Present up-dates on treatment options an symptom management. (5) Screening of DVD: Living well with lymphedema (6) Q&A The educational objectives include: (1) Focusing attention on longterm and late effects of breast cancer and it’s treatment (specifically lymphedema). (2) Providing up-to-date medical information on lymhedema

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management. (3) Providing an overview of the psycho-social sequelae. (4) Providing a lymphedema DVD to reinforce and expand the reach of these objectives. Our program will include the speaker’s presentations: Dr Cormier will be addressing the medical issues, and Dr McMahon will address the emotional/social issues. Patient advocate/lymphedema patient, Susan Nessim will share the patient perspective. The short documentary DVD profiling survivors with lymphedema will be screened; this is a critical element of this program, providing a learning tool that workshop participants can take with them to their intuitions. The enduring material that will be produced in connection with this program is a sort DVD entitled, Living Well with Lymphedema.

810 The Patient Enablement Instrument (PEI) as an Economic and Valid Outcome Measurement in Psycho-Oncological Care? Psychometric Characteristics of the German Version of the PEI in a First Explorative Study Neumann Ma, Schwarzkamp Uc, Pfaff Hb a Medical Department of the University of Cologne, Center for Health Services Research, Cologne, Germany; bUniversity of Cologne, Division of Medical Sociology, Cologne, Germany; cAssociation LebensWert, Cologne, Germany PURPOSE: The PEI (Howie, 1999) is recognized as a short and valid outcome measurement in general practice, which is designed to draw out patients’ feelings of empowerment and their ability to understand and cope with their illness after a consultation. The aim of this research was to adapt the German version of the PEI as an economic outcome measurement in patients using psycho-oncological therapies. METHODS: The PEI was employed with a written questionnaire in two studies that are operated almost in the same period. The first study was a cross-sectional one with n ¼ 326 cancer patients of which n ¼ 15 patients use the psycho-oncological institution. The other study was a focus group study with n ¼ 16 users of the same psycho-oncological institution. Before merged data was analysed, socio-demographic variables were compared to remove patients that participated in both studies. RESULTS: The six items of the PEI show acceptable levels of reliability (e.g. Cronbach’s alpha 0.86, Guttman’s lambda 0.86; Guttman’s split-half 0.84). Average item discrimination index

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is very good ðr ¼ 0:66Þ and the average item difficulty level of 80% is tolerable. Conform to theoretical assumption factor analysis (PCA, varimax rotation) identified one factor, which explains 60.5% of the variance. Convergent validity is tested by correlation with a global question to enablement ðr ¼ 0:41Þ: CONCUSIONS: The results of this small size ðn ¼ 30Þ; two-sample-study must be interpreted with caution. Nevertheless the explorative psychometric characteristics are satisfactory so that further research seems to be promising. ACKNOWLEDGEMENT: This research was supported by grant number P43/05//A33/05//FO from the Else Kro¨ner-Fresenius-Foundation.

811 Barriers of Using Psycho-Oncological Therapies} Findings from Focus Groups with Users, their Family Members, Non-Users, Physicians and Nurses Neumann Ma, Pfaff Ha,b a Medical Department of the University of Cologne, Center for Health Services Research, Cologne, Germany; bDivision of Medical Sociology, University of Cologne, Cologne, Germany PURPOSE: As there is a lack of investigating individual perceptions of and experiences with psycho-oncological therapies, the aim of this qualitative study was to gain understanding how different stakeholders (users, their family members, non-users, physicians and nurses) think about difficulties using such a service. METHODS: The research setting is a German psychooncology institution, which offers psychological counseling, art, music and cognitive-behavioural therapies for their patients. In 2005 seven focus groups and additional five individual interviews were carried out. We purposefully selected stakeholders ðn ¼ 34Þ with different characteristics to achieve a diverse range of perspectives. Following Bohnsacks (2003) ‘Documentary Method’, the focus group and interview transcripts were examined in ‘reflecting case analysis’ and on this basis a ‘comprehensive and comparative analysis’ was conducted. RESULTS: The barriers of using psycho-oncological therapies identified by the stakeholders are as follows: (1) patients, physicians and nurses have not enough information about the offered services; (2) many patients don’t understand the information about the institution, because the language is too abstract; (3) the desire of being ‘normal’ don’t fit with using

Copyright # 2006 John Wiley & Sons, Ltd.

psycho-oncological therapies, because it makes patients feel even sicker than they already are and it is a stigma to be ‘psychological ill’; (4) physicians and psychooncological therapists confirm this ‘pathological character’ when they offer psycho-oncological support only to individual patients and only in crisis situations. CONCLUSION: This qualitative study provides a deeper understanding of the reasons rejecting psychooncological support and gives practical recommendations.

812 Sex and Empathy of Physicians and Affection of Nurses Can Improve Patients’ Anxiety Level in First Months after Cancer Diagnosis}An Explorative, Retrospective Study in Patients with Bronchial, Oesophagus, Colorectal, Breast, Prostate and Skin Cancer Neumann Ma, Pfaff Ha,b a Medical Department of the University of Cologne, Center for Health Services Research, Cologne, Germany; bDivision of Medical Sociology, University of Cologne, Cologne, Germany PURPOSE: The present study addresses the following research question: can psychosocial care of nurses and physicians improve cancer patients’ anxiety? METHODS: A written questionnaire was sent to 710 cancer patients, who have been treated inpatient in the University Clinic of Cologne between 2005/02 and 2005/08. Examining the Toil-Design-Method a return rate of 49.5% ðn ¼ 326Þ emerged. Patients’ anxiety levels were measured using the STATE-Scale of the State-Trait Anxiety Inventory (STAI). The German version of the CARE-Scale is used for assessing physician empathy in combination with scales reporting physicians’ characteristics and patient-centred behaviour. Scales measuring nurses’ behaviour of affection, support and confidence are also employed. RESULTS: Bivariate analysis shows no relationship between psychosocial behaviour of health care professionals and anxiety. Following theory that anxiety is more frequent in the beginning of a cancer diagnosis, a subgroup analysis with patients’ in the first two months after cancer diagnosis ðn ¼ 23Þ was conducted. In a linear regression analysis female sex of a physician, affection of nurses and empathy of physician were found to decrease cancer patients’ anxiety level. This model accounted for an adjusted value of 52.3% of the variance. CONCLUSION: This

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study cautiously shows that in tee first months after cancer diagnosis psychosocial care of nurses and physician could help to diminish patients’ anxiety. Additional research is needed to validate these findings in a prospective study design with a larger sample size of patients immediately after diagnosis. ACKNOWLEDGEMENT: This research was supported by grant number P43/05//A33/05//FO from the Else Kro¨ner-Fresenius-Foundation.

813 Influence of Psychosocial Care of Physicians and Nurses on Cancer Patients with Moderate and Severe Depressions Neumann Ma, Pfaff Ha,b a Medical Department of the University of Cologne, Center for Health Services Research, Cologne, Germany; bDivision of Medical Sociology, University of Cologne, Cologne, Germany PURPOSE: Clinical depression is a frequent source of suffering among patients with cancer. The aim of this explorative, retrospective study was to examine whether physicians and nurses psychosocial behaviour can decrease cancer patients depression. METHODS: A written questionnaire was sent to 710 patients with bronchial, oesophagus, colorectal, breast, prostate and skin cancer, who have been treated inpatient in the University Clinic of Cologne between 2005/02 and 2005/08. Examining the Total-Design-Method a return rate of 49.5% ðn ¼ 326Þ was realized. Patients’ depression level was measured using the Major (ICD-10) Depression Inventory (MDI). Different scales assessing physicians and nurses characteristics and their psychosocial behaviour are conducted. RESULTS: Bivariate analysis shows weak relationship between psychosocial care of health care professionals and depression. Focussing on patients with moderate and severe depression, a subgroup analysis ðn ¼ 31Þ was conducted. After identifying the relevant explanatory variables with correlation analysis, a linear regression analysis shows that ‘great confidence to nurses’ and ‘physician encourages patient to talk about emotions and concerns’ accounted for an adjusted value of 31.2% of the variance. CONCLUSION: Specific aspects of psychosocial behaviour of physicians and nurses seem to be a useful treatment to diminish depression in moderately and severely depressed German cancer patients. Further research with larger samples of moderate

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and severe depressed cancer patients is needed to verify the therapeutic effectiveness of physicians and nurses. ACKKNOWLEDGEMENT: This research was supported by grant number P43/ 05//A33/05//FO from the Else Kro¨ner-FreseniusFoundation.

814 PCR Diagnostic Methods and Testing Protocols for HPV-DNA Infection in Cervical Cancer Niakan Ma, Tajzichi Sb, Qaeem Mb, Jalali MRc a Microbiology, Shahed University, Tehran, Iran; b Gynecology, Tehran University, Tehran, Iran; c Pathology, Shahed University, Tehran, Iran OBJECTIVE: Cervical cancer is one of the most frequently found cancers in women and appears to have a viral etiology. Since HPVs now comprise more than 100 different HPV types, the Polymerase chain reaction (PCR) has been the preferred methodology for virus identification and typing on isolated DNA. MATERIAL AND METHODS: we examined three groups of patients from Tehran region. Aged 21–27 years. The first group comprised 12 females with squamous cell carcinoma (SCC), the second group included 6 female who suffered from cervical intraepithelial neoplasia (CIN) and 2 dysplasia. Formalin fixed, paraffin embedded tissue specimens representing 20 cases of gynecology, oncology Imam and Mirza hospitals stage 2 and 3 were used. HPV DNA was detected by Polymerase chain reaction (PCR) with DNA kits (BIOTOOLS Inc.). RESULTS: All 18 carcinomas were positive for HPV 6/11 11(6101%), HPV 16/18, 10(55.5%) and 31/33/51 14(77.7%). In 2 patients (10%) HPV types could not been further classified and these cases were therefore categorized as HPVx. CONCLUSION: These findings are consistent with the hypothesis that HPV infection is the primary cause of cervical neoplasia. Furthermore, they support HPV vaccine research to prevent cervical cancer and efforts to develop HPV DNA diagnostic tests. Key words: DNA, Human papillomavirus (HPV); cervical Tumor, Polymerase chain reaction (PCR).

815 Psychological Distress and Associated Factors in Spouses of Outpatients with Advanced Gastrointestinal Cancer Niitani M, Miyashita M, Moriyama M, Hitoshi O Hiroshima University Graduate School of Health Sciences, Hiroshima, Japan

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PURPOSE: The purpose of this study was to demonstrate psychological distress, including anxiety or depression, and associated factors in spouses of outpatients with advanced gastrointestinal cancer. METHOD: The subjects were spouses of outpatients undergoing chemotherapy for advanced gastrointestinal cancer at three hospitals in Hiroshima, Japan. A semi-structured interview was conducted, and the Spielberger State-Trait Anxiety Inventory (STAI) and the Center for Epidemiologic Studies Depression Scale (CES-D) were used to evaluate anxiety r depression, and sociodemographic and medical factors were evaluated as associated factors. RESULTS: The subjects were 4 men and 16 women, and their mean age was 62:0  9:3 years. Five subjects had scores that exceeded the STAI cutoff point (54/55), and 7 had scores that exceeded the CES-D cutoff point (15/16). Patients’ performance status (PS) ðp ¼ 0:02Þ; length of chemotherapy ðp ¼ 0:04Þ; and spouses’ economic status ðp ¼ 0:04Þ were significantly associated with the CES-D score. CONCLUSION: The results suggested that some spouses of outpatients with advanced gastrointestinal cancer suffered from psychological distress, and that their economic status and patients’ physical conditions were associated with spouses’ depression.

816 A Bereavement Support Programme for Spouses During One Year After the Patients’ Death Nilsson Ia, Carlsson Mb a Sjukva˚rdsteamet Uppsala Sweden; bPublic Health and Caring Science, Uppsala University, Uppsala, Sweden One cornerstone in palliative care is to offer the patients’ family support during the illness and after the patients’ death. PURPOSE: In order to improve the support to bereaved spouses during the year after the patients’ death, a project was started. The intervention consisted of three visits by a nurse (after 1, 3 and 13 month). METHOD: Spouses, to patients cared for by The Advanced Home Care Team in Uppsala, were invited to the project. Each person was encouraged to talk freely about his or her situation, but enough direction was given to ensure that all items listed on a standardised questionnaire were covered. RESULTS: Fifty-one spouses fulfilled the inclusion criteria and were invited to the project, 45 (28 women and 17 men) accepted. Nearly 98% were

Copyright # 2006 John Wiley & Sons, Ltd.

positive or very positive to the project when they got the invitation. The spouses felt quite healthy but tired and suffered from sleep disturbance. Forty-nine percent had experienced post-bereavement hallucinations. The spouses’ grief reactions were initially quite high but showed a small decline from 1 (mean 1.78), 3 months (2.06) to 13 months (2.52) (on a 5 grade scale, low mean values indicate a high level of grief). CONCLUSION: Our opinion is that when spouses are offered bereavement follow-ups they are mostly positive. The visits have been highly appreciated and fulfill a great need even when the spouses have good social support. ACKNOWLEDGEMENTS: This project was supported by grants from the Swedish Cancer Foundation.

817 Use of Complementary and Alternative Medicine (CAM) Among Cancer Patients Anker Na, Egholm Inger Lb a Patient Support Department, The Danish Cancer Society, Copenhagen, Denmark; bPatient Support Department, The Danish Cancer Society, Copenhagen, Denmark PURPOSE: The purpose of this study was to explore the use of CAM among cancer patients contacting the Cancer Helpline in The Danish Cancer Society. METHODS: Telephone interviews}based on a structured questionnaire}with 250 cancer patients who called the Cancer Helpline the last 3 months of 2004. RESULTS: With a wide definition of CAM 75% had used some kind of CAM since the cancer had been diagnosed. With a more narrow definition}not including fish oil, daily use of green tea, some mind–body interventions and extra supplement of vitamins} 55% had used CAM. Herbal medicines/diet contributions and vitamins/minerals were the most commonly used type of CAM. Multivariate analyses suggest that especially female gender and under 60 years of age are important predictors of CAM use. About 50% of the users seem to benefit from CAM use with the reduction of sequelae as the most frequent benefit mentioned. Multivariate analyses suggest that especially users of acupuncture and guided imagery followed by reflexology and prayer perceived benefits from their use of CAM. Patients ask for both general and specific information about CAM related to cancer diagnoses, sequelae, etc. At the same time remarkably

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few have conferred these questions with a physician. CONCLUSIONS: The study shows a need for: Establishing further evidence of CAM and motives of patients to become CAM-users, offering educated counselling of CAM and strengthen the dialogue about CAM between patients and health care staff.

818 Patient Education and Psychosocial Care Integrated in the Dutch Guideline Renal Cell Carcinoma Nogossek JMJa, de Hullu NMa, Koldewijn Eb, Mulders Pc, de Louwere E (until June 2005)a a Patie¨ntenzorg Integraal Kankercentrum Zuid, Eindhoven, The Netherlands; bUrologie Catharinaziekenhuis, Eindhoven, The Netherlands; cUrologie Universitair Medisch Centrum Nijmegen, Nijmegen, The Netherlands PURPOSE: Patient-education and psychosocial care: a crucial component of cancer guidelines. METHODS: We started with a clear view on the task of the medical specialist in patient education and psychosocial care. Since this task is crucial it deserves attention in tumour-specific guidelines, following the medical path of diagnosis, treatment and follow-up. This view was continuously expressed by two members of the Dutch society of psychosocial oncology (NVPO) in the group that developed the evidence-based guideline for renal cell carcinoma. Evidence of the importance of patient-education and psychosocial care for cancer patients is convincing and thus relevant for tumour-specific guidelines. The dialogue with patients is essential for quality of care. A search in the oncological literature was performed with the keywords: patient, education, counseling, communication, information, needs in Medline, Cinahl and Psycinfo via WinSPIRS 5.00. The number of records found was 793, none specific for renal cell carcinoma. Further selection, focussed on the task of urologists in education and support in all phases of disease, on patients needs and preferences and on similar cancer sites, led to 47 records. RESULTS: Eventually we convinced most members of the national group that evidence on medical issues should be accompanied by evidence on patient communication and patient support although not tumour specific. The guideline will be available online in May 2006. CONCLUSION: It is necessary and useful to review the evidence from the literature in a brief

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and concise manor and to integrate this in tumour-specific guidelines.

819 Children and Adolescents with Cancer: Support to the Teachers, Parents and Schoolmates Nucci NAGa, Pedrosa AMb a Psychology, APACC-Associac¸a˜o de Pais e Amigos da Crianc¸a com Caˆncer, Campinas/SP, Brazil; b Psychology, NACC-Nu´cleo de Apoio a` Crianc¸a com Caˆncer, Recife/PE, Brazil PURPOSE: Children or teenagers who undergo a cancer treatment have special needs, therefore deserving adequate medical treatment, as well as care of psychological and educational aspects aiming at their health recovery, within a whole and harmonic developing process. The mediating role performed by the school in this context become most significant. Quite often the professionals in question do not have enough information and specific academic capacities for such demand. This program had the purpose to assist these educational agents: the patients themselves, teachers, the school team, schoolmates, parents. METHODOLOGY: The elaboration of a handbook with essential guidelines, clear and concise information about medical, psychological and pedagogical aspects of infantile cancer. The handbooks have been edited and distributed freely by two supporting associations of Children with Cancer, at scheduled meetings with schools and teachers of different levels of action, involving official and governmental organs. RESULTS: A better school adaptation for the child/adolescent with cancer; a higher acceptance of these students by their schoolmates; calmer and confident teachers at their work with his/her students; less anxious parents dealing with their child’s schooling. CONCLUSION: Public as well as private schools have been reached, receiving and spreading knowledge about cancer, allowing them to better receive a child or adolescent with cancer. This project has been acting in a preventive way when educating about cancer, and in a curing one when establishing strategies to reach the needs of children and adolescents with cancer, their school, schoolmates, and relatives.

820 Palliative Care in Psycho-Oncology: The Look to Life and Not to Death}The Report of a Case Enge JR, Nucci NAG

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Psychology Hospital Municipal Dr. Ma´rio Gatti Campinas}SP Brazil INTRODUCTION: In cases in which therapeutic possibilities run out, psychology finds a function, as much important as the healing itself: palliative care. To reduce suffering and to offer better quality of life must be the psychologist’s goals. Facing a chronicle or fatal disease, the most important is to add more life to the years left than years of life. OBJECTIVE: Emotional support to a patient, 28 years old, diagnosed with lung metastatic renal sarcoma, aiming to increase his life quality and how to face the disease and oncologic treatment. METHODOLOGY: Individual psychotherapeutic attendance during the five months of treatment. The contents developed were mainly the psychological impact of cancer and metastases, values, loses, relationships, world vision. RESULTS: Active participation of the patient in the treatment; change on its view of the world and its view of chemotherapy. ‘Today I enjoy life more than before’; ‘I never thought of doing what I have been doing during my treatment’; ‘many people do not believe that I am in treatment’; ‘I hope that my disease gets better as I have in my interior’; ‘the important thing has been my joy to live’. CONCLUSION: The importance of emotional support to oncologic patients under palliative care and humanization of health care. Although there is bad prognostic and low perspective of life, the importance of investment of psychology in the patient, aiming life quality during the time that one has left. To value the present time and to work with life, even with death prognostic.

821 Taking Care of a Child with Cancer: The Mother and the Woman Pedro SE, Nucci NAG Psychology APACC-Associac¸a˜o de Pais e Amigos da Crianc¸a com Caˆncer Campinas/SP Brazil PURPOSE: Based on our social context, many children need to relocate from distant places to large urban locations in order to undergo a specialized oncologic treatment. Some of them don’t rely on any financial condition to allow them this relocation. Reaching out to this demand, there are Supporting Houses kept by volunteers who freely accommodate these children and respective responsible adults, usually the mother,

Copyright # 2006 John Wiley & Sons, Ltd.

for as long as it is necessary. Depending on the original distance and on the evolution of the illness, these mothers stay a long time away from their home, husband, other children, friends, while sharing a life with people of different regions and costumes, what results in one more harm over the impact caused by the diagnosis of cancer in her child and by the long-term treatment. This study was developed with five of these mothers seeking to understand how they deal with their own sexuality within this context. METHODOLOGY: Interviews with guiding questions were carried out and were analyzed under the phenomenological referential. RESULTS: Besides the maternal and careful being, we found an impotent one, guilty, without the right for pleasure, denying her femininity, sublimating her sexuality, envying the male/paternal role. CONCLUSION: This study ratified the importance of a therapeutic care through listening and the possibility of a place for deepening intimate issues, allowing the mothers too the psychological attention until then dedicated to the sick children, seeking to promote a better Quality of Life and a relief of tensions.

822 Tobacco Use: Preventive and Cure Actions in Psychosocial-oncology Enge JR, Nucci NAG, Leite EL Psychology Hospital Municipal Dr. Ma´rio Gatti Campinas}SP Brazil INTRODUCTION: Tobacco is the cause of a high number of deaths in the world. People smoke for various causes, essentially social and behavior causes. 30% of cancer is related to the cigarette consumption being the main ones: lung, mouth, larynx, stomach. Some patients with cancer cannot stop smoking; others do not have the awareness of the cigarette consumption damage on the oncology treatment. The WHO considers the tobacco use a public health problem that needs to be fought. PURPOSE: To establish a preventive and remediable action of awareness about the damages caused by cigarette consumption to patients submitted to oncology treatment through information and reflection on the risks of tobacco use and the benefits of not smoking. METHODS: To form groups at the waiting rooms with patients and their companions at the Centre of Integral Attention in Oncology of the Hospital Mario Gatti. The groups have motivational and informative nature. RESULTS: The application of

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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knowledge about the tobacco use and cancer prevention; awareness of the patients about the benefits of quitting smoking during the cancer treatment; promotion of education in public health; consciousness that quitting smoking is necessary and possible. CONCLUSION: The number of participants, the involvement and the results obtained show the great interest in the tobacco use theme. Besides, they show the need and real possibility to work on the subject in a simple and efficient way. It gives the conclusion of extreme importance of developing effective actions in the fight against tobacco use and in health promotion.

823 Mothers of Children with Cancer: Playing as a Therapeutic Space Nucci NAG Psychology APACC-Associac¸a˜o de Pais e Amigos da Crianc¸a com Caˆncer, Campinas/SP, Brazil PURPOSE: In Brazil, there are few specialized centers in cancer treatment. This situation forces some families to come from distant regions to Campinas, where they find some of the main Oncology Centers in this Country. Some families, with no financial support during the treatment, appeal to Supporting Homes. These houses host the child and a companion, usually the mother, for the necessary period. To face a serious disease as cancer involves an emotional impact due to the diagnostic and, in these conditions, huge suffering with the distances from home, other children, friends, and the original environment. Tied with the child care, the mother loses the contact with her one self. The psychological intervention had the purpose to provide to the mothers hosted in APACC Supporting Home a space to her-selves, to recover the pleasure, joy, and leisure. METHODOLOGY: ‘Funny Afternoons’ is the name of the group with the psychologists coordination, formed by the mothers every fifteen days, where playing activities such as games, dancing, music and conversation session are developed. RESULTS: The activities provide: relax; integration; better relationship; increase of the self-esteem and joy recovery. CONCLUSION: Playing as a therapeutic space shows an effective strategy in psychological assistance to the mothers of children with cancer. The return to the childhood acts as an element of mother’s identification with the needs of the child. This strategy makes a better relation-

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ship between mother and child, with her-selves as well as a better adaptation to the reality.

824 Quality of Life and Cancer Nucci NAa, Valle ERMb a Oncology Center Hospital Municipal Dr. Mario Gatti, Campinas/SP, Brazil; bInstituto Psicologia Universidade de Sa˜o Paulo Ribeira˜o, Preto/SP, Brazil PURPOSE: The psychological implications in etiology and in cancer therapy are arousing an increasing interest, originating studies and researches. The Quality of Life (QoL) evaluation has been added to effectiveness and safety of treatment in clinical studies. This study had a purpose to evaluate the difference between the QoL of patients undergoing a cancer treatment and no cancer people. METHODOLOGY: The evaluation instrument WHOQOL-brief was applied to compare 50 adult patients engaged in treatment of different types of cancer in public hospital with 70 control-volunteers with no cancer. Syntax SPSS-WHOQOL-brief Questionnaire was used to statistical analysis. T-test to the continuous variables and Chi-Square to the categorical data were applied. The 0.05 level of significance was considered for all tests. Cronbach Coefficient was used to check the internal consistency and the result was satisfactory. RESULTS: The groups didn’t show any differences statistically significant in the two general questions: Evaluation of their own QoL ðp ¼ 0:328Þ; Satisfaction with their health ðp ¼ 0:451Þ and in the psychological health domain ðp ¼ 0:261Þ; but did so in the following domains: physical health ðp ¼ 0:003Þ; social-relationships ðp ¼ 0:023Þ and environment ðp ¼ 50:001Þ: CONCLUSION: This study helps to approach the QoL concept and reassured its complexity, subjectivity and magnitude. The subjects received an opportunity to reflect about their own lives, satisfactions and necessities. To increase its subjective comprehension the association of the questionnaire to a qualitative methodology evaluation is suggested.

825 World Assumptions (WA) and Posttraumatic Cognitions (PTC) Related to Trauma Response in Cancer Patients Ochoa C, Sumalla EC, Gil F

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Psycho-oncology Unit Hospital Duran i Reynals, Catalan Institute of Oncology (ICO), Barcelona, Spain PURPOSE: The aim of this study is compare the profile of WA and PTC in a sample of PTSD and non-PTSD cancer patients on the basis of two cognitive theories of PTSD. In her social-cognitive model of trauma Janoff-Bulman (1992) regarded three common assumptions as the most significant in influencing response to trauma: the world is benevolent, the world is meaningful and the self is worthy. Other cognitive theories, focused mainly on traumatic event itself rather than on its wider personal and social context, have been termed information-processing theories (Foa, 1989). We hypothesised PTSD cancer patients have more cognitive disturbances: socio-cognitive and trauma-specific. METHODS: N ¼ 46 cancer patients entered the study after 6 months treatment completion. Subjects completed the Posttraumatic Checklist Civilian version (PCL-C), Word Assumptions Scale (WAS), Posttraumatic Cognitions Inventory (PTCI). Data analysis was conducted using Independent-Samples T-Test. RESULTS: In comparison to non-PTSD, PTSD cancer patients view the world as less benevolent and just. As well, they perceive less control over their fate. PTSD cancer patients inform about more PTC related to Negative Cognitions about Self (general negative view of self, permanent change, alienation, hopelessness, self-trust, and negative interpretation of symptoms). CONCLUSIONS: Posttraumatic symptomatology in cancer patients is related with cognitive disturbances in a wide form. Not only cognitions focused on traumatic event seems to be affected but also the assumptions that we have in common for living in a particular sociocultural context. In our opinion these results would reinforce a psychosocial model in the treatment of PTSD cancer patients.

826 Mental Health Literacy in Japanese Cancer Patients: Ability to Recognize Depression and their Preferences of the Treatments}Comparison with Japanese General People Okuyama Ta,b, Nakane Yc, Endo Ca,b, Seto Td, Kato Mb a Department of Psychiatry and Cognitive-behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; b Course of Specialized Clinical Care, Psychiatry

Copyright # 2006 John Wiley & Sons, Ltd.

Tokai University School of Medicine, Isehara, Japan; cDepartment of Social Science, Nagasaki International University, Sasebo, Japan; dCourse of Internal Medicine, Medical Oncology, Tokai University School of Medicine, Isehara, Japan PURPOSE: Although it has been indicated that patients’ insufficient knowledge about mental illness and its treatment is one of the major barriers to its adequate care in general population, few studies have reported this issue in cancer patients. The purpose of this study is to assess the Japanese cancer patients’ (CP) ability to recognize depression and their preferences of its treatments, and to compare them with those of the lay public (LP). METHODS: Randomly selected 100 lung CP and 300 LP were participated in the study. Structured interviews using a vignette of a person with both cancer and depression were conducted with CP, and those using a vignette of a person with depression were done with LP, respectively. RESULTS: Only 11% of CP recognized the presence of depression in the vignette, while 25% of LP did (p50.001). There were few significant differences in the preference for standard psychiatric treatments between CP and LP: standard treatments such as antidepressants (CP: 39%, LP: 36%) were less often rated as helpful, whereas non-standard treatments such as physical activity (CP: 85%, L: 66%) were most often rated as helpful. People whom CP rated as helpful were attending oncologist (87%), family (84%), while LP found counselor (86%), family (86%) as most helpful. CONCLUSIONS: The results indicated that cancer patients’ knowledge about mental illness and its treatment were insufficient. Psychological education may reduce patient-related barriers to seek and to utilize optimal mental health care in cancer patients.

827 The Meanings of ‘Hope’ to Patients Living and Dying with Cancer Olver INa,b,c, Eliott JAa,b a Royal Adelaide Hospital Cancer Research Centre, Royal Adelaide Hospital, Adelaide, Australia; b Medicine University of Adelaide, Adelaide, Australia; cCancer Council Australia, Sydney, Australia PURPOSE: Following a report on spontaneous use of hope by cancer patients discussing end-oflife decisions (Qual Health Res 2002 12: 179–193), we investigated cancer patients’ prompted and unprompted talk on hope. METHOD: Semi-

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structured interviews with two groups of patients (23 considered not dying; 28 considered dying) were transcribed and analysed using discourse analytic techniques. Spontaneous use of hope emerged throughout interviews, with a specific question occurring at the end of the 2nd study. RESULTS: In both studies, differences emerged between use of hope-as-a-noun (HN: typically seen as objective, outside patient control, and presented as ‘no-hope’), and hope-as-a-verb (typically seen as subjectively determined by the patient, and associated with depiction of a positive future). HN was typically variable in amount, with patients generally holding the more, the better; however, even 1% (though scientifically trivial) may have personal import. Quantifiable hope was associated with a medical prognosis, and thus to deemed to dwindle to no-hope as death approached. However, 19/20 dying patients hoped for a longer life to achieve specific tasks and be with their family, but also acknowledged their imminent death, suggesting this hope is not deathdenying, but life-affirming. Some hoped to leave a legacy to others, either through dying or living well. For some, hope was changeable, for others, enduring beyond death. CONCLUSION: Patients find it difficult to talk of hope in the abstract. Hope can be positive and sustaining, or disillusioning when not attained.

828 Improving Informed Consent to Chemotherapy: Written Information versus an Interactive CD-ROM Olver I, Whitford H Medical Oncology, Royal Adelaide Hospital, Cancer Centre, Adelaide, Australia PURPOSE: This study aimed to determine whether an interactive CD-ROM improved cancer patients’ recall of chemotherapy treatment information over standard written information, and whether cognitive and psychological factors better predicted recall than this mode of delivery. METHODS: Ninety-eight new patients about to commence chemotherapy were randomized to receive written information or a CD-ROM containing treatment information before giving informed consent. Patients’ recall, concentration, short-term memory, reading comprehension, anxiety, depression and coping styles were assessed with standardized measures pre-treatment. Seventy-three patients completed tests for recall of treatment information before their second

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chemotherapy session. RESULTS: Results indicated no significant differences between the written information and CD-ROM groups across recall questions of number of drugs received ðp ¼ 0:33Þ; treatment length ðp ¼ 0:09Þ and treatment goal ðp ¼ 0:59Þ; although effect sizes indicated some small effects. Binary logistic regressions indicated that for groups combined different variables predicted each of the recall questions. Two models were significant with strongest predictors being concentration for recall of number of drugs ðp ¼ 0:06Þ and gender (female) for recall of treatment length ðp ¼ 0:08Þ: However, no individual predictors were significant. CONCLUSIONS: An interactive CD-ROM did not improve cancer patients’ recall of chemotherapy treatment information enough to warrant changes in informed consent procedures. However, analyses of missing data indicated those who did not complete data collection had poorer immediate recall ðp ¼ 0:03Þ and greater depression ðp ¼ 0:004Þ bringing into question the validity of results in studies of recall of treatment information.

829 Five Years of Conducting Group Work with Young Adult Cancer Patients in the Community: Lessons to be Learned Ophir Ra, Spira Oa, Yagil Yb, Cohen La, Ziv Ma a The Israeli Cancer Association, Givatayim, Israel; b Bob Shappell School of Social Work, Tel-Aviv University, Tel-Aviv, Israel BACKGROUND: For now over five years, an extensive experience has been accumulated in conducting ten cycles of young adult cancer patients groups in the Israeli Cancer Association with 128 participants. The groups are conducted in the community. AIM: The current presentation focuses on a theory oriented analysis of the processes that takes place in these ongoing groups. Participants: Aged 18–30, non-married, both men and women, diagnosed as cancer patients while in their young adulthood. METHOD: Using citations and case vignettes, in light of human development theories and group practice theories, an analysis of processes that took place in three groups will be presented. FINDINGS: An analysis of the overt verbal processes that take place in the groups reveal an association between four interacting factors: (i) Each participant’s unique personality he/she brings into the group; (ii) the need of the participants to cope with the cancer

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disease; (iii) the participants’ stage in their life cycle (young adulthood) and its developmental tasks; (iv) universal developmental processes that occur in groups. CONCLUSIONS: Any intervention on behalf of the group conductors, including the very initial planning of the group setting and post-sessions analysis, needs to be performed in light of individual personality and coping theories, lifecycle theories and group work practice theories, and with regard to the interaction between these four perspectives.

830 Comparison of Two Instruments Measuring Psychosocial Distress of Cancer Patients Oppenauer Ca, Kryspin-Exner Ia, Jagsch Ra, Six Nb, Wo¨lfl Hb a Faculty of Psychology, University Vienna, Vienna, Austria; bDepartment for Radiotherapy and Radiobiology, Medical University Vienna, Vienna, Austria OBJECTIVES: In this study the Stress Index RadioOncology (SIRO) was compared with the Hornheider questionnaire to verify if the SIRO really measures psychosocial distress and if quality of life and psychosocial distress are two different working models. Furthermore information about the psychosocial distress with the Hornheider questionnaire was gained and quality of life date were assessed. METHODS: 108 cancer patients (27–91 years) with different diagnosis under radiotherapy have been included in this study. The data have been collected by means of the SIRO, the EORTC QLQ-C30, the Hornheider questionnaire and a questionnaire for the evaluation of the psychooncological ambulance. RESULTS: After a Factor Analysis with all scales of the three questionnaires a solution with two factors seems to be the best. The first factor explains 33.3% and the second factor 24.7% of total variance. Furthermore Pearson Correlations show that the SIRO really measures psychological distress like the Hornheider questionnaire and total scores of both instruments correlate ðr ¼ 0:841Þ high. CONCLUSIONS: Psychosocial distress covers up the psychological aspect of quality of life, and can not be divided from the quality of life model. In contrary, this study recommends a combination of these two types of questionnaires to obtain complete information about the physical and psychosocial aspects of quality of life in order to achieve an optimal medical treatment and if necessary also psychological support. In the end

Copyright # 2006 John Wiley & Sons, Ltd.

the SIRO can be recommended to be used for a good overview of psychosocial distress of radiotherapy patients.

831 To Gradually Attain True Equality Between Doctor and Patient Oppenheim Da, Dauchy Sa, Hartmann Ob a Unite´ de psycho-oncologie et De´partement de Pe´diatrie Institut Gustave Roussy, Villejuif, France; b De´partement de Pe´diatrie, Institut Gustave Roussy, Villejuif, France Improving doctor–patient relationship is a major issue of psycho-oncology. This relation is unequal. The causes and elements of this inequality are diverse. Knowing them is a prerequisite to attaining better equality. Firstly, it is the patient who is suffering and who may die. It is the doctor not the patient who belongs to a group, has wide knowledge, the ability to cure and is active. Sharing treatment decisions, renouncing being paternalistic, promulgating new laws (on the right to be informed, to refuse, etc.), being more informed and more involved in patients’ associations, aim at increasing the patients’ rights. But to progressively attain true equality, patients and doctors must also promote solidarity, mutual information, respect and confidence, and acknowledge their specific objectives. They should also have an equal level of rights and duties, of competence in their own tasks, of power and of responsibility (towards each other, the other patients, themselves). They also need to feel at ease with their situation, tasks, ideals, to keep their sense of dignity and of value and their markers of identity. Equal freedom to think and act as they see fit is also necessary: this freedom can be hindered by reality for both of them, inadequate emotions, the influence of others but also by unconscious thoughts which can produce paradoxical behaviour, misunderstanding, conflicts. Psycho-oncologists and psychoanalysts are therefore useful to help patients and doctors understand and overcome some of these obstacles to their freedom and to establish and preserve true equality between them.

832 Efficacy of a Supportive Program for the Oncological Staff Ostacoli L, Agnesone M, Negro M, Picci RL, Sguazzotti E

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Department of Mental Health, A.S.O. S. Luigi, Orbassano, Turin, Italy OBIECTIVE: To evaluate the effectiveness of a 3 days experiential supportive program for the oncological staff. METHODS: 75% of the oncological staff (nurses and medical doctors) of the five medical wards of S. Luigi University Hospital with high prevalence of oncological admissions participated to the research program. They were divided in a treatment (26) and a control (24) group. Treatment consisted in a 3 full days seminar of non verbal communication work, visualizations on personal resources and personal death, reflexology. Evaluations: Treatment and controls: T0 (before treatment) and T2 (6 months after treatment): HADS (Hospital Anxiety and Depression Scale), WIS (Work Impact Scale), ASQ (Attachment Style Questionnaire), MBI (Maslach Burn Out Inventory). Only Treatment group: satisfaction for the treatment. RESULTS: T0: at baseline there was no difference between the two groups. T1: in the treatment group the percentage of persons with anxiety (HADS A>7) decreased from 40% to 25% (P50.001) in the treatment group, and from 40% to 30.8% in the control group. Even if in the control group it was not statistically significant, it may suggest a clinical effect also in the control group which shares the same clinical setting. All the other variables evaluated were not statistically significant. 100% of participants of the treatment group rated the seminars ‘very effective’ for their daily work with oncological patients.

833 Psychiatric Morbidity in Turkish Women with Breast Cancer O¨zalp E, Soygu¨r H, Sahin CE, Turhan L Psychiatry Clinic, Ankara Oncology Training and Research Hospital, Ankara, Turkey PURPOSE: Breast cancer affects psychologically women because of its social, cultural constitutions (1). The prevalence of depression was 1.5–50% in breast cancer patients (1). This discrepancy depended on differences in study methodology and cultural features, differences in diagnosis criterions. The aim of the study was to assess psychiatric morbidity and to dedicate the severity of anxiety and depression in Turkish women with breast cancer patients. METHOD: Two hundred and four cancer patients who attended Ankara Oncology Training and Research Hospital

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between January 2004 and August 2005 participated in the study. They completed a questionnaire that included a demographic and clinical data form, Hospital anxiety and depression scale (HADS), and they were examined with the structured clinical interview for DSM-IV (SCID). RESULTS: The overall level of psychiatric morbidity in this sample was 22.6% (46): Of these diagnoses, 12.3% (25) were adjustment disorders, 8.3% (17) depression, 2.0% (4) anxiety disorders. The mean total HADS scores of the patients were 10.91 and the mean HADS-D score of the patients were 5.24, the mean HADS-A score of the patients were 5.66. CONCLUSIONS: Psychiatric morbidity is obviously an important component of the experience of Turkish women in breast cancer. Therefore patients must be helped with appropriate programs of biopsychosocial treatments.

834 Family Typology and Psychological Distress Among Japanese Childhood Cancer Survivors and Their Parents Saeki Ta, Mantani Tb, Okamura Hc, Ogata Ad, Yamawaki Sb a General Medicine, Hiroshima University, Hiroshima, Japan; bPsychiatry and Neuroscience, Hiroshima University, Hiroshima, Japan; cInstitute of Health Sciences, Faculty of Medicine, Hiroshima University, Hiroshima, Japan; dClinical Psychology, Hiroshima University, Hiroshima, Japan PURPOSE: The purpose of this study was to develop family typology among Japanese childhood cancer survivors and their family members. METHODS: Eighty-nine families (247 individuals: 88 adolescents of cancer survivors, 87 mothers, and 72 fathers) completed self report questionnaires. Documented informed consent for the study was obtained from ach family member. Perception of family functioning were assessed using the Family Relationship Index (FRI) and its three dimensions (cohesiveness, expressiveness, and conflict), and classified into groups by a cluster analytic approach. Post-traumatic stress symptoms were assessed by the Impact of Event Scale. Psychological distress was assessed using the State-Trait Anxiety Inventory (STAI), the Zung Self-rating Depression Scale (SDS) for only parents, Children’s Depression Inventory (CDI) for only survivors. RESULTS: The result of cluster analysis in FRI, survivors and their parents were classified into 3 types; ‘Supportive-Type (41%)’,

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‘Conflictive-type (13%)’, and ‘Intermediate-type (46%)’. Among 3 family types, analysis of variance revealed that ‘Conflictive-Type’ members were higher level of post-traumatic stress symptoms, depression and state-trait anxiety. CONCLUSIONS: These findings suggested that that the perception of family functioning might relate to psychological distress. A family-focused intervention could help to reduce their psychological distress, especially for the ‘Conflictive-Type’ survivors or parents.

835 Quality of Life and Coping in Patients with Port-A Cath in Chemotherapy for Thoracic Malignancies Pacchiana Parravicini MVa, Ostacoli La, Patta Ja, Ghio Pb, Selvaggi Gc a Mental Health, A.S.O. S. Luigi, Orbassano, Torino, Italy; bPalliative Care, A.S.O. S. Luigi, Orbassano, Turin, Italy; cPulmonary Oncology, A.S.O. S. Luigi, Orbassano, Turin, Italy PURPOSE: To compare the emotional reactions and coping at the onset of a course of intravenous chemotherapy in patients with an implant of a central venous port versus standard needle sticks. PATIENTS AND METHODS: Lung cancer and mesothelioma patients beginning a course of intravenous chemotherapy using a surgically implanted venous access port (Port-a-Cath) versus patients using standard needle stick. Outcome measurements include evaluation of anxiety and depression (Hospital Anxiety and Depression Scale [HADS] and Depression Self-Test [ZUNG Questionnaire]), quality of life (Functional Assessment of Lung Cancer Therapy [FACT-L]), sleep quality (Pittsburgh Sleep Quality Index [PSQI]), coping (Mental Adjustment to Cancer [MINIMAC]) and physician-patient relationship [PPRI]. Subjects with port ðn ¼ 15Þ and controls ðn ¼ 30Þ are evaluated at three different steps: T0: semistructured interview and questionnaires at the beginning of chemotherapy to all patients using standard needle sticks. Randomization in 2 groups (porth-a-cath and needle sticks) T1: evaluation with HADS, ZUNG, FACT-L, PSQI and PPRI to both groups one month after the implant.T2: evaluation of all patients with HADS, ZUNG, FACT-L, PSQI and PPRI one month after completion of chemotherapy. RESULTS: Preliminary data indicate that the implantation of a porth – a - cath is well tolerated in comparison to needle sticks, with significant reduction of local

Copyright # 2006 John Wiley & Sons, Ltd.

side effects. CONCLUSIONS: Final results about emotional and coping parameters will be reported when the research is completed.

836 Does Cancer Patients Emotional Sphere Change After Psychosocial Interventions?: The Experience of ‘Tea-time’ and ‘Pet-therapy’ Pacetti Pa, Cantore Ma, Mambrini Aa, Tagliani Mb, Orlandi Ma a Oncological USL1 Massa Carrara, Carrara, Italy; b Psycho-oncological Spedali Civili Brescia, Italy BACKGROUND: Cancer patients suffer from psychological distress; it is important they continue their daily life although chemotherapy. Aim: to evaluate the impact of ‘Tea-time’ and ‘Pettherapy’, like psychosocial supports to patients admitted to our Oncological ward. Tea-time: weekly, patients, nurses, doctors and relatives meet and stay together sitting around a table in the ‘Tea-room’; they can drink a tea, sing a song, listen music or simply talk. Pet-therapy animals have a natural power to stimulate curiosity and socialization between people, to induce a good moon and to reduce anxiety. Twice a week, we selected a room where experimenting the presence of a pet during chemotherapy. METHODS: For ‘Tea-time’ study, STAI questionnaire (Spielberger, 1997) evaluating state anxiety, was administered to 100 patients before and after ‘Tea-time’. The control group was represented by 30 patients. For ‘Pet-therapy’ study, ADeSsO test (simplified version of Symptom Questionnaire, Kellner, 1981), evaluating anxiety, depression, aggressiveness and physical symptoms, was administered before and after ‘Pet-therapy’ to 80 patients staying with pet during chemotherapy; main vital parameters were also evaluated. Forty patients represented the control group. RESULTS: A statistically significant reduction of state anxiety was seen in patients participating to ‘Tea-time’. ‘Pet-therapy’ seems to reduce depression and increase blood oxygen saturation in experimental group. CONCLUSION: psychosocial interventions like ‘Tea-time’ and ‘Pet-therapy’ have a positive impact on cancer patients emotional sphere; they should be deeper evaluated to be considered for a routinely employment in Oncological ward.

837 The Acceptance and Commitment Therapy in Psycho-oncology. A Preliminary Study

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Pa´ez-Blarrina MBa, Luciano-Soriano Cb, Gutie´rrez Martı´ nez Oc, Montesinos Marı´ n Fd a Spanish Cancer Association, Almeria, Spain; b Personalidad Evaluacio´n Y Tratamientos Psicolo´gico, University of Almeria, Almeria, Spain; c Personalidad, Evaluacio´n Y Tratamientos Psicolo´gico, University of Granada, Granada, Spain; d Spanish Cancer Association, Almeria, Spain PURPOSE: To compare the effects of two psychological group treatments. METHOD: Twelve women diagnosed of breast cancer and attending to the Spanish Cancer Association received either a control-focused intervention, (the usual psychological group treatment used in Spanish Cancer Association), or an acceptancefocused psychological treatment, a reduced and adapted to small groups ACT protocol. Dependent measures were, anxiety and depression (H.A.D.S.) quality of life (F.A.C.T.-B), discomfort level and general satisfaction with actions towards values. The treatment program consisted of a pre-treatment evaluation session, five group therapy sessions, three individual therapy sessions, a post-treatment evaluation session and the follow up evaluations at three, six and twelve month. RESULTS: Anxiety and depression scales scores have decreased at post treatment and for both of the conditions. Quality of Life, have increased after the treatment and for both of the conditions. Discomfort level for ACT subjects it has no changed, and the fidelity with their values has increased in every case at post-treatment and it has maintained at the follow up. About control subjects, the discomfort level has decreased at short but this change did not maintain at follow up. Fidelity with values has no changed. CONCLUSIONS: The clinical improvement showed by subjects in the ACT condition was more evident in women who showed more number of affected domains, here the ACT treatment has produced the most relevant clinical effect.

838 The Psychosocial Issues and Experiences Surrounding the Informal Caregiver of Patients Getting Palliative Care in Kerala, India and Their Impact on the Caregiver Palat Ga, Suresh Ua, Pillai Sa, Venkateshwaran Cb, Kumar TMc a Pain and Palliative Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India; bDepartment of Psychiatry, Amrita Institute of Medical

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Sciences, Kochi, Kerala, India; cConsultant in Liaison Psychiatry, Liaison Psychiatry Service, Becklin Centre, Leeds, UK PURPOSE: This study aims to highlight the main psychosocial issues and experiences of informal caregivers, commonly a spouse or adult child, if those patients who are in the palliative care phase of illness. It will explore the levels of mental illness, the financial difficulties, the impact on self esteem, schedule and health and the family support and if any of the carer’s demographics, for example level of education, are linked with the issues and experience. It is important to analyse this research because family care, especially in developing counties, is one of the most important provisions of care; more than three-quarters of patients are cared for by informal caregivers in their home. Therefore, health services around the world rely heavily on this informal resource. Research into their needs and experiences is also important so resources for them can be implemented to make their task easier, which will rebound good effects on both them and the patient. METHOD: This quantitative study will recruit informal caregivers of patients receiving palliative care from the Department of Pain and Palliative Care, Amrita Institute of Medical Sciences, Kerala, India. They will answer translated Malayalam questionnaires on themselves (their age, gender, relationship to patient, years of schooling, primary daily activity), a few details on the patient’s situation (diagnosis, length of illness) and then will be administered a Caregiver Reaction Assessment questionnaire. RESULTS: Statistical analysis will be done and discussed.

839 From Diagnosis to Recovery: A Longitudinal Study Investigating the Emotional and Psychological Journey of the Adolescent and Young Adult Cancer Patient Palmer S, Thompson K, Baxter H, Thomas D Peter MacCallum Cancer Centre, Melbourne, Australia BACKGROUND: There is increasing recognition that adolescents and young adults have specific needs when it comes to a diagnosis of cancer and its management. In particular, the social, emotional and psychological challenges facing adolescents and young adults with a diagnosis of cancer remain among the most complex faced by both

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patients and health care providers. However, despite this growing recognition, and the extensive literature evaluating psychosocial needs of paediatric and adult cancer patients, there is very little research available that specifically looks at these issues within this unique cohort of patients. PURPOSE: The purpose of the research was to investigate the emotional and psychological responses of adolescent and young adults undergoing treatment for cancer. This will enhance current understanding of this under-researched population and inform the development age appropriate psychological screening and targeted interventions. Ultimately, this will enable health professionals to better support this unique group of cancer patients both during and following cancer treatment. METHODS: A longitudinal survey approach was employed to assess the ongoing emotional and psychological impacts of cancer treatment for the adolescent and young adult population. A battery of psychological tools investigating depression, anxiety, posttraumatic stress, and quality of life were administered at standard intervals throughout the participant’s treatment period and beyond. All patients between the ages of 16 and 30 who were treated at Peter MacCallum Cancer Centre from 2005 onwards were invited to participate. Current enrolment in the research is 27 patients. Preliminary results have been analysed. RESULTS: The results identified a number of psychological issues and areas of concern for the young people in relation to their diagnosis, ongoing treatment, and post-treatment emotional state. The results will be discussed and recommendations based on these findings will be highlighted.

840 Factors Influencing the Process of Psyche–body Interaction and Its Role Over the Course of Cancer Therapy Palumbo Ga, Chikota Ob, Ceccarelli Fc a Psychosomatics, European Association Ontopsychology, Roma, Italy; bPsychosomatics, Catarinense Psychosomatic Association, Santa Catarina, Brazil; cSurgery, General Hospital, Latina, Italy PURPOSE: The authors will propose a multidisciplinary, psychosocial approach focussed on understanding the role that can be played by the psychic activity in the development of illness, especially in cancer patients and to illustrate how the ontopsychological approach can be used, as a

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form of complementary intervention by oncological medicine, in order to improve cancer prevention and patient’s quality of life. The understanding of the psychic activity will be discussed through the analysis of patients outcomes and follow-up. METHODS AND RESULTS: Three International Seminars have been organised (Geneva, 1997; Assisi, 1998; Cattolica, 1999) open to specialists in the field to study the neurophysiological aspect correlated to the somatic aspect. In addition to medical treatment, patients at the presence of their medical doctors, received interview according to the ontopsychological approach. In order to investigate subject’s psychic activity and to identify the underlying drive the five steps of the therapeutic process were followed. Patient’s change in the psychic activity (images/ ideas/thoughts) and in lifestyle proved to help change into the somatic aspect. CONCLUSIONS: The results from this study highlight the importance of evaluating subject’s psychic activity at early stage and treating elevated levels of distress can improve the outcomes of cancer therapies and increase patients’ quality of life and survival. ACKNOWLEDEGMENTS: The authors thanks the chair of ontopsychology of the faculty of psychology, State University of Saint Petersburg for scientific support.

841 Is There an Association Between Depression and Its Role Over the Course of Cancer Therapy? Palumbo Ga, Chikota Ob, Dander Bc a Psychology, European Association Ontopsychology, Roma, Italy; bPsychosomatics, Catarinense Psychosomatic Association, Santa Catarina, Brazil; cMedicine, European Association Ontopsychology, Milan, Italy PURPOSE: Recent epidemiological research has shown that about 10/15 per cent of people suffers from an episode of depression at lest once in one year term/one female over 4 and one male over 8/. About 50 per cent of people after the first episode of depression suffers from a second one, after three episodes the possibility to have a forth episode increases to 90 per cent. The WHO rates it as the fourth most important problem as sufferance and disability and if not contrasted will increase to the second place by 2020. Loss of interests and tendency to obsessively think to the same think is also increased by depression. This study will illustrate in details subject characteristic

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traits and the three phases of depression course through cases history. METHODS AND RESULTS: The subject personality traits and the interpretative styles analysed through psychological interview has shown subject underlying emotion of hyper vitality blocked, constrained with no way out. The psychosocial intervention; according to the ontopsychological understanding and how its methodology can contribute to avoid that depression becomes the start point and how encouraging patient to improve his/her well being will be illustrated. CONCLUSIONS: The results from this study highlight the importance of taking into consideration depression and to increase intervention that enhance effective coping and reduce affective distress for beneficial effects in cancer patients. ACKNOWLEDGEMENTS: The authors thanks the chair of ontopsychology of the faculty of psychology; State University of Saint Petersburg for scientific support.

842 Distress, Anxiety and Depression in Patients with Head Neck Cancer Undergoing Treatment with Curative Intent Pandey Ma, Devi Nb, Ramdas Kc, Krishnan Rb, Thomas BCc a Surgical Oncology, Institute of Medical Sciences, Varanasi, India; bPsychology, HH The Maharajah’s College for Women, Trivandrum, India; c Radiation Oncology, Regional Cancer Centre, Trivandrum, India INTRODUCTION: Psychological problems in cancer patients often go unrecognized until they are specifically sought. This is more in patients with depression as they are reluctant to complain about their symptoms. The present study was carried out to evaluate the distress, anxiety and depression in patients with head and neck cancers undergoing treatment with curative intent. PATIENTS AND METHOD: A cross-sectional survey of 130 patients was carried out using Distress Inventory for Cancer version 2 (DIC2) and the Hospital Anxiety and Depression scale (HADS). The data was analyzed by correlation analysis and multiple logistic regression. RESULTS: The mean age of patients was 54.2 years, 93 (75.6%) were males. Nearly 50% had early carcinoma and were node negative. The mean DIC 2 scores were 24.6 while that of subscales ranged from 2.6 to 11.0. Fifteen patients were

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found to have clinical caseness for anxiety while 12 (10%) were caseness for depression. Mood disturbances for anxiety and depression were seen in 17 (14%) and 20 (16%) respectively. Distress and emotional and social subscales were found to have positive correlation with anxiety and depression. In multivariate analysis only belief in god was found to significantly affect the distress. CONCLUSIONS: Results of present study suggest significant psychological morbidity in head neck cancer patients undergoing curative treatment. Belief in god is the single most important factor influencing distress. This suggests need for a psychological assessment for each patient and also suggests need for intervention to improve psychological morbidity. ACKNOWLEDGEMENT: The HADS is under copyright and the publisher is: nfer-Nelson, The Chiswick Centre, 414 Chiswick High Road, London W4 5TF, UK http://www.nfer-nelson.co.uk. Permission was obtained for its translation and use, the translation were approved by the copyright owners after examining the back translations. The authors work on Quality of Life in breast cancer is funded by a grant from the Indian Council of Medical Research (ICMR) New Delhi, India vide grant number 5/13/74/2000/NCD-III.

843 The Impact of Parental Communication Skills About Cancer on Children’s Suffering In Families Comprising a Parent Treated For Cancer Paradis Ma, Consoli SMb, Pelicier Nc, Lucas Vd, Andrieu Je a 3rd Sector of Adult Psychiatry, Sainte Anne Hospital, Paris, France; b3rd Sector of Adult Psychiatry European Georges Pompidou Hospital, AP-HP, Paris-5 University of Medicine, Paris, France; cMedical Oncology and Haematology, La Source Hospital, Orleans, France; dOncology, European Georges Pompidou Hospital, Paris, France; eHepato-Gastro-Enterology, European Georges Pompidou Hospital, Paris, France PURPOSE: To explore the role of both parents’ facility in communicating about cancer, on children’s distress. METHODS: 30 nuclear families of patients treated for a cancer not related to sex, having children aged 4–16 living with them (54 children: 25 boys, 29 girls) were studied. Ill parents were fathers in 19, and mothers in 11 cases. Each parent separately completed the Openness to Discuss Cancer in the nuclear Family

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(ODCF) scale in its original version and a version adapted for the spouse, and the Child-BehaviorCheck-List (CBCL). RESULTS: No association was found between children’s CBCL and any parental ODCF score. Couples of parents were subsequently divided in four classes according to the median-split ODCF scores of each partner (limited-limited, limited-open, open-limited and open-open communication). When the cancer patient was the mother, CBCL total ðp ¼ 0:007Þ as well as internalized ðp ¼ 0:024Þ scores were as much higher than the communication within the couple was open (two-way ANOVA). CONCLUSION: Contrary to what was expected, higher levels of communication skills within the couple of parents not only did not alleviate children’s distress, but were associated with more pronounced total behavior disorders and internalized disorders in the subgroup of children whose mother was affected by cancer. Such results stress that the so called openness to discuss about cancer, aimed at maintaining authentic interactions within the family, can also lead to negative effects on children’s emotional balance, possibly when the information given to the children is not adapted to their age or their expectations.

calculated. RESULTS: No association was found between children’s CBCL scores and children’s gender or age, or parental cancer severity, but higher levels of CBCL total scores were observed when ill parent’s educational level (EL) was high (p50.02). No association was found between children’s CBCL scores and cancer parent’s or his/her spouse’s GHQ-28 scores. CBCL total scores were both higher when the scoring parent’s gender (p50.02) and the ill parent’s gender (p50.02) were female (ANOVA for repeated measures). Similar effects for scoring parent’s gender and ill parent’s gender were respectively found for CBCL internalized disorders (for ex. anxiety) (p50.02) and CBCL externalized disorders (for ex. aggressive behavior) (p50.001). CONCLSION: Our results confirmed the more disturbing impact on children’s behavior, especially for externalized disorders, when the cancer parent is the mother. Mothers appeared more sensitive to internalized disorders. Paradoxically, a high EL of cancer parent does not protect children from psychological suffering, possibly because in such families children are more driven to share the burden of parent’s disease.

845 844 Higher Levels of Children’s Distress are Observed When Mothers-vs-Fathers are Treated for Cancer and When the Scoring Parent is the Mother Paradis Ma, Consoli SMb, Jian Rc, Andrieu Jd, Lucas Ve a 3rd Sector of Adult Psychiatry, Sainte-Anne Hospital, Paris, France; bC-L Psychiatry European Georges Pompidou Hospital, Paris, France; cHepato-Gastro-Enterology, European Georges Pompidou Hospital, Paris, France; dOncology, European Georges Pompidou Hospital, Paris, France; eMedical Oncology and Haematology, La Source Hospital, Orleans, France PURPOSE: To explore the respective role of children’s and cancer parent’s characteristics, and both parents’ distress, on children’s distress. METHODS: 30 nuclear families of patients followed up for a cancer not related to sex, having children aged to 16 living with them (54 children: 25 boys, 29 girls) were studied. Ill parents were fathers in 19, and mothers in 11 cases. Each parent separately filled out the GHQ-28 and the Child Behavior Check-List (CBCL). The average of the two CBCL measures, if both available, was

Copyright # 2006 John Wiley & Sons, Ltd.

Problem Faced During Counseling with the Patients and Relatives Parashar Da, Ganesh Nb a Social Oncology, Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; b Palliative Care, Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India; cResearch Department, Jawaharlal Nehru Cancer Hospital and Research Centre, Bhopal, India In India the majority of the patients come with advance diseases, facing mental stress, pain, agony and malnutrition. When the patient is receiving palliative treatment, the family have some hope but all the time their mind in trouble, struggling with only ‘one question patients prognosis?’ At Jawaharlal Nehru Cancer Hospital and research Centre, Bhopal, We the social Oncology group analyzed our subject on the basis of above queries. The subject is grouped into two categories. The Patients itself. The Relatives. Total 60 patients at random selected were admitted in the palliative unit in the second group contains variable number. They were analyzed on the basis of dynamic human behaviour and personalities. They are: Active constructive Horse, Passive construc-

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tive Bulls, Passive destructive Donkeys, Active destructive Snakes, All 60 patients belongs to lower middle low socio economic status. Before applying the counselling tools on the group we found that out of 60, 39 were Passive destructive, 17 were active destructive and 4 were passive constructive. We applied Johari Window, fish N Bowl and Transactional analysis. It was observed that the time taken to remove the agony, to promote the palliative therapy was taken less by passive constructive. But due to the mental stress and external queries (relatives) the two group with 39 patients and 17 patients has taken more time to well conversant and the word palliation. So, we conclude that slow and steady, observation, involvement and follow up has played a major role to define the goal of palliation in patients suffering from mental stress, agony and pain.

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We next examined whether CDIS scores moderated the effects of optimism on self-efficacy after surgery (controlling for baseline factors). There was a significant interaction between CDIS and LOT scores in predicting SE 6 weeks after surgery ðp ¼ 0:04Þ: Graphical representation of the data suggested that the beneficial effects of optimism on changes in SE by 6 weeks after surgery disappeared when satisfaction with the physicianpatient relationship was low. CONCLUSIONS: These results highlight the importance of the physician-patient relationship and good communication skills in helping facilitating patients’ confidence in managing surgery and treatmentrelated concerns following prostate cancer surgery. ACKNOWLEDGEMENTS: Funded by NIMH/ NCI grant #RO1MH59432.

847 846 Physician–Patient Communication, Optimism and Self Efficacy in Men with Prostate Cancer Undergoing Radical Prostatectomy Parker PAa, Cohen La, Baile WFb a Behavioral Science, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA; b Section of Psychiatry, Department of NeuroOncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA

The Effects of a Pre-Surgical Stress Management Intervention for Men with Early Stage Prostate Cancer Undergoing Radical Prostatectomy Parker PAa, Cohen La, Pettaway Cb, Babian Rb, Pisters Lb a Department of Behavioral Science, University of Texas, M. D. Anderson Cancer Center, Houston, USA; bDepartment of Urology, University of Texas, M. D. Anderson Cancer Center, Houston, USA

PURPOSE: Self-efficacy has been associated with better psychosocial adjustment in cancer patients. We examined the associations between physicianpatient communication and optimism on selfefficacy in men before and after surgery for prostate cancer. METHODS: As part of a larger stress management study, 158 men completed measures of physician communication (Cancer Diagnostic Interview Scale}CDIS), optimism (Life Orientation Test}LOT), and self-efficacy to manage surgery and treatment-related side effects (SE) 2 weeks before and again 6 weeks after surgery. RESULTS: Men were primarily Caucasian (78%), married (85%) and highly educated (80% some college or higher). Univariate analyses, controlling for medical (Gleason scores) and demographic (age, education) factors, indicated that CDIS and LOT scores were both positively associated with SE scores at baseline (beta ¼ 0:29; p50.001; beta ¼ 0:32; p50.001, respectively) and, when controlling for baseline SE scores, at the 6-week follow-up (beta ¼ 0:22; p ¼ 0:04; beta ¼ 0:24; p ¼ 0:03; respectively).

PURPOSE: We conducted a three-arm randomized controlled trial to examine the efficacy of a two-session pre-surgical stress management intervention for men who underwent radical prostatectomy. METHODS: 158 men were randomly assigned to one of three conditions–stress management (SM), supportive attention (SA), or usual care (UC). Men completed psychosocial measures including mood disturbance (POMS-18), intrusive thoughts and avoidance behaviors (IES), and pain (MPI) at baseline (2–4 weeks before surgery), 2–7 days before surgery (POMS and IES only), the morning of surgery (POMS only), and 6 weeks later. RESULTS: Men were primarily Caucasian (78%), married (85%) and highly educated (80% some college or higher). Medical and demographic characteristics, except ethnicity (control group had more men from minority groups), were similar between groups. Mixed model analyses, controlling for ethnicity and the respective baseline measure, indicated a significant decrease in mood disturbance over the study period for men in all groups ðp ¼ 0:01Þ: There was also a significant

Copyright # 2006 John Wiley & Sons, Ltd.

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group main effect ðp ¼ 0:02Þ: Adjusted mean POMS scores were 8.2 (SM), 9.5 (SA), and 11.2 (UC). Post-hoc analyses revealed significantly lower POMS scores for the SM vs. UC group; no other comparisons reached significance. IES levels decreased significantly over time (p50.01), but there were no group differences in IES or MPI levels. CONCLUSIONS: Results suggest that even a very brief pre-surgical stress management intervention is beneficial in terms of reducing mood disturbances before and following prostate cancer surgery. ACKNOWLEDGEMENTS: NIMH/NCI Grant #RO1MH59432

848 Arm and Hand Swelling among Long-term Breast Cancer Survivors: CALGB 79804 Paskett EDa, Abbott JMa, Katz MLa, Dowell JMb, Herndon JEIIb a Comprehensive Cancer Center, The Ohio State University, Columbus, USA; bCALGB Statistical Center, Duke University Medical Center, Durham, USA PURPOSE: Lymphedema is an under-reported and debilitating consequence of axillary node dissection among breast cancer survivors. The goal of this paper is to describe the characteristics of arm and hand swelling, including treatmentseeking behaviour and effects on quality of life (QOL), among a population of breast cancer survivors who participated in a clinical trial coordinated by the Cancer and Leukemia Group B (CALGB 8541) 9–16 years ago. METHODS: Three hundred thirty-one eligible survivors of CALGB 8541 were contacted and asked to complete a mailed survey assessing questions about demographics, quality of life, arm and hand swelling, sexuality, breast cancer anxiety, spiritual beliefs, and depression. RESULTS: Of the 245 women who completed a survey, 75 (31%) reported ever having arm/hand swelling since their surgery. Of the women who ever experienced swelling, 75% reported current swelling, and half reported constant swelling, mainly in the upper arm. Self-reported swelling was either mild or moderate in 88% of the women. Women perceived the causes of their swelling to be removal of lymph nodes (73%) and general arm use (23%). Swelling interfered with wearing clothing (36%) and perceptions about general appearance (32%). Few women (37%) sought treatment for swelling.

Copyright # 2006 John Wiley & Sons, Ltd.

No effects of swelling on quality of life were observed. CONCLUSIONS: Arm/hand swelling is still a significant problem for long-term survivors of breast cancer, and few omen seek treatment for it. ACKNOWLEDGEMENTS: This study was funded by NIH grants AG16602, CA79883 and CA57707.

849 Maximizing Utilization of Depression Screening in Lung Cancer Patients Passik SDa, Levy LBa, Byers Ka, Kirsh KLb a Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, USA; b Pharmacy Practice and Science, College of Pharmacy, University of Kentucky Markey Cancer Center, Lexington, USA PURPOSE: 1. To examine the impact of depression screening in lung cancer patients when the results of the screening are made available to the patient, the physician, both or neither on detection of depression, provision of recommendations and the quality of the doctor–patient interaction from the patient’s perspective. 2. To examine psychological and demographic subsets of patients (ie, defined by age, gender, rural vs urban status, and low vs high self-efficacy) and how they interface with how screening information is directed. METHODS: In this collaborative study at Memorial Sloan-Kettering Cancer Center (MSKCC) and the University of Kentucky Markey Cancer Center (UKMCC) we are screening all patients with lung cancer for depression. Patients who screen above normal for depressive symptoms are assessed for a range of characteristics including self-efficacy. Patients are then randomly assigned to one of four groups in a 2x2 factorial design in which the results of the screening are made available to the patient, the physician, both or neither (standard of care-control). Following the visit, we assess recognition/discussion of depressive symptoms, recommendations made for treatment and the quality of the interaction from the patient’s point of view. RESULTS & CONCLUSIONS: While at this time we cannot report any results, based on our current rate of accrual, we expect to have at least 70 patients complete the study by the time of the conference. This should provide us with a good basis upon which to report interim analysis results and preliminary conclusions.

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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850 Efficacy of Cognitive Behavioral Therapy for Young Brain Tumor Survivors Poggi Ga, Pastore Va, Adducci Aa, Galbiati Sa, Massimino Mb a Acquired Brain Injury Unit, IRCCS Eugenio Medea Bosisio Parini, (LC), Italy; bPediatric Oncology Unit, National Cancer Institute, Milano, Italy PURPOSE: Behavioral and emotional disorders are among the most frequently observed sequelae in brain tumor survivors. Even though Cognitive and Behavioral Therapy (CBT) is often used to treat these disorders and its efficacy has been described in several studies, its efficacy with this population of patients has rarely been evaluated. The goal of this work is to describe the efficacy of the CBT in the treatment of psychological problems in child and adolescent brain tumor survivors. METHODS: 40 children and adolescents (mean age: 9.4 years; range: 4–17 years) were included in the study. The treatment group, consisting of 17 patients, received sessions of CBT. The Child Behavior Checklist 4–18 (CBCL/ 4–18) and the Vineland Adaptive Behavioral Scales (VABS) were administered to parents at admission and at discharge. The statistical significance of treatment changes for the clinical subjects was analyzed. RESULTS: A significant advantage was found for the clinical group on the following CBCL/4–18 scales: Withdrawn, Somatic Complaints, Social Problems, Attention Problems, Internalizing and Total Problem Scales. On the VABS, the treatment group showed a more significant improvement in the domain of Socialization. CONCLUSIONS: These results substantiate that cognitive and behavioral therapy is an effective intervention for children and adolescents surviving brain tumors. The CBT may be particularly helpful in managing cancer-related limitations in younger individuals.

851 The importance of Social Support at Breast Cancer Surgery Patra˜o Ia, Leal Ib, Maroco Jc a Psychology SPA, Lisboa, Portugal; bPsychology ISPA, Lisboa, Portugal; cEstatistics ISPA, Lisboa, Portugal A study was conducted to assess the social support in women with breast cancer. In this study 120

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women were assessed after surgery for breast cancer, at Dr Alfredo Costa Maternity (Lisbon).We found that, with breast cancer surgery lower satisfaction with social support. Data suggests that a psychological intervention with these women should be focus on a search for alternative social support that can be more satisfying, enabling a beneficial emotional response to breast cancer diagnosis and prevent a poor adjustment in the future, during the disease experience and adjunct treatments.

852 Understanding the Needs of Young People who have a Family Member with Cancer Patterson Pa, Slawitschka Eb, Visser Ab, Desille Nb a Research and Evaluation CanTeen, Sydney, Australia; bPsychology University of Western Sydney, Sydney, Australia PURPOSE: Confrontation with a family members’ cancer can be a very daunting and distressing experience for young people, resulting in serious unmet needs. The purpose of this study was to explore the needs of these young people, specifically those who have a parent with cancer or a brother or sister with cancer. METHODS: A mixed methods approach was utilised, employing a combination of focus groups and questionnaires to elicit a clearer understanding of these young people’s needs. It was a further aim to involve the young people as purposeful agent in the research process and not mere functionaries. To this end the outcomes of the focus groups in which some participated directly fed into the construction of the needs questionnaires used in this study and which will subsequently be assessed for reliability and validity for future use with young people living with cancer. RESULTS: Utilising both the qualitative and quantitative data, the study highlighted specific domains of unmet needs for both groups of young people and outcomes for informing service delivery for young people living with cancer. An example of the application of these outcomes is discussed within the context of CanTeen (the Australian Organisation for Young People Living with Cancer). CONCLUSIONS: Delineating the needs of young people living with cancer is imperative in appropriately delivering services and developing evaluation frameworks for programs, and relevantly informing advocacy. Further, the establishment of the

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needs measures to assist in this process provides valuable tools.

853 Evaluation and Management of Distress in a Cancer out Patient Setting Pavese Ia, Satta Fa, Palladino Aa, Di Palma Ma, Leonardi Lb a Department of Oncology, S Pietro Fate Bene Fratelli Hospital, Rome, Italy; bPsychology Service, S Pietro Fate Bene Fratelli Hospital, Rome, Italy PURPOSE: Of the study was to evaluate the utility of a routinely recognition and evaluation of distress in a setting of adult out-patients affected by cancer and receiving chemotherapy. The distress is an unpleasant emotional experience of a physical, psychological, social or spiritual nature. METHODS: From September 2005 to March 2006 the oncological team in Day Hospital routinely screened patients coping with cancer for the level and nature of distress by a consensus based clinical practice validated tool the Jimmie C. Holland thermometer. 75 patients (46 F, 39 M, median age 42y) with different cancer types (lung 8, breast 23, colon-rectal 20, head and neck 15, ovarian 7, gastric 2) were evaluated. Each patient was screened at initial visit, after 3 months of chemotherapy and at the end of treatment. RESULTS: 82% of patients showed mild-moderate distress in the initial evaluation and a significant reduction during the course of treatment. CONCLUSIONS: In our setting the distress was considered the sixth vital parameter in the global patient approach. It is a very useful procedure to improve skills in multidisciplinary approach, asses the efficacy of the oncological team, improve the staff-patient communication and the perceived objective symptom referral. We believe that screening and management of distress is a part of medical oncologist care which can result in a better clinical outcome.

854 Structural Validity of the Stanford Acute Stress Reaction Questionnaire in a Sample of Cancer Patients Pedersen AF, Zachariae R Department of Psychology, University of Aarhus, Aarhus C, Denmark AIM: To investigate the structural validity of the Stanford Acute Stress Reaction Questionnaire

Copyright # 2006 John Wiley & Sons, Ltd.

(SASRQ) in cancer patients. The SASRQ has been shown to be a reliable and valid self-report measure of acute stress disorder (ASD) in various samples. A previous exploratory factor analysis on responses from firestorm survivors extracted three factors: Dissociation, Intrusion, and Hyperarousal. A fourth Avoidance-factor has been added later. METHODS: The SASRQ was translated into Danish using translation-back translation and completed by 116 patients (mean age ¼ 61 years) recently diagnosed with lung cancer (63%), ovarian cancer (21%), bladder cancer (15%), and sarcomas (2%). RESULTS: The mean SASRQ score was 38.7 (SD: 29.0) with an internal reliability of 0.96. These results correspond to previous studies of cancer patients indicating an adequate translation of the scale. The results of a confirmatory factor analysis revealed inadequate fit of our data to the model (X2 ¼ 983:66; p ¼ 0:000; GFI ¼ 0:61; RMSEA ¼ 0:13) which may reflect that a cancer diagnosis differs from other traumatic events: When diagnosed with cancer, anticipatory future threats constitute the traumatic event and symptoms of ASD could be mixed with side effects of treatment such as concentration deficits and confusion. Further analyses indicated that the lacking of fit could also be due to insufficient N-to-item ratio. CONCLUSIONS: The revealed measurement inequivalence of the SASRQ could indicate that the scale does not tap into the same underlying construct when completed by cancer patients and survivors of natural disasters.

855 The Family Support Project: A Unique Concept of Family Care within the Hospital Setting Peltenburg H, Schopenhauer R, Van der Linden MHM Department of Medical Oncology, VUmc University Hospital, Amsterdam, Netherlands PURPOSE The Family Support Project was initiated by prof. dr. H.M. Pinedo and started in 2004 at the department Medical Oncology. It aims at improving communication between cancer patients, their family members, their doctors and other health professionals. METHODS: In 2003 the project recruited sponsor finances of the foundation ‘TimeOut rooms Vu Medical Center’. The room comprises an internet cafe, a kitchenette, a children’s corner, and a comfortable sitting area with audio-visual facilities. Family make a

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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great use of the library and multi-medial information on psycho-oncology. It is a quiet and comfortable place in close vicinity of loved ones. The experienced oncology nurse is available for support and for relieving concerns. RESULTS: So far, the project has been a great success; the first year 469 families have used the Family Room ‘Time Out’ to celebrate birthdays and marriages, make homework and share joyous and sad moments together in private. Family members report that the family room and services of the ‘family nurse’ is of great help in the coping process and empowerment in the course of dealing with the disease and cancer treatment. CONCLUSIONS: It’s a strong clinical impression that the Family Support Project showed that the ‘Family nurse’ facilitates effective communication between the patient, his family and all professionals within the hospital setting. ACKNOWLEDGEMENT: A special note of thanks is due to the ‘TimeOutrooms VU Medical Center’ Foundation for recruiting sponsors for the Family Support project.

856 CIPOMO PROJECT: Women’s Narratives about Breast Cancer: A Qualitative Study (Preliminary Data) Perez Ma, Crispino Sa, Falzetta Aa, Martignetti Aa, Menoni Eb a DipartimentoOncologico, USL 7, Siena, Italy; b Struttura Semplice Psicologia Clinica di Liaison, Azienda Ospedaliera Universitaria Senese, Siena, Italy CIPOMO PROJECT: Women’s narratives about breast cancer: a qualitative study (preliminary data). PURPOSE: The present qualitative study aimed to explore 14 Italian women’s lived experience of surgically treated breast cancer with a view to gaining a deeper understanding of their individual experiences and the meanings that it holds for them with reference to a specific stage of treatment (adjuvant chemotherapy or hormonal therapy). METHODS: This study is based on the narrative method, which acknowledges the role of experts and protagonists of the research played by the patients. Data were collected using in-depth pre-medical treatment interviewing. RESULTS: Phenomenological analysis of the narrative resulted in three interrelated clusters of meanings (and respective sub categories): (a) To be helped; To help myself; To help the others, with

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reference to factors which are subjectively perceived as being (or not being) of assistance in the cancer experience. CONCLUSIONS: This research method has been confirmed to be of value for acquisition of significant data even if of qualitative nature. We discuss the importance of our findings for better understanding the psychological aspects of adjuvant treatment experience. On the basis of the results achieved, this study is aimed at improving the quality of clinical assistance supplied. ACKNOWLEDGEMENTS: This research is being carried on thanks to Cipomo Funds.

857 Bereaved Families Groups: Memories of the Beloved One Perina EMa, Vasconcellos Ea, Bettega PBb, Pozzi NTc, Aguiar Sd a Department of Mental Health, Boldrini’s Children Hospital, Campinas, Brazil; bBoldrini’s Research Institute, Boldrini’s Research Institute, Campinas, Brazil; cSocial Service Department, Boldrini’s Children Hospital, Campinas, Brazil; dOncology Department, Boldrini’s Children Hospital, Campinas, Brazil The loss of a child is one of the most catastrophic experiences in life. The long period of time suffering, since the diagnosis of cancer, brings on significant marks on the whole family. The psychosocial repercussion on each member of the family will depend on each one’s life story, degree of significance and type of bonds held with the person lost. A few studies report on risk factors for the breaking out of a complicated bereavement. In order to support the parents in the process of elaboration of the mourning, we have accomplished a Meeting of Bereaved Families. OBJECTIVE: Understand the process of parents’ mourning and the different ways to overcome grieving and accepting loss. METHODOLOGY: Qualitative study using techniques of Group Dynamics and Art therapy. SUBJECTS: Thirtytwo Bereaved Families. RESULTS: Different ways for the expression of feelings roved by the loss, leading the parents to understand the anthropological, spiritual and transcendental sense of death. It also gave way to reviewing and reinstating the relationship with the lost loved one, so that the lessons learned could bring strength to rebuild their lives. CONCLUSION: This work contributed so that some of the propositions of

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intervention, with the mourning parents, could be outlined in helping them to restart their personal and social universe as well as offering subvention for the development of preventive measures which void the unleash of a complicated mourning of the family who is accompanying the loved one’s pathway of pain and grieving through cancer.

858 Quality of Life and Psychological Distress after a Liver Transplant: A Prospective Study Perrone Ma, Condoleo MFa, Ettorre GMb, Vennarecci Gb, Pugliese Pa a Service of Psychology, Regina Elena Cancer Institute, Rome, Italy; bDepartment of Surgery, Regina Elena Cancer Institute, Rome, Italy PURPOSE: A transplant is a complex psychological experience where psychophysical resources and external support are necessary for adaptation. In the present study, psychological data were prospectively collected for 125 patients waiting for a transplant and its variations. The aim of the study was to evaluate the effect of a liver transplant (OLT) on the Quality of Life (QoL) and psychological distress of patients at baseline and up to 1 year post transplant. METHODS: The stud was conduced with quantitative and qualitative methods. For the quantitative study the patients were assessed with HADs for anxiety and depression and SF-36 questionnaire for QoL. The qualitative evaluation used an interview aimed to better understand the meaning of the transplant, personal control, social support, cognitive response, self-perception, satisfaction with the information, needs, and future perspectives. RESULTS: At 1 year post-transplant the patients with high levels of anxiety and depression prior to transplant showed a worse psychological outcome while the other patients showed a significant improvement in QoL and in most psychological domains. Patient information needs, pointed out by interview, regarded future conditions and the explanation of examinations and treatments. CONCLUSIONS: The study underlines the baseline distress levels, a good QoL, external support and satisfaction with the received information are important elements of adaptation over time. The identification of patients t risk determines the proposal of transplant support groups with the main goal being to reduce psychological distress and to improve QoL.

Copyright # 2006 John Wiley & Sons, Ltd.

859 The Terminally Ill Patient: The Law in Israel Perry Sa, Steinberg Ab a Oncology, Davidoff Cancer Center, Beilinson Hospital, Petach-Tikva, Israel; bMedical Ethics Unit, Shaare Zedek Medical Center, Jerusalem, Israel Israel has become one of the first countries where a comprehensive management and approach to the terminally ill patients has been legalized. In December 2005 the Terminally Ill Patient Law was passed by the Israeli Parliament, and will be implemented as of December 2006. The Terminally Ill Patient Law is, undoubtedly, an important breakthrough in Israeli medical ethics and the philosophy of health and illness. The Terminally Ill Patient Law aim is to guiding the treatment of the terminally ill patient while balancing the norms and cultural values involved; the sanctity of life, quality of life, intractable pain and suffering, justice and autonomy. The law defines a set of ethical and legal norms that should guide the treatment of the dying patient. It refers to the competent patients and those who are not competent, to all kinds of treatment, advance directives, surrogate, and the statues of the caregivers, family, friends and professionals. Although the Law does not imply the act of euthanasia it recognizes the patients’ right to receive palliative care}easing symptoms and providing a more satisfactory quality of life to the very end of life.

860 Patient–Physician Paradigm: Individual Centered or Family Centered Perry Sa, Baider Lb a Institute of Oncology Davidoff Cancer Center, Beilinson Hospital Petach-Tikva, Israel; bSharett Institute of Oncology Hadassah Medical Center, Jerusalem, Israel PURPOSE: To challenge the patient-physician paradigm, and to show that from the initial health context of genetic counseling and prevention, to the terminal stage of the disease there is a continuum where the family should be considered as a necessary integral part of medical decision and treatment. METHOD: Theoretical research and conceptualization of the patient-physician paradigm. DISCUSSION: Medical care has evolved into an expression of individual rights in which privacy, informed consent and confidenti-

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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ality are the pivotal values. The patient-physician paradigm has been debated from the cultural perspective, especially in non-Western cultures, where families are highly integrated within the society and autonomy might be perceived as isolation. Extensive research in the field of psycho-oncology has revealed that cancer is indeed a ‘family affair’ and not just an individual illness. Furthermore, the unique social implications of hereditary breast/ovarian cancer and endof-life care have posed a new challenge to the patient-centered paradigm. Concerning genetic diseases, information affects not only the concerned patient but also other members of the family. In the case of terminal illness, family support is essential for the basic care of the patient. CONCLUSION: Our goal as psychooncologists should be to search for a more appropriate model of care that will respect universal values and cultural diversity, while simultaneously safeguarding the boundaries of individual and family bonds.

861 Pessimism, Depression, and Quality of Life in Breast Cancer Survivors Petersen LRa, Clark MMa, Kung Sa, Novotny Pb, Sloan JAb a Psychiatry & Psychology, Mayo Clinic, Rochester, USA; bBiostatistics, Mayo Clinic, Rochester, USA PURPOSE: Prior investigation suggests that attributional style and depression are related to general mental and physical health. Few studies have investigated these factors with breast cancer patients, and existing studies are limited by small sample sizes. This study examined the relationship between depression, pessimism, and quality of life (QOL) with breast cancer patients. METHODS: The study used an observational cohort design. Patients included 268 adult women with breast cancer who completed the Minnesota Multiphasic Personality Inventory (MMPI, on average, 10 years prior to diagnosis. They completed the Medical Outcome Study Short Form General Health Survey (SF-36 or SF-12), on average, eight years after diagnosis. MMPI scores were divided into quartiles, and t-tests were used to determine differences between groups on pessimism and depression for QOL measures and disease status. RESULTS: The mean age at diagnosis of was 63 years, and 95% had early stage (0, I, II) breast cancer. There were no significant differences in

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QOL scores by stage of disease. Patients with higher pessimism ðp ¼ 0:009Þ and depression scores ðp ¼ 0:000Þ were significantly lower on all mental health QOL scores. Pessimistic patients ðp ¼ 0:008Þ and patients exhibiting more depression ðp ¼ 0:090Þ also had lower social functioning scores. No association existed between the variables and physical health QOL scales or survival. CONCLUSION: Women with breast cancer exhibiting more pessimism or depression prior to diagnosis report poorer mental health QOL after diagnosis, compared to other breast cancer patients. ACKNOWLEDGMENTS: Saint Mary’s Hospital Sponsorship Board, Mayo Clinic.

862 Psychological Functioning in Persons Considering p53 Genetic Counseling and Testing for Li-Fraumeni Syndrome Peterson SKa, Pentz RDb, Blanco AMc, Ward PAd, Strong LCe a Behavioral Science, University of Texas, M.D. Anderson Cancer Center, Houston, USA; bWinship Cancer Institute, Emory University, Atlanta, GA, USA; cColorectal Cancer Prevention Program, University of California, San Francisco Comprehensive Cancer Center, San Francisco, USA; d Human and Molecular Genetics, Baylor College of Medicine, Houston, TX, USA; eClinical Cancer Genetics, University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA PURPOSE: Li-Fraumeni syndrome (LFS) is an inherited cancer syndrome that confers an increased risk for several primary cancers in both children and adults. Clinical genetic testing fordeleterious germline p53 gene mutations can identify most LFS families. Little is known about the psychological functioning of families considering p53 genetic testing. METHODS: We evaluated factors associated with cancer-specific distress and perceived self-efficacy in coping with a positive gene test result among persons who were at risk for carrying deleterious p53 mutations. RESULTS: 128 persons were invited to take part in a study that offered p53 genetic counseling and testing. Participants ðn ¼ 82Þ were more likely to be younger, be female and have experienced a first-degree relatives’ (FDRs) cancer death compared with non-participants ðn ¼ 46Þ: Participants completed psychological measures prior to counseling and testing. In multivariate analyses, greater cancer-specific distress was associated with lower

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quality of life, a higher perceived risk of carrying a p53 mutation, having no personal history of cancer and having a greater number of FDRs affected with cancer. Also, lower self-efficacy in coping with a positive test result was associated with greater cancer worries, higher decisional conflict about p53 testing, no personal history of cancer, and experiencing an FDR’s cancer death at a young age. CONCLUSIONS: Individual perceptions about cancer risk and p53 genetic testing, as well as personal experience with FDRs’ cancer diagnoses and deaths, should be addressed during the counseling and testing process for LFS families.

863 Sexual Dysfunction and Quality of Life after Treatment for Prostate Cancer. A Multidisciplinary Study Pietrangeli Aa, Pugliese Pb, Bonucci Ab, Barberis Fa, Sperduti Ic a Department of Neurology, Regina Elena Cancer Institute, Rome, Italy; bService of Psychology, Regina Elena Cancer Institute, Rome, Italy; c Biostatistical Unit, Regina Elena Cancer Institute, Rome, Italy PURPOSE: Improvements in the management of prostate cancer have increased the need to consider patients’ Quality of Life (QoL) and sexual dysfunction. For this complication, previous studies have reported rates ranging between 60% and 93% after radical prostatectomy and between 67% and 85% following external beam radiotherapy. The purpose of this study is to evaluate the impact of these treatments on QoL and sexual function through a multidisciplinary approach (neurophysiologist and psychologist). METHODS: 37 prostate cancer patients (mean age 61 years), submitted to radiotherapy or surgery, were studied before and after treatments every six months for two years. All the patients were evaluated with a neurophysiological test (sudomotor skin response) for the autonomic nervous system, with the ‘IIEF’ (International Index Erectile Function), with a semi-structured interview for the assessment of sexual function, with EORTC QLQ C-30 questionnaire for QoL and with HAD scale for anxiety and depression. RESULTS: Six months after medical treatment, 81% of patients showed erectile dysfunction, 81% showed a decrease of sexual enjoyment and 64% a decrease of frequency of intercourse. The

Copyright # 2006 John Wiley & Sons, Ltd.

sexual desire, the body image and the psychological distress showed no change over time. The worst QoL areas were the emotional and role functioning. CONCLUSIONS: During the cancer process both some QoL areas and sexual function worsened These results underline the need for rehabilitation to improve the well-being of prostate cancer patients.

864 Place, Function and Tasks of NGO’s in Psychooncological Support in Poland Pietrzyk AS Department of Oncology, Leszczynski’s Hospital, Katowice, Poland The purpose of my paper is presentation of the following considerations on: (1) the place and the function of NGO’s in Polish public oncological care}BEING BETWEEN PATIENTS AND STATE; (2) the methods of cooperation of NGO’s with Polish public oncological care}PROGRAM OF ACTIVE SUPPORT GROUP; SELF-HELP GROUP; PSYCHOSOCIAL REHABILITATION; (3) the possibilities of cooperation of volunteers with public oncological care}DISTRUSTFUL ALLIES OF PROPER AFFAIR. The main motive of my paper is to demonstrate the different possibilities of cooperation of NGOs with Polish public oncological care. For this moment, Polish public oncological system doesn’t take into account non-medical professional services.

865 Silesian Cancer League’s Psychosocial Rehabilitation Program for Patients and their Families Pietrzyk AS Department of Oncology, Leszczynski’s Hospital, Katowice, Poland Five modules of training compose the whole program. I. Education for patients and their families: (a) medical about disease and its treatment; (b) about diet in cancer; (c) about social services for patients and their families; (d) legal about patient’s rights at work and social services. II. Physiotherapy for patients. III. Artherapy. IV. Psychoeducation for patients’ families. V. Cognitive behaviour therapy for patients. Each module has its own theoretical background and the improvement of quality of life of patients and their families is the common goal of the whole program. The quantity and the dynamics of group

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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meetings depend of physical and psychic condition of patients or time possibilities of their families. The psychologist, the lawyer, the physiotherapist and the artist of University of Silesia supervise this program.

866 Anxiety and Depression at the Point of Cancer Diagnosis and Its Relationship to Coping Pikunas JDKAa, Springer Cb a Private Practice, Honolulu, USA; bOncology, Windsor Regional Cancer Centre, Windsor, Ontario Canada PURPOSE: The purpose of this study was to examine the relationship between anxiety/depression and the number of coping-related difficulties experienced by women awaiting diagnosis regarding breast cancer, upon their first visit to the cancer centre. METHOD: Anxiety and depression were measured using a 14-item self-administered scale (Snaith and Zigmond, 1983) and coping difficulties via 10 nurse- and oncologist-administered, close-ended (yes/no) questions formulated by the Radiation Program Group at the cancer centre. Forty-four women participated, 38 completing both instrumens. RESULTS: Based on their responses, 58.9 and 15.8% were at-risk for clinical anxiety and depression, respectively. A product moment correlational analysis revealed that both anxiety and depression were significantly related to coping concerns, such that greater anxiety and depression were associated with more problems coping. The most prevalent difficulty was to find oneself worrying or feeling hopeless (63%). Further, when the experiences of patients awaiting diagnosis regarding breast cancer, lung cancer and prostate cancer were compared, an analysis of variance revealed that type of diagnosis did affect the amount of depression experienced; however, the result did not reach statistical significance. CONCLUSIONS: Brief screening at the particularly stressful point of diagnosis, followed by a clinical interview and psychosocial intervention, has a preventive function and helps ensure continuity of care. A 10-year follow-up study is being conducted to explore the impact of anxiety and depression on longevity.

867 Role of Psychologists in Cancer Screening Programmes Guarino A. Serantoni G. Federici A

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School of Psychology, University of Rome ‘La Sapienza’, Rome, Italy Cancer Screening Programmes are essential levels of organized care with complex welfare profiles. At present, there are three Screening Programmes of proven effectiveness in Italy: breast cancer screening, cervical cancer screening, colorectal cancer screening; these ones draw mostly healthy people, in their age of highest risk of oncologic disease incidence. The professional contribution of Psychology is essential in each stage of the screening’s development, since the beginning. The Psychologist participates to the coordination of the screening Programmes and contributes to the interdisciplinary planning of the development of this kind of Programmes, characterizing psychological needs in every stage of this planning. He applies Community Psychology and Health Psychology models for analysing the social contexts of the target-territory, with the aim to improve the adherence and the local attendance. He contributes to the planning of both informative campaigns on mass media and writing the call letters for the first and second level screening. He develops and applies, with Social Psychology’s models, techniques of Empowerment for fostering aware adherence to the Programmes and suggests methodologies for reducing the stressful impact of screening’s attendance and for the improvement of quality of communication also through the training of health workers about communication techniques and listening, from first reception to following call-backs. He applies: ‘role playing’ techniques for training the medical staff about communication of diagnosis and Clinical Psychology’s models for supporting patients from diagnostic doubt through the oncologic treatment course (with possible psychotherapies) and Work Psychology’s models for preventing and managing the health workers’ burn-out.

868 ‘I Can’t Remember Anything’. An Anthropological Study of Loss of Memory in the Case of Cancer Hansen HP Institute of Public Health, University of Southern Denmark, Odense, Denmark This presentation is based on a research project about Danish women, cancer and rehabilitation. PURPOSE: The overall purpose of the study was to examine how women treated for cancer

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experienced courses of cancer rehabilitation. The purpose of the part of the study presented here was to explore women’s experiences with loss of memory in relation to chemotherapy. METHODS: This part of the study was based on an ethnographic fieldwork with participant-observation and ethnographic interviews among women joining residential cancer rehabilitation week-long courses at different locations in Denmark. In total 40 women joined the three investigated courses and 24 women were interviewed at home after the end of the course. RESULTS: (1) The women experienced loss of memory and concentration in relation to resuming their daily work and have to perform multiple tasks at the same time. They interpreted loss of memory as a side-effect of the chemotherapy treatment reproducing a part of the dominant health discourse, where loss of memory is understood as cognitive impairment. (2) The women showed through their stories of illness experiences that they remembered quite well and with a lot of details about bodily feelings, emotional matters connected to the discovery of the disease, the investigations and the different kinds of treatment}they just remembered something else, than they thought they should remember. CONCLUSIONS: Women experiencing a severe disease as cancer concentrate a great deal of their attention on their body, forgetting acts and experiences outside their own living body.

869 Cognitive and Psychological Disorders at Different Ages in Brain Tumors Children and Adolescent Poggi G, Liscio M, Galbiati S, Adduci A, Pastore V Acquired Brain Disorders Unit, IRCCS E. Medea Bosisio Parini, Lecco, Italy PURPOSE: Cognitive and psychological disorders are among the most frequently observed sequelae in brain tumor survivors. The goal of this work was to verify the presence of these disorders in a group of children and adolescents diagnosed with brain tumor before age 18 years, differentiate these disorders according to age of assessment, identify correlations between the two types of impairments and define possible associations between these impairments and clinical variables. METHODS: The study involved 76 patients diagnosed with brain tumor before age 18 years. Three age groups were formed, and all the patients received a standardized battery of age-matched cognitive

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and psychological tests. The following scales were administered: Child Behavior Checklist and Vineland Adaptive Scale. RESULTS: According to our findings, all three groups present with cognitive and psychological-behavioral disorders. Their frequency varies according to age of onset and is strongly associated to time since diagnosis. The Performance Intelligence Quotient (PIQ) was more impaired than the Verbal Intelligence Quotient (VIQ). Internalizing problems, Withdrawal and Social problems were the most frequent psychological disorders. Correlations were found between cognitive impairment and the onset of the main psychological and behavioral disorders. CONCLUSIONS: These findings are relevant as they point out the long-term outcome of brain tumor survivors. Hence, the recommendation to diversify psychological interventions and rehabilitation plans according to the patients’ age.

870 Individual Meaning-Centered Psychotherapy in Advanced Cancer: A Focus on Meaning and Legacy Poppito SR, Abbey J, Cassileth B, Rosenfeld B, Breitbart W Department of Psychiatry & Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, USA PURPOSE: The goal of this pilot study was to investigate the impact of Individual MeaningCentered Psychotherapy (IMCP) on spiritual wellbeing, psychological distress, and quality of life in advanced stage cancer patients. METHOD: Patients with advanced stage cancer were recruited from the ambulatory care facilities of Memorial Sloan-Kettering Cancer Center between July 2004 and May 2006. Patients were randomized to seven (50-minute) sessions of either Therapeutic Massage or Individual Meaning}Centered Psychotherapy, a novel psycho-educational intervention based on Viktor Frankl’s existential work. All participants were administered (baseline, posttreatment and 2 month follow-up) evaluations measuring spiritual well being (SWBS), psychological distress (HADS), hopelessness (BHS), physical symptom severity and distress (MSAS), quality of life (MQOL), and perceived social support (FSSQ). Patients enrolled in IMCP were taught basic sources of meaning, which would help them find, maintain and enhance meaning in life. Patients were also given the opportunity to engage

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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in legacy projects to creatively explore personal sources of meaning. RESULTS: Patients receiving IMCP revealed impressively large effect sizes for improvement in spiritual well-being, end-of-life despair (hopelessness, depression and anxiety), quality of life, and symptom distress. These improvements were reported at post-treatment and two-month follow up assessment periods; particularly in the areas of overall spiritual well being, meaning, depression, quality of life and symptom distress. This presentation will focus on qualitative therapeutic aspects of IMCP, focusing on cancer patients’ sources of meaning and their legacy projects. FUNDING SOURCE: The Kohlberg foundation.

871 Existential Issues in Pain and Palliative Care: A Monthly Lecture Series for Palliative Care Clinical Fellows Poppito SRa, Coyle Nb, Obbens Eb a Psychiatry & Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, USA; b Pain & Palliative Care, Memorial Sloan-Kettering Cancer Center, New York, USA PURPOSE: This presentation will focus on the development of a psycho-educational mini-course, entitled ‘Existential Issues in Pain & Palliative Care,’ specifically designed for Pain & Palliative Care clinical fellows at Memorial Sloan-Kettering Cancer Center. This monthly lecture series was created to offer clinical fellows an opportunity to learn about existential issues that arise in pain management and end-of-life care, and to offer a supportive environment to share difficult patient cases and concerns. METHOD: A psychologist, who is well-trained in existential psychology and psycho-oncology, developed this mini-course to provide knowledge and support for palliative care fellows to enhance their end-of-life training and clinical work. The four main goals for this lecture series were to (1) help fellows identify specific existential issues (e.g. existential pain, angst, guilt) that may arise in their interactions with patients and families, (2) examine a patient case presentation in light of specific existential themes, (3) evaluate potential transferential and countertransferential responses that may arise in patient encounters, and (4) explore personal and professional concerns through supportive discussion around difficult patient cases. RESULTS: To

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date, 12 lectures have been developed and offered to Pain & Palliative Care fellows over the last year. Lectures, such as those exploring existential suffering, death anxiety/denial, transitional presence, and meaning and dignity in end-of-life care, have been well-attended and supported by the clinical fellows. This presentation will offer an overview of the mini-course, and fellows’ feedback in response to it.

872 Adolescents’ Lives in Families where a Parent is Diagnosed with Cancer Poulsen R, Friis-Andersen K Cancer Councelling Office, Hillerød Danish Cancer Society, Hillerød, Denmark QUESTIONS IN THE STUDY: (1) How does the cancer illness influence the life of the young relatives? (2) How does social support (i.e. emotional, tangible informative and network support) from close relations during illness period help the youngsters? (3) Who ARE their important relations? RESULTS HAVING INFLUENCED OUR COUNCELLING IN 2005–2006: (1) The younger (13–15 years old) seem to postpone the normal individuation process because of their dependence of parents. Relationships with peers are important in terms of recreation activities and amusements. Parents are most important relations. (2) The older (16–20) seem to forge into adulthood, making them feel grown-up earlier than peers. Relationships with peers are of the utmost importance in terms of closeness, intimacy and confidence. (3) The resiliency is present in everyone asked. ‘I feel stronger and more mature now’}in spite of the serious emotional strain. (4) Need of more instrumental support (i.e. materiel or tangible support as being taken on picnics or given small gifts). Almost none is received from family and friends. NEW INTERVENTIONS: (1) For children under 15: More family-meetings, in order to implicate more instrumental support. Pointing out a ‘stop-gap-parent’ for each child during the illness period (and to continue during possible mourning periods). Grief-groups and psychoeducating parents-groups. (2) For youngsters more than 15: Counselling grief-groups (without having to enroll), where a friend or a boy(girl)friend can participate. The youngsters put up items to discussion on every meeting.

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873 Evolution of Psychological Distress Among French Canadian Women Who Undergo Brca1/2 Genetic Testing Power TEa, Dorval Mb, Maunsell Eb, Dugas Mc, Patenaude AFd a Psychosocial Resources, Tom Baker Cancer Centre, Calgary, Canada; bUnite de Recherche en Sante des Populations, Centre de Recherche Centre Hospitalier Affilie Universitaire de Quebec, Quebec City, Canada; cDepartment of Psychology, Concordia University, Montreal, Canada; dDanaFarber Cancer Institute, Children’s Hospital, and Harvard Medical School, Boston, USA Little is known about how having had cancer influences psychological adjustment to BRCA1/2 test results or about the evolution of distress related to BRCA1/2 testing. We studied this in 449 French Canadian women who underwent BRCA1/2 testing. Questionnaires completed at pre-test genetic counseling, and again at one and 12 months post-disclosure were used to assess general distress (Psychiatric Symptom Index) and cancer-specific distress (Impact of Event Scale). Ninety-six women were found to be carriers of the mutation, 128 were non-carriers, and 225 had inconclusive results. Overall, 35% had high levels of general distress at pre-test, which is a significantly higher proportion than that among similarly-aged Quebec women (24%; p50.0001). Among carriers who had had cancer, the proportion with high distress significantly increased from pre-test (31%) to 1-year (44%; p ¼ 0:03). In the other study groups, proportions of women with high general distress remained constant over time. Cancer-specific distress significantly decreased in non-carriers with no cancer history (p50.002), but did not change among carriers. Our findings suggest that BRCA1/2 testing does not increase cancer-specific distress and may increase general distress in one group, supporting the view that BRCA1/2testing in high-risk populations has limited negative psychological effects. Scarce psychosocial resources may be targeted towards carriers who have also had cancer, who may underestimate the emotional impact of disclosure of a positive result (Dorval et al. JCO, 2000).

874 Destructive Socio-economics of Tobacco Use: High Price Paid by Developing Nations

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Pramod DSa, Vaishali PSb, Nirmal ARc a Community Cancer Care Health Alert Organsiation of India [NGO], Dhule, India; bNGO Volunteer Health Alert Organsiation of India [NGO], Dhule, India; cMedicine Health Alert Organsiation of India [NGO], Dhule, India OBJECTIVES: Since past decade pressure on Tobacco industry about health hazards of tobacco-products. Many studies done on tobacco related health-hazards but limited data in Asia. In terms of cost Asian region has paid highest price. This project analyses socio-economics of Tobacco-use. METHODS: Health disorders and mortality due to cardio-pulmonary manifestations of chronic tobacco use are of serious concern. morbidity rate increased 4.3% aggregate per annum. Data collected-analysed for assessment of economic impact by actual price per annum, expenditure on tobacco-induced health injury and passive smoking hazards, cost for tobaccode-addiction programme. These clubbed to asses impact on GDP and social life of tobacco addicts. Target was Rural/tribal tobacco consumers divided 11 groups on economic/social/cultural and ethnic background. RESULTS: Tobacco consumption in rural areas 78%. 68% males [22–35 years], 20% males [35–50 years] and 11.3% females. 8.7% in health care workers. 77% using smoking, 26% are tobacco chewers [available as Ghutka & Paan]. Among smokers 77% cigarettesmokers while 23% BIDI-smokers. CONCLUSION: Cardio-pulmonary complications of tobacco 78%, 20% psychological disorders, 15% nutritional deficiencies. Among chronic users [Age group 22–35 years], 26% did report sexual impotence. Cost calculations show expenditure of Rs 17 690 per annum for smokers and Rs10 500 per annum for tobacco chewers. Loss of life due to early deathis 1–4 years [average Asian life expectancy 55 years]. This is threatening to grow at 5.2%. Evaluate socio-economic destruction of tobacco use in resource-poor-nations.

875 Personality, Illness Perception and Adjustment to Cancer: A Comparative Study Pucheu Sa, Consoli SMa, Landi Bb, Lecomte Tb a C-L Psychiatry European Georges Pompidou Hospital, AP-HP, Paris-5 University of Medicine, Paris, France; bHepato-Gastro-Enterology European Georges Pompidou Hospital, AP-HP, Paris-5 University of Medicine, Paris, France

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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PURPOSE: To evaluate illness perception and adjustment to illness in cancer patients compared with other severe or life-threatening diseases and to study the moderating role of sociodemographic variables, severity of the disease, and personality traits on the quality of adjustment. METHODS: 40 patients (64% males) followed up for a colon cancer were compared with 35 type 1 diabetics, 37 congestive heart failure patients and 33 non diabetic haemodialysis patients. Groups were matched according to three stages of disease severity. Patients completed the IPQ-R, the PAIS-SR and the NEO-PI-R for respectively assessing illness perception, adjustment to illness and personality. RESULTS: After controlling for gender, age, educational level and disease severity, several components of illness perception were found satisfying or slighter in cancer patients, compared with the other groups: illness identity (or burden of symptoms), time cyclical, chronicity, consequences, treatment and personal control, emotional impact. After the same confounding variables were controlled for, adjustment to illness differed from one disease to another, looking more efficient in cancer patients and diabetics (p50.001). Neuroticism score (NEO-PI-R) was correlated with PAIS-SR (r ¼ 0:42; p50.001). After controlling for neuroticism, adjustment to illness still remained better in cancer compared with haemodialysis patients (p50.001). Several illness perception components were associated with adjustment to cancer. CONCLUSION: These paradoxical results can be interpret considering that for some patients colon cancer constitutes a less chronic and less disabling disease than the other diseases here studied, and keeping in mind the adaptive role of denial in this area.

876 Does Alexithymia Moderate Adjustment to Cancer? A Comparative Study Pucheu S, Consoli SM C-L Psychiatry European Georges Pompidou Hospital, AP-HP, Paris-5 University of Medicine, Paris, France PURPOSE: To compare alexithymia prevalence in different medical conditions and to search for its potential adaptive effect on adjustment to illness in patients suffering from more severe forms of disease. METHODS: 40 patients (64% males) followed up for a colon cancer were compared with 35 type 1 diabetics, 37 congestive heart failure

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patients and 33 non diabetic haemodialysis patients. Groups were matched according to three stages of disease severity. Patients filled out the TAS and the PAIS-SR for respectively assessing alexithymia and adjustment to illness. RESULTS: Only 18.4% of cancer patients could be considered as alexithymic (TAS>55), compared with 31.4% of diabetics, 37.1% of heart-failure and 41.9% of haemodialysis patients, with no significant difference between pathologies, neither association between alexithymia and severity of disease. After controlling for gender, age, educational level and disease severity, adjustment to illness differed between clinical groups (p50.001), with less difficulties in colon cancer patients and diabetics, and was poorer in alexithymic patients, whatever the disease (p50.01). Our hypothesis of a moderating role of alexithymia in the more severe cases was only confirmed within the diabetic population (less difficulties when the disease was severe; p ¼ 0:03). CONCLUSION: The prevalence of alexithymia in our colon cancer population was similar to data found in general populations (8– 15%). Alexithymia was associated with a poorer adjustment to illness, excepted for diabetics suffering from a severe disease. The low levels of alexithymia in our cancer population could partially account for such a negative result.

877 The Integration of the Psychologist Within a Core Multidisciplinary Team for the Oncological Care Pugliese P, Perrone M, Condoleo MF, Falcicchio C, Maggi G Service of Psychology, Regina Elena Cancer Institute, Rome, Italy In 2005, our Institute set up the Disease Management Team (DMT) which work in the clinical and research process for the best cancer care. PURPOSE: To describe a new strategy centred on the regular integration of the psychologist within the breast, colorectal and ovarian DMT aimed to favour prevention, cure and rehabilitation intervention for psychosocial morbidity. METHODS: In the pre-operative phase, the psychologist interviews the patient, assesses anxiety and depression levels and Quality of Life, contains the disease and medical treatment anxieties and favours the elaboration of information. For the patients at risk, the psychologist suggests a structured interview and a brief crisis intervention. In the DMT weekly meeting the assessment of the psychosocial

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variables is constantly reported and shared with oncologists. This confrontation allows for a continual understanding of the patient’s clinical and psychological situation so assuring a better clinical management. During the Medical Treatment phase, the multidisciplinary interventions are proposed with the aim of assessing and improving the psychological and medical sequelae. In the Follow-up phase, the presence of unsolved emotional problems determines the proposal of structured individual, group or couple interventions. RESULTS: This new approach shows a high level of patient satisfaction, an increase in health professionals’ awareness as regards some neglected issues such as sexual activity, fatigue, fertility and menopause, an improvement of physician-patient relationship and communication and an increase of research centred on psychosocial aspects. CONCLUSION: These results have led to the need to prepare psychological guidelines in conjunction with medical guidelines.

878 Impact of Surgery and Adjuvant Treatment on the Quality of Life of Women with Breast Carcinoma: A Prospective Study Pugliese Pa, Fabi Ab, Maggi Ga, Falcicchio Ca, Cognetti Fb a Service of Psychology, Regina Elena Cancer Institute, Rome, Italy; bDivision of Medical Oncology, Regina Elena Cancer Institute, Rome, Italy PURPOSE: To evaluate prospectively and simultaneously the impact of surgery and medical treatment (radiotherapy, chemotherapy, hormonal therapy) on breast cancer patients Quality of Life (QoL). METHODS: QoL was assesed with EORTC QLQ C30 questionnaire and QLQ BR 23 module, the psychological distress with HAD scale, the sexual function and the psychosocial variables with a structured interview, before and after surgery, after chemotherapy, after hormone therapy and 18 months after the end of medical treatment. RESULTS: Over time, the whole sample reported improvement in body image, future perspectives and global QoL (p5 0.01). Both cancer diagnosis and all medical treatment showed a negative effect on sexual function (sexual desire, sexual enjoyment, sexual satisfaction, frequency of intercourse), while no effect was observed in the couple relationship. In the period closer to surgery women with mastectomy and reconstruction showed a worse body image and

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sexual functioning compared to women submitted to lumpectomy. By 6 months after surgery, the two groups reported similar QoL scores. In women submitted to hormonal therapy the results showed a worse sexual functioning, more side effects and better emotional functioning. CONCLUSION: Women with breast carcinoma could experience a range of adjustment problems at various points in the different phases of the disease. Interventions that would help reduce the negative impact of treatment on QoL need to be designed and integrated into routine clinical practice.

879 A Longitudinal Evaluation of the Impact of Chemotherapy on Cognitive Functioning in French–Canadian Women Treated for Non-metastatic Breast Cancer Quesnel Ca,b, Savard Ja,b, Ivers Ha,b, Godbout Lc, Robert Jd a ´ Ecole de Psychologie, Universite´ Laval, Que´bec, Canada; bCentre de recherche en cance´rologie de l’Universite´ Laval, L’Hoˆtel-Dieu de Que´bec, Que´bec, Canada; cDe´partement de Psychologie, Universite´ du Que´bec a` Trois-Rivie`res, Trois-Rivie`res, Canada; dCentre des maladies du sein DescheˆnesFabia, Hoˆpital du Saint-Sacrement, Que´bec, Canada Cross-sectional studies that have evaluated the relationship between chemotherapy for breast cancer and cognitive functioning have revealed that patients treated with chemotherapy have impaired performances on neuropsychological tests, as compare to those treated without chemotherapy or to healthy controls. However, participants of these studies were evaluated on only one occasion several months following the end of treatment. This prospective study aimed at assessing the impact of chemotherapy on cognitive functioning in French-Canadian women treated for non-metastatic breast cancer. A total of 41 patients receiving a combination of chemotherapy and radiotherapy and 40 patients treated with radiotherapy only were evaluated at pretreatment, post treatment and 3-month follow-up evaluations. Study measures included a comprehensive battery of neuropsychological tests and a selfreport scale of cognitive function (Broadbent Cognitive Failures Questionnaire). A mixed model covariance analysis for repeated measures and partial canonical correlations revealed that the only significant between-group difference in neuro-

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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psychological performance was on the number of words generated during a test of verbal fluency. Specifically, only patients who had received chemotherapy generated significantly less words following cancer treatment. However, no significant association was found between the subjective report of cognitive functioning and results obtained on neuropsychological tests. Overall, results of this study suggest that chemotherapy has a specific negative impact on verbal evocation capacities and that a greater emphasis on this cognitive function in self-report questionnaires might improve consistency between subjective and objective measures of cognitive functioning in breast cancer patients.

880 Project Open Channel Zemel GS, Diz MDPE Oncology, Department of the Radiology Institute, Hospital das Clı´nicas, of the Medicine College of the University of Sa˜o Paulo, Sa˜o Paulo, Brazil INTRODUCTION: Issues related to the shock of diagnosis and unavoidable of death may deeply affect the medical staff at the Oncology Clinic, especially during their training period. Objective: Provide a discussion forum with the oncology residents (OR) to improve the patient-doctor relationship, humanize the service and facilitate the interchange of daily anxieties and stress factors. METHODS: All OR along with the chief resident were invited to participate. Six monthly one-hour meetings oriented by the psychologist in charge were held. Topics discussed were: patientdoctor communication, impact of diagnosis, death and dying, and depression. Participants evaluated the activity by a questionnaire. RESULTS: Of the six planned-to-be meetings, only 4 actually took place. Of the 6 OR invited, one never participated. Attendance was 5 participants in the first meeting and 4 in the others. The evaluation questionnaire showed that the participants considered the topics to be interesting, useful and relevant. They pointed out that the project contributed to their medical practice, since it favored the exchange of experiences, better acquaintance among them, as well as it prepared them more effectively to cope with the daily routine and provided the opportunity for them to self-evaluate their response to the circumstances in question. CONCLUSION: Despite the short period of the implementation of the project we presume that it effectively contributed

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to lower the anxiety and stress of the oncology residents. Instruments to evaluate the impact of the attitude adopted in the patient-doctor relationship still must be implemented.

881 Cancer and the Media Zanon CCS, Souza GCF, Santiago CEG, Lima CSP Department of Internal Medicine, State University of Campinas, Campinas, Brazil INTRODUCTION: The cancer is the second cause of death world-wide. The patients with cancer present great anxiety associated with this pathology to the death. Given the ignorance of the great majority of the population to the causes of the cancer, many negative aspects are associated with carriers. Additionally, the media explores the illness as being an attribute of emotional origin, typically feminine. The collateral effect of the illness treatment, such as the alopecia, widely is divulged and used in prevention campaigns. OBJECTIVE: Due to the fancies presented by the cancer patients in relation to the illness, the objective of this work is to research as the different media types influence the population with messages of pessimism about the cancer. METHODS: A set of images was sampled from media (e.g. television, movies, internet, among others) with great penetration in the Brazilian and global population. RESULTS: As result of this research some stereotypes related to cancer were identified, such as: the feminine association with the illness; its negative exploration, death and suffering. The feminine image is displayed as devoid and fragile. The media relates the cancer to some types of people, such as the sufferers, the losers, the depressive and those who do not live healthfully. The vulnerability of the human being is evidenced. The patients demonstrate guilt feeling knowing that they are cancer carriers. Positive images on patient’s victories against the cancer are rarely divulged. CONCLUSIONS: The media portrays the negative side of the illness preferentially, and usually associates cancer with the feminine image.

882 Caregivers Burden in Oncology: Results from an Open Study on 79 Cases Treated with Psychological Support Racalbuto SS, Berra C, Torta R

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Psychoncology Unit, University of Turin, Turin, Italy PURPOSE. Most of the literature on caregivers is focused on Alzheimer. Little is known about cancer patients caregivers. The aim of this study is to evaluate the psychological distress of cancer caregivers and assess the usefulness of a psychological support. METHODS. We studied 79 oncological patients’ caregivers, afferent to the Psychoncological Unit between January-December 2005, treated with psychological support (8 session), focused on their psychological distress. The Beck Depression Inventory, State-Trait Anxiety Inventory, and Caregiver Burden Inventory were administered before and after the treatment. RESULTS. The sample was mainly composed by children (46.8%) and partners (38%) of cancer patients; at baseline BDI showed mild levels of depression (mean score 14.8  7.7) STAI-Y1 and Y2 no state and trait anxiety, respectively 29.95  5.39 and 30.61  5.08. This population had also a high level of burnout, measured by CBI (0.87). After treatment, levels of depression decreased (mean BDI: 7.6  2.8), though without statistical significance. On the contrary, global caregiver burden (p50.001), and the sub-items of time dependence (p50.05), developmental (p50.001), physical (p50.05), and emotional burden (p50.001) significantly improved. CONCLUSIONS. Time dependence, developmental and physical burdens are the main contributors to caregivers burden, and are related to mild depressive symptoms. Psychological support, focused on gaining consciousness of the taking care management, and on the importance of accepting assistance in this task, could help to improve the caregivers’; burden.

883 Rural Oncology Social Work Randall H Angelina Radiation Oncology Associates, Martinsville, USA While incidence rates of cancer are similar in both rural and urban areas, health care services are often limited or not available in rural communities. Rural cancer patients are often faced with barriers such as, lack of transportation, healthcare professionals, and specialized treatment options. The Social Worker role of advocate is vital to addressing these issues faced by rural oncology

Copyright # 2006 John Wiley & Sons, Ltd.

populations. This presentation will define rurality and advanced rural generalist practice. In addition, the specialized skills of social workers to collaborate and network to meet complex rural oncology needs will be addressed through case examples. Interventions will be highlighted that involve multiple levels and use of formal and informal networking to include issues related to uninsured patients, access to treatment, transportation to treatment, emotional support issues and financial obstacles.

884 Social work Students}a Rural Innovative Practice Solution? Randall Ha, Csikai Eb a Angelina Radiation Oncology Associates, Martinsville, USA; bSocial Work University of Alabama, Alabama, USA The use of social work students can be an innovative practice solution, particularly in rural areas where oncology social workers are lone practitioners. As social workers we often wish we had more time to spend on multiple levels of practice to impact greater numbers of people. Social work students can assist us to develop innovative solutions to problems we identify in our practices, but do not necessarily have time to tackle. We may also want to research a problem we have identified, again with no time for this type of practice, students can fill this gap. It is also part of our professional responsibility to train the next generation of oncology social workers. One must be familiar with the educational needs of students, university requirements and your agency’s needs to ensure an effective, mutually beneficial relationship. In order to develop a good practicum site, implementing a plan that will meet students educational objectives, as well as, meeting your agency’s needs is imperative. We will review practice examples of students working with individuals, families, groups, communities and organizations. We have had students many years and have a system in place which may be beneficial to other social workers who have contemplated having students or who are new as field instructors. We will also leave participants with tools to implement an oncology social work practicum site. Examples of a student orientation manual, orientation checklist, learning contracts, agency visit checklist, and evaluation of your agency as a practicum site will be provided. Comments: We

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have a second presenter, Kelli Bass, LCSW, OSWC, P.O. Box 632452, Nacogdoches, Texas 75963, 936-634-2940; [email protected]; American Cancer Society. Csikai EL, Bass K. 2000. Health care social workers’ views of ethical issues, practice, and policy in end of life care. Social Work Health Care 32 (2): 1–22.

885 A Strategic Approach to Psycho-Oncology in Australia}The Cancer Institute NSW Rankin NMa, Mason Cb, Butow PNc, Bishop Ja a Cancer Services & Education Cancer Institute, NSW, Sydney, Australia; bSydney West Cancer Network, Westmead Hospital, Westmead, Australia; cMedical Psychology Research Unit, University of Sydney, Sydney, Australia Each year, over 32 000 new cases of cancer are diagnosed in New South Wales (NSW), Australia’s most populated state. The Cancer Institute NSW (‘the Institute’) is Australia’s first government-funded state based cancer control organisation. The Institute has dedicated over $2.5million to build capacity in psychosocial clinical services and research and to implement evidence into practice. Clinical initiatives include funding 28 nw positions for clinical psychologists and social workers. Many positions are located in regional and rural areas and will substantially increase psychosocial services. The Psycho-oncology Clinical Fellowship Program has resulted in five Fellows who engage in dual roles as researchers and clinicians. The Institute commenced work by establishing a working party and conducting a review of psycho-oncology services in NSW. The review gathered baseline data about gaps in current service delivery. Seventy oncology health professionals from 26 cancer services participated. Results and recommendations will be reported. Psycho-oncology research is being support through academic scholarships and an infrastructure grant that established the Psycho-oncology Cooperative Research Group (PoCoG). PoCoG seeks to foster research collaborations and develop large-scale multi-centre psychosocial studies of clinical relevance and significance. The Group has successfully gained a grant to systematically identify the needs of culturally and linguistically diverse populations in Australia. The challenges of developing a strategic, state-wide approach to developing psycho-oncology capacity will be considered. These initiatives are greatly contribut-

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ing to building multidisciplinary approaches to coordinated care for cancer patients, their families and carers.

886 Sundowning in Cancer Patients Rashid Aa, Baile Wb a Psychiatry, UT M.D. Anderson Cancer Center, Houston, USA; bPsychiatry, UT M.D. Anderson Cancer Center, Houston, USA Sundowning is the name given to a constellation of behavioral and neuropsychiatric symptoms characterized by confusion and often agitation occurring in the late afternoon and early evening. Cancer patients are particularly predisposed to this problem because of the age at the onset of cancer and. the presence of co-morbid illnesses. Cancer chemotherapy and multiple other medications that are taken make them more vulnerable to develop sundowning. Sundowning has often been treated as an independent clinical syndrome caused by the loss of visual cues at darkness. Sundowning is actually a form of delirium, which is, associated with changes in the physiology and availability of melatonin and other biochemical mediators of brain function. It is also influenced by the disturbances in the circadian rhythm and changes in hepatic and renal metabolism and other physiological processes occurring at night. Studies have shown that melatonin plays a role in sundowning and it has direct relationship with the immune system and acts as oncostatic factor. In this paper we will review the prevalence of sundowning and discuss its risk factors and neurobiology with particular emphasis on the circadian rhythm in cancer patients. We will also review the treatment options for improving and treating behavioral and neuropsychiatric symptoms of sundowning.

887 The Perception of Time}Cancer Survivors Experiences in Everyday Life Rasmussen DMa, Elverdam Bb a Research Unit of General Practice, Institute of Public Health, University of Southern Denmark Odense, Denmark; bReasearch Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark PURPOSE: Life after cancer: time disruption and time appropriation. Methods: Fieldwork:

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participant observation and ethnographic interviews. Fieldwork (9 weeks) at a Cancer Rehabilitation Centre in Denmark. Of 150 participants at the centre 23 informants}10 men and 13 women were interviewed twice, two weeks after their stay and 18 months later. The informants were adults, who had experienced different forms of cancer. Interviews lasted for 1–3 hours, were audio-taped and transcribed verbatim. Data were analysed from a phenomenological and culture analytical perspective. NVivo was used for data-handling. RESULTS: Surviving cancer means that time becomes essential for everyday life: survivors talk about time and reflect on it. Time can be measured, but the experience of living time cannot. An analysis of time has to focus on the way the concept of time enters everyday discourse of the survivors and how they handle time in their lives. Cancer survivors experience the diagnosis of cancer as a disruption of time and life. The future becomes unreal and the present becomes essential. The further away from the diagnosis and treatment the survivors come, the more they are able to relate to the future and make plans for it. The disruption of time created by the cancer diagnosis makes them re-evaluate life and reorganise it. They prioritize how they want to spend their time and with whom they want to spend it. CONCLUSION: Cancer disrupts time and life, but gives cancer survivors the incentive to appropriate time.

888 Emotional Impact of the Positron Emission Tomography (PET) and Comprehension of Information: A Study Control Among 30 Cancer Patients Montreuil Ea, Reich Mb, Christophe Vc, Fournier Cd, Gauthier He, Carpenter P a Oncology Department, Hoˆpital Duchenne, Boulogne sur Mer, France; bUnit of Psycho-Oncology, Centre Oscar Lambret, Lille, France; cUPRES URECA EA 1059, University of Lille 3, Villeneuve d’Ascq, France; dMedical Information Department, Centre Oscar Lambret, Lille, France; eNuclear Medicine Department, Centre Oscar Lambret, Lille, France PURPOSE: The aim of this study was first to assess anxiety felt by patients exposed to the PET, and the comprehension of the methods and objectives of the examination. Secondly if the contribution of information on the unfolding and the object of this examination had an effect on the anxiety felt by patients before and after the PET.

Copyright # 2006 John Wiley & Sons, Ltd.

METHODS: This study was conducted among 30 cancer patients. They filled out the same questionnaire four times: (1) the receipt day of the convocation for the PET, (2) the examination day, (3) during the consultation of the results notification, and (4) 15 days later. In addition to general information, these questionnaires dealt with the level of anxiety (STAI}Spielberger) and the general comprehension of the methods and objectives of the PET. RESULTS: Globally, we note that patients have anxiety level pretty raised (p ¼ 0:0004), and this, whatever the moment of the fill in of the inventory. ANOVA results reveal moreover an effect of the moment of the fill in of the test (p50.001). Though the majority of patients estimate to have received sufficient information on this examination, the right answer score to the inventory of knowledge seems to moderate this assertion. CONCLUSION: Understand the anxiety impact of the PET makes it possible to try to cure it in order to improve the experience of the making of the examination. The problem of the comprehension of some information highlights the necessity to adapt the transmitted information to patients.

889 Quality of Life, Marital Status and Sexuality Among Women with Breast Cancer Dupont Aa, Reich Mb, Antoine Pa, Sedda ALb, Beve Cc a Psychology Department, Universite´ Lille 3, Villeneuve d’Ascq France; bPsycho-Oncology Team, Centre Oscar Lambret, Lille, France; cPalliative Care Unit, Hoˆpital Duchenne Boulogne sur Mer, France PURPOSE: Aims of this study were: evaluate the impact of breast surgery (lumpectomy or mastectomy) on quality of life, marital status and sexual life for primary breast cancer and treated by adjuvant chemotherapy. Study the impact of hormonotherapy on quality of life, marital and sexual life of women with breast cancer in a remission status. METHODS: The sample consisted of 72 women; mean age 47 (r22–67): 24 with lumpectomy, 15 with mastectomy, 15 with hormonotherapy, 18 without hormonotherapy. Questionnaires used were the Functional Assessment of Cancer Therapy-Endocrine Scale and the Relationship and Sexual Scale. RESULTS: Generally, we found no significant differences in terms of quality of life, marital status and sexual activity

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between women with mastectomy and lumpectomy as with hormonotherapy and without hormonotherapy. We notice a slightly difference in terms of complicity (p ¼ 0:039; Chi2) and femininity (p ¼ 0:026 Chi2) between those 2 groups (mastectomy /lumpectomy). Women under hormonotherapy would feel less physical pain and would be more disturbed by the treatment side effects than women without hormonotherapy. They would be more satisfied of their quality of life but would have more vaginal pruritus (or irritation) than women without treatment (p50.05 U Mann–Whitney). We notice a slightly difference in terms of complicity and orgasm occurrence between those 2 groups. CONCLUSION: Our results are in concordance with literature finding. They may have important aftermath and implications in terms of improving quality of life among those women and conduction of psychosocial interventions for women with breast cancer.

890 Screening for PTSD Among Bereaved Relatives of Cancer Patients Reinholt Na, Elklit Ab a Counseling Centre, Odense Danish Cancer Society, Odense, Denmark; bInstitute of Psychology, University of Aarhus, Aarhus, Denmark PURPOSE: Several recent studies have documented high levels of distress among relatives of cancer patients. No studies have investigated the risk of relatives of cancer patients developing Post Traumatic Stress Syndrome (PTSD) as a consequence of the disease course. This study assesses the prevalence of PTSD in a sample of bereaved relatives of cancer patients and the impact of distress associated with caretaking, peritraumatic circumstances, previous trauma, recent life stressors, social support, attachment patterns, negative affectivity, and somatization on the development of PTSD. METHODS: 151 consecutive bereaved (110 females, 41 men) seeking counselling in a regional Danish Cancer Society Counselling Centre were asked to participate in the study one month or later after the death and in a six months’ follow-up. Four standardized questionnaires (HTQ, TSC; RAAS; and CSS) were applied in the study. RESULTS: The preliminary results showed that 49% of the bereaved fulfilled the DSM-IV-criteria for a PTSD diagnosis and additional 29% the criteria for a subclinical PTSD diagnosis (missing the full diagnosis by one

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symptom). The study is still ongoing. The main findings will be presented from the initial assessment and from the six months follow-up. CONCLUSIONS: The preliminary results showed a surprisingly large prevalence of PTSD cases in the bereaved seeking counselling. This could indicate a need for early intervention for the bereaved of cancer patients based on identified risk factors. As a result of the study, we plan to develop a short screening instrument for the use of primary healthcare professionals.

891 Cognitive–Behavioural Therapy with a Cancer Patient via Handheld Computing Reis JCa, Lucas HMa, Travado LSb, Carric¸o LMc, Sa´ Mc a PsiSau´de, Psychology Department, Independent University, Lisbon, Portugal; bClinical Psychology Unit, Centro Hospitalar Lisboa (zc)- Hospital S. Jose´, Lisbon, Portugal; cLaSige, Departamento de informatica, Faculdade de Cieˆncias da Universidade de Lisboa, Lisbon, Portugal PURPOSE: Over the last decade there was many technological applications to psychotherapy such as computer administered therapy and palmtop computer therapy. Cognitive-behavior therapy (CBT) is particularly will suited to be administered via computers because it relies on the systematic application of well-delineated methods of assessment and intervention. New clinical applications that utilized handheld and overall mobile devices such as PDAs or tabletPcs are available. However they only cover partial steps of the therapy process and do not allow the customization of the therapists and patients’ tasks along the process of therapy. So, we developed a prototype (SCOPE) that take advantage of emerging mobile technologies aimed to be used during therapy sessions and outside by patients and therapists and that covered all the steps of the therapy process. We will describe the prototype and the application of a CBT assisted by this prototype to one cancer patient. Method: The SCOPE provides computational support to CBT through all the steps of the process. It ranges from: (1) the construction of electronic assessment records and questionnaires adequate to each patient; (2) assessment by the therapist of patients’ emotions and dysfunctional thought without the company of the patient; (3) patients homework record of emotions and thoughts without the therapist presence; through

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(4) a set of tools that they use in co-presence and that include all the above activities. RESULTS: The results of the application of a CBT assisted by the prototype to one cancer patient will be presented and illustrated.

892 Palliative Patients: A Qualitative Study into the Construction of Meaning and Well-being Sereno SCa, Reis JCb a Community Nurse in Palliative Care, Centro de Sau´de de Odivelas, Odivelas, Portugal; bPsiSau´de, Department of Psychology, Independent University, Lisbon, Portugal PURPOSE: Palliative patients are challenged with demands to which they have to respond if they want to maintain a meaning in their life and a positive sense of well-being. The study has three main objectives: (1) to assess in depth the meanings of palliative patients about their condition; (2) to assess their levels of sense of coherence about life and levels of psychological well-being and (3) to compare the measures of sense of coherence and well-being of palliative care patients with the same measures on a control group of healthy people. METHODS: Two groups were constituted: (1) a group of twenty five palliative patients of both genders, from 55 to 65 years old, with knowledge of their diagnosis, taken care by one communitarian Palliative Care team and (2) a group control of twenty five healthy people. People of both groups were submitted to the sense of coherence scale and a well-being scale; interviews were undertaken with patients of palliative care to assess their meanings. RESULTS: Preliminary results show that both groups have similar scores on the sense of coherence scale and on the well-being scale. One of the most pressing questions of the palliative patients have been the ones concerning to the communication with health professionals: they were particularly critical about the delivering of bad news by the doctor which makes us to think about the importance of the quality of communication as a fundamental technique in Palliative Care.

893 Illness Representation and Levels of Quality of Life, Anxiety and Depression in Patients with Prostate Cancer Reis JC, Lucas HM

Copyright # 2006 John Wiley & Sons, Ltd.

PsiSau´de, Department of Psychology, Independent University, Lisbon, Portugal PURPOSES: One of the biggest concerns about prostate cancer treatment is sexual dysfunction and its impact on the quality of life of patients. Subjective meanings about disease and coping strategies influence psychosocial morbidity. The study has three main objectives: (1) to assess subjective meanings and coping strategies of prostate cancer patients about their illness and their sexual dysfunction; (2) to assess their levels of anxiety, depression and quality of live; and (3) to compare the measures of anxiety, depression and quality of live of prostate cancer patients with the same measures on a control group of healthy people. METHODS: 30 men with a diagnose of prostate cancer with at least 1 year, were randomly selected and submitted to a semi-structured interview based on Leventhal’s Model of illness representation. Levels of anxiety, depression and quality of live were assessed using HADS and FACT-P, respectively. The data went through a statistical analysis to describe and compare it in both groups and with qualitative data. RESULTS: Final results will be presented at the congress as data is being collected at presented time. CONCLUSIONS: Its implications for clinical practice will be discussed.

894 The Spirituality Human Dimension as a Join Forces Against Cancer Respini Da, Lissandrello Ga, Aragona Mb, Tralongo Pa a Psychology Service, Hospital ‘G.Di Maria’, Avola (SR), Italy; bDepartment of Oncology, Policlinico, University of Messina, Messina, Italy The experience of cancer can have a negative impact on both and physical psychological health and on quality of life. In recent decades the number of cancer patients seeking complementary therapies that considerate the human dimension, to deal with their disease, has increased steadily. The interest of the complementary therapy is to nurturing the human dimension that we call Spirituality. New trend is to use thousands year old techniques as meditation and mandala construction in a scientific way. In different health care centers of Sicily there is the application of practice that use the mindfulness meditation. At the Department of Medical Oncology of Messina it is applied meditation at

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contemporary use of binaural beat metamusic facilitating the access to different levels of consciousness, from somatic to emotional, psychological, social, spiritual aspects. At the Department Medical Oncology of Avola there is the use of Harmonic Chant, technique and the construction tibetan mandala like. The aim of these integrative program is to involve and transform the relationship with the own disease. Spirituality, and cultural beliefs are important elements of the health and well being of many each one. These techniques try to observe the qualitative and quantitative benefits for the cancer patients.

895 Pilot Study on Brief Supportive-expressive Group Therapy for Patients with Primary Breast Cancer and Malignant Melanoma Reuter Ka, Muell Sa, Birmele Mb, Haerter Ma a Department of Psychiatry and Psychotherapy, University Medical Center, Freiburg, Germany; b Department of Psycho-Oncology Tumorbiology, Center at the University, Freiburg, Germany PURPOSE: Due to the growing need for short term, cancer specific, group interventions, this study aimed to investigate brief supportive-expressive group therapy (Classen et al., 1993) for two different types of cancer and to test the feasibility of this therapy module in the German health care setting. METHODS: The uncontrolled pre-post design included four intervention groups (2 for primary breast cancer, 2 for malignant melanoma), with 12 weekly sessions. Participants were recruited in Interdisciplinary Breast Cancer Treatment Centers and the department of dermatology of the University Medical Center, Freiburg. Participants (N ¼ 32; 82% female: 18% male) completed self report questionnaires measuring quality of life and fatigue, mood disturbances, and coping as well as social support. After intervention, patient satisfaction and group experiences during therapy were assessed with self rating inventories. RESULTS: Acceptance of the intervention was high with a drop out rate of 14% and an average rate of 2.4 missed sessions per patient. Although not statistically significant, patients quality of life, in particular emotional well-being, fatigue and body image, improved from pre to post intervention in both cancer groups. Satisfaction with treatment was highest in patients coping with their illness by actively seeking information and experiencing positive social support. The most

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important therapeutic experiences in both patient groups were expressing true feelings and belonging to a group. CONCLUSION: Brief supportiveexpressive group therapy can be adapted to different groups of cancer patients and implemented in oncological outpatient settings in Germany. Randomized studies are needed to examine treatment effects in controlled conditions.

896 Impact of Treatment with Interferon Alpha (IFN-a) on Depression and Quality of Life in Patients with Malignant Melanoma Reuter Ka, Beckmann Ja, Ermuth Tb, Nashan Db, Haerter Ma a Department of Psychiatry and Psychotherapy, University Medical Center, Freiburg, Germany; b Department of Dermatology, University Medical Center, Freiburg, Germany PURPOSE: Over the past several years, adjuvant treatment with immune therapy in malignant melanoma has gained increasing importance. While depression, besides other severe psychological and somatic side effects, is one of the most frequent causes of discontinuation of high dose IFN-a treatment in chronic hepatitis C and malignant melanoma, the impact of the recently established low dose IFN-a treatment on mental health and quality of life is unknown. This study explored the difference between malignant melanoma patients with and without low dose IFN-a treatment in regards to depression, anxiety, and various dimensions of quality of life as well as examining whether treatment with IFN-a serves as a predictor for poorer adjustment. METHODS: 186 patients with malignant melanoma participated in the cross-sectional study, one third of which received IFN-a treatment at assessment. Patients filled out a set of self-report questionnaires (HADS, Brief-PHQ, FACT-G,-F,-BRM) and medical data was assessed from their clinic charts. RESULTS: Analysis of covariance showed significant differences between patients with and without current IFN-a treatment for general quality of life, physical well being, and fatigue. Correspondingly, in regression models IFN-a proved to be a predictor only for the physical dimensions of quality of life. The level of emotional and social well-being, as well as depression and anxiety could not be predicted by IFN-a treatment. CONCLUSION: In comparison to high dose IFN-a treatment where high propor-

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tions of patients suffer from psychological symptoms, treatment with low dose IFN-a seems to produce primarily physical symptoms and is psychologically tolerated better. Longitudinal studies will have to confirm these findings.

897 Global Expression Profiling in Brain of TumorBearing Clonal Zebrafish Revskoy Sa, Mizgireuv IVb a The Asher Center, Department of Psychiatry and Behavioral Sciences, Feinberg-School of Medicine, Northwestern University, Chicago, IL 60611, USA; b Laboratories of Genetic Toxicology, N.N. Petrov Research Institute of Oncology, St. Petersburg 197758, Russia In order to dissect the complex neurobehavioral mechanism of an organism’s response to cancer, it seems essential to investigate the phylogenetic aspects of this phenomenon beginning from the phylogenetically oldest species that develops human-like malignant tumors and whose genetic and environmental variables could be tightly controlled, i.e. zebrafish. We hypothesize that CNS system such as archipallium in lower vertebrates, including zebrafish, mediates the integral organism response to tumor growth and translates it into alteration of complex behaviors, including social behavior. A possible adaptive or maladaptive role of these processes in a psychosomatic context, and psychopharmacological modulation of these processes, are practically unknown. We utilized the recently established model of serially transplantable tumors in zebrafish to study molecular mechanisms of tumor}brain interaction and to determine molecular changes in brains of tumor-bearing animals. Tumor growth had significant effect on the global gene expression profile in the brain of tumor-bearing fish. We were able to establish the major metabolic and signal transduction pathways in brain that respond to tumor growth in a gender specific fashion. These experiments set a baseline for a more comprehensive investigation of the role of behavioral factors in cancer control and survivorship of tumorbearing animals, including the effect of social and psychopharmacological interventions on the rate of tumor growth and animal survival.

898 Multidimensional Assessment of Caregivers of Women in the Terminal Phase of Cancer Through

Copyright # 2006 John Wiley & Sons, Ltd.

the Portuguese Version of the General Comfort Questionnaire}GCQ Rezende VLa, Derchain MSFb, Botega EJb, Perdicaris MAAc a Centro de Atenc¸a˜o Integral a` Sau´de da Mulher (CAISM), Universidade Estadual de Campinas (Unicamp), Campinas}Sa˜o Paulo, Brazil; bFaculdade de Cieˆncias Me´dicas (FCM), Univesidade Estadual de Campinas (Unicamp), Campinas}Sa˜o Paulo, Brazil; cSau´de Coletiva Universidade Cato´lica de Santos}Sa˜o Paulo, Brazil PURPOSE: The demands of terminal cancer patients make informal caregivers an important part of the palliative treatment strategy. The purpose of this study was to identify some aspects of the general comfort of caregivers of women in the terminal phase of cancer, using a Portuguese version of the General Comfort Questionnaire, and to analyze the association of these aspects with symptoms of anxiety and depression in caregivers. METHODS: For this cross-sectional study, 133 informal caregivers of terminally ill women completed the GCQ between August 2002 and May 2004, at a University Hospital. The Hospital Anxiety and Depression Scale was the first questionnaire to be completed, followed by the GCQ and a short interview. Mean scores of each component of the GCQ were calculated. To assess the effects of the caregivers’ characteristics on GCQ scores, analysis of variance followed by Tukey’s were applied. Stepwise multiple linear regressions were used to determine possible correlation between caregivers’ characteristics and comfort. RESULTS: Caregivers under 35 years of age demonstrated less comfort than those aged 36–55 years (p50.01). Patients’ spouses showed significantly greater degrees of comfort than other caregivers (p50.001). Multivariate analysis confirmed the negative correlation between symptoms of anxiety and depression and general comfort measured by GCQ (p50.001 and p ¼ 0:02; respectively) and that female caregivers presented lower mean GCQ scores. CONCLUSIONS: Symptoms of anxiety and depression and female gender were significantly associated with lower GCQ scores.

899 Health Professionals Psychological Distress and its Influence in the Cancer Care: the Experience of a Brazilian Research Group

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Rezende SNa, Andrade MdGGb, Santiago SMb, Salerno VLb a Psychiatry and Medical Psychology, State University of Campinas, Campinas}SP, Brazil; b Social and Preventive Medicine, State University of Campinas, Campinas}SP, Brazil The health professionals that take care of cancer patients are exposed to psychological distress arisen from the social conception of the disease and the feelings of omnipotence/impotence related to the care demands. To conduct a study about the health teams difficulties in the oncological attention, a multidisciplinary group of The University of Campinas was compound, conduct by a psychoanalyst, who is producing reflections about the patient care. The group identified projectives/ introjectives and identificatories situations concerning the patient compliance; the need of tools to identify and treat emotional demands of patients and professionals; an inability for communication with patients and among the team members; conflicts related to hierarchical relationships; mechanisms to under or super-estimate the patients suffering. The group looked for the professional development to acquire new tools to deal with the psychological phenomenon and the communication features. As a consequence, the learning through the shared emotional experience facilitated a better integration, satisfaction and creativity among the health professionals. The raising points have been stimulating to build capacity among the general practitioners, that face the challenge of co-participate in the cancer patient care.

900 The Epidermal Growth Factor Receptor and Symptom Clustering in Cancer Patients Rich T Department of Radiation Oncology, University of Virginia, Charlottesville, VA, USA A hypothesis presented here is that symptom clustering of fatigue, appetite loss, and sleep disruption can be produced by targeted signalling by members of the epidermal growth factor receptor (EGFR) that disrupts anterior hypothalamic modulation of the circadian axis. A simplified model of the circadian axis shows it is composed of a dominant input (ambient light), a central oscillator (the clock), and outputs to the anterior hypothalamus that are mediated by hard

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wired connections and ‘diffusible’ messengers that convey clock signals to specific nuclei in the anterior hypothalamus. The hypothalamic nuclei modulate, amplify, or inhibit signals from the core oscillator to downstream brain centres depending on the specific nucleus and the presence of specific signals. In a laboratory rodent brain infusion model, exogenous administration of transforming growth factor-alpha (TGF-a) and neuregulin-1 into the third ventricle produces circadian locomotor inhibition, loss of appetite, temperature disruption and sleep alterations. Additional support for this hypothesis are the clinical data from patients with metastatic colorectal cancer that indicate a significant correlation exists between circulating levels of TGF-a with disrupted circadian motor activity, and fatigue and loss of appetite. These preclinical and clinical data support the hypothesis that ligands of the EGFR target specific hypothalamic nuclei that play a modulatory role in the circadian axis. This knowledge may prove useful in the design and study of targeted interventions in the future management of cancer patient’s symptoms.

901 Assessment of the Patients’ Spiritual Needs and a Questionnaire to Evaluate the Investigators’ Spiritual Background Riedner Ca, Fegg MJb, Roser Tb,c, Borasio GDb, Frick Ed a Private Oncology Practice, Muenchen, Germany; b Interdisciplinary Center for Palliative Medicine, University of Munich, Muenchen, Germany; cPastoral Care Team, Munich University Hospital, Grosshadern Muenchen, Germany; dDepartment of Psychotherapy and Psychosomatics, University of Munich, Muenchen, Germany BACKGROUND: We investigated the patients’ spiritual needs using a semi-structured interview (SPIR) that has been published recently. SUBJECTS AND METHODS: The phase I study took place in two outpatient and an inpatient setting. Patients were first assessed with the SPIR interview. They were asked to rate the self-perceived helpfulness, distress and importance of the interview using visual analogue scales (0–10). Surprisingly, we found a high drop out rate that was probably due to the interviewers. Therefore, a follow-up study was conducted to evaluate the investigators’ (physician/chaplain) spiritual background and their attitude towards the study.

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RESULTS: Seventy oncological patients and 23 not oncological patients (comparison group) have been evaluated. The data indicate a low distress (patients 1.0  2.2, interviewers 1.6  1.7), a high degree of helpfulness (pts. 7.2  2.7, int. 6.6  2.4), and importance of spiritual/religious questions (pts. 6.6  2.9, int. 6.6  2.8) in the participants. We found that higher levels of importance in investigators’ spirituality as well as a positive attitude to the study were correlated with a larger number of spiritual interviews (p ¼ 0:038 and p ¼ 0:05; respectively). Chaplains reported more spiritual care training (p ¼ 0:004) and expertise (p ¼ 0:038) than physicians. DISCUSSION: Previous research has shown the importance of spiritual wellbeing for the quality of life of cancer patients. This study indicates that the SPIR is a simple, effective method of assessing the patients’ spiritual needs. Chaplains are better trained and have more experience in spiritual care. The investigators who had a positive attitude towards the study and for whom the spirituality is important, had fewer drop outs. Training in spiritual care for physicians might improve the acknowledgement of the patients’ spiritual needs. We hope that this study will strengthen the role of spiritual care within the provision of medical services to cancer patients.

902 Preferences of the Dutch General Public for a Good Death and Associations with Attitudes Towards End-Of-Life Decision-Making Rietjens JACa, Van der Heide Aa, OnwuteakaPhilipsen BDb, van der Maas PJa, van der Wal Gb a Erasmus MC, University Medical Center Rotterdam, Department of Public Health, The Netherlands; bVU University Medical Center, Department of Public and Occupational Health and Institute for Research in Extramural Medicine, Amsterdam, The Netherlands PURPOSE: Euthanasia and other end-of-life decisions have been shown to be acceptable to the large majority of the Dutch public. Insight in the relationships of such acceptance with the characteristics considered important for a ‘good death’ can contribute to the understanding of this liberal attitude. METHODS: Questionnaires were mailed to 1777 members of the Dutch public (response: 78%), measuring whether 11 predetermined items were considered important characteristics of a good death. Also, associations between

Copyright # 2006 John Wiley & Sons, Ltd.

characteristics of a good death and attitudes towards euthanasia, terminal sedation, and the use of high dosages of morphine were analyzed. RESULTS: Characteristics that were considered important for a good death by many respondents were the possibility to say goodbye to loved ones (94%), dying with dignity (92%), being able to decide about end-of-life care (88%), and dying free of pain (87%). Items that were less often considered important were: having solved existential problems (47%) and determining the moment of death (38%). Acceptance of euthanasia, terminal sedation and the use of high dosages of morphine was related to the wish to have a dignified death and with being concerned about burdening relatives with terminal care. Acceptance of euthanasia was also associated with the wish to be able to decide about medical end-of-life treatments and about the moment of death. CONCLUSIONS: Besides saying farewell and dying pain free and with dignity, many members of the Dutch public consider values of control and maintenance of independency as important for a good death, especially people who consider euthanasia as acceptable.

903 From Psychoanalytical Observations Across Dialogues to Oncological Team-work Risko´ A´, Molna´r Z, Va´rady E, Rosta A, Schneider T Chemotherapy ‘A’ Nat. Inst. Oncology, Budapest, Hungary In the last 15 years the members of our multidisciplinary oncological team worked out the well functioning complex team-work towards better care and curing. In the first year we began to talk to each other thoughtfully and regularly: patients, relatives, experts. Medical oncologists, nurses, clinical psychologist on the ward began to talk about patients/relatives as cases, tasks, appropriate emotions more openly and clearly. We learned to listen and talk to each other, to learn from each other, integrate and contain new ideas and approaches. It was a deep process without immediate, ‘palpable’ issue. After the ‘groping’ first year with the help of psychodiagnostic and psychotherapeutic work with cancer patients and their relatives in case of need we become aware of their frequent pathological psychological state and we could plan the right psychosocial intervention for those concerned. Many patients in emotional

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crisis are unable to express their thoughts and feelings verbally. On our chemotherapeutical ward they have the possibility to take part in psychotherapeutically oriented physiotherapy. After some years we could alter the special, frequent ‘onco-talk’ into dialogues about our work, about our emotions in connection with our daily work. Technically the psychotherapist takes part in doctor’s round, in oncological case-discussions and in oncological conferences and oncologists and nurses participate in oncopsychological congresses and in writing psychoeducational materials and curricula. For the last years we have worked together in a ‘good-enough’ cooperation for better treatment and care, in addition preventing burn-out.

904 Intervention in ‘Emergency’: Theory and Practice in Psycho-Oncology Riva M, Lurati C, Resega R, Mencacci C Department of Mental Health, Azienda Ospedaliera Fatebenefratelli, Milan, Italy INTRODUCTION: Authors begin from the definition of oncological illness as psychophysical ‘emergency’ which implies anguish. Starting on this ‘dimensional’ point of view, a clinical practice has been organized inside an Ambulatory of Psychoncology situated inside the Oncological Division, in order to encourage ‘direct’ contacts between psycho-oncologist and patients. The oncologists, during the first visit, propose the opportunity of psychological interview to every new patient. METHOD: During clinical interview and assessment with tests (HADS, MINI-MAC, EORT CLQ) the psychologist defines the actual ‘configuration’ of anguish, and the skills of the patient in elaborating it. On these responses, it is possible to propose different interventions: pharmacological, brief psychotherapy focused on crisis (individual or group), both of them. The emerging anguish of death, and all its different configurations, confirmed the need of a specific intervention. Endpoint of the study was to determine the needing of an intervention and the kind of intervention. RESULTS: In 1 year 117 patients have been visited: 93 female, 24 male sex; median age 58. 46 of them accepted an intervention from the Ambulatory. The results of the tests have confirmed the presence of a traumatic impact in the ‘emergent’ moment of illness: high values of anxiety and depression. It has also been measured

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a decrease of these results at the end of psychotherapy. The hypothesis about the necessity of a rapid intervention is therefore confirmed: this means carried on contemporary with the oncological diagnosis, in order to reduce, the risk of psychopathological ‘organizations’ of psychophysical trauma.

905 Cognitive Impairment in Prostate Cancer Patients Treated with Hormonal Therapy Rizzi RLa,b, Ferrucci REb, Monti Ab, Zago Sb, Paparella Sc a Scienze Motorie, Universita` degli Studi Carlo Bo’, Urbino, Italy; bScienze Neurologiche, Universita` degli studi di Milano IRCCS Ospedale Maggiore Policlinico, Milano, Italy; cUrologia, Universita` degli studi di Milano IRCCS Ospedale Maggiore Policlinico, Milano, Italy PURPOSE: Recent studies showed cognitive impairment in prostate cancer patients treated with hormonal therapy, in particular in memory, attention and executive functions (e.g. Jenkins et al., 2005). In addition, the conversion of testosterone to its androgen metabolites or to estradiol may play a special role in the preservation of memory in aging (e.g. Salminen et al., 2004). The aim of this study is twofold: (a) to verify the presence of cognitive, mood and quality of life problems in prostate cancer patients, (b) to characterize the deficits, specifically of patients treated with LH-RH agonists with or without antiandrogens. METHODS: We are testing cognitive functions and mood with a battery of neuropsychological test (screening examination, memory, language, attention, logical reasoning verbal-non verbal, constructional praxis and frontal efficiency) and three inventories to evaluate: depression, anxiety and quality of life. Two groups of patients are evaluating: patients treated with LH-RH agonists or with LH-RH agonists and antiandrogen. Patients who scored below the inferential fifth centile of the normal population were considered to have specific cognitive deficits. CONCLUSIONS: Consistent with previous studies, we found that cognitive functioning, mood and quality of life could be affected by hormonal therapy. An extensive neuropsychometric evaluation should prove to be beneficial for increasing the accuracy of subclinical nature of early cognitive impairment and evaluating individual variation in response to hormonal treatment.

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Early identification by sensitive neuropsychological instruments can fill in the void necessary to managing changes in mood and cognitive function associated with drug therapy in cancer.

906 Predictors of Adjustment Among Young Adult Survivors of Childhood Cancer Robinson KEa, Gerhardt CAa, Vannatta Ka, Noll RBb a Center for Biobehavioral Health, Columbus Children’s Research Institute and The Ohio State University, Columbus, OH, USA; bChild Development Unit, Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA PURPOSE: Given improved survival rates and concern about quality of life, this study examines predictors of long-term adjustment among survivors of childhood cancer and comparisons. METHODS: Children with cancer (ages 8–15) and their families were recruited during initial treatment to participate in a longitudinal study about the psychosocial impact of cancer on families. At that time, the family of a classmate of the same gender, race, and closest in birth date, was recruited as a comparison. Participants included 95 children undergoing treatment for non-CNS cancer (53% leukemias, 29% lymphomas, 18% solid tumors) and 98 comparisons. Over 90% of eligible families participated. Children and parents completed measures of distress (CDI, SCL-90, CBCL), family environment (FES), social support (NSSI), and demographics. After survivors turned 18 years old, families of 57 survivors and 60 comparisons completed follow-up measures of distress (BDI, POMS, CBCL) and demographics. Results: Young adult survivors did not differ from comparisons on demographic variables or distress at follow-up. Controlling for child distress at initial treatment, initial parental distress was associated with child distress at follow-up. Treatment severity and gender moderated the association between mother and child distress at follow-up. CONCLUSIONS: A history of non-CNS cancer had minimal effect on survivors’ distress. Children whose parents were distressed were more likely to have long-term distress. Additional research on mediators and moderators of the association between parent and child distress is needed. This will help clinicians promote better adjustment of families over time.

Copyright # 2006 John Wiley & Sons, Ltd.

907 Development of PTSD Symptoms in Young Males in the First Six Months Following Cancer Diagnosis Robitaille Ra, Rosberger Zb,c, Achille Ma, Chan Pd a Psychology, University of Montreal, Montreal, Canada; bPsychology, Jewish General HospitalSMBD, Montreal, Canada; cPsychology, McGill University, Montreal, Canada; dMale Reproductive Medicine, McGill University Hospital Centers, Montreal, Canada PURPOSE: Testicular and lymphatic cancers (Hodgkin’s and non-Hodgkin’s disease) are among the most common cancers in young males aged 18–40. It has recently been acknowledged that symptoms of post-traumatic stress (PTSD) may be present following a cancer diagnosis, with incidence varying between 1.9% to 35.1% (Kangas et al., 2002). Few studies have investigated the emergence of PTSD symptoms in the first six months after diagnosis. This study investigates early manifestations of PTSD symptoms and their predictors (history of traumatic exposure, sociodemographic characteristics, depression, anxiety, and infertility distress). METHODS: 51 cancer patients (n ¼ 32 testicular, n ¼ 19 lymphatic), 53 community controls and 16 infertile controls were recruited. Participants were assessed on measures of PTSD, depression, anxiety, infertility distress and sociodemographic information at diagnosis (T1), 3 months post-diagnosis and 6 months postdiagnosis. RESULTS: One-way ANOVAs revealed no differences between groups on PTSD outcomes at any of the time points. There were significant differences between groups at T1 on scores of depression and anxiety, with the cancer patient group experiencing higher levels of these symptoms, (F ¼ 2:965; p50.05 and F ¼ 5:344; p50.01) but not at other time points. Sociodemographic data were uncorrelated to levels of PTSD. Depression and anxiety were correlated to PTSD symptoms (p50.01). Worries concerning possible infertility were also correlated to PTSD scores at all time points. CONCLUSION: This study revealed low levels of PTSD symptoms across groups and time. This indicates a fairly good adjustment of cancer patients to their diagnosis. Infertility distress may exacerbate PTSD in newly diagnosed patients. ACKNOWLEDGEMENTS: Funded by a Research Studentship Award to the first author from the National Cancer Institute of Canada with

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funds from the Canadian Cancer Society and by a Canadian Institutes of Health Research Operating Grant.

908 Methodological Issues in Complementary Therapy Research Wyatt GK, Sikorskii A College of Nursing, Michigan State University, East Lansing, MI, USA PURPOSE: Complementary Alternative Medicine (CAM) is used by 60–80% of individuals with cancer. Well-conducted CAM research is needed to inform nursing practice. To date many CAM research findings have been inconsistent due to design and methodological issues. The purpose of this paper is to outline key design and methodological issues related to securing long-scale funding for complementary therapy research. From the perspective of both a funded CAM investigator and reviewer, specific criteria will be shared. METHODS: The specific issues that will be covered include: 3-group longitudinal randomized clinical tail (RCT) to detect the effect of the protocol dose of the complementary therapy compared to standard care control and placebo control; randomization with computer minimization on key variables to assure equivalence of 3 groups at baseline; sample size considerations for having adequate power to detect medium effect sizes in the comparison of the means of outcome measures across groups; sequencing of specific aims to perform pair-wise comparisons of the groups; adjusting for relevant covariates in the analyses; addressing the issue of multiple correlated outcomes; and ways to strengthen the intervention protocol for both the complementary therapy and placebo. RESULTS: These design decisions will contribute to researcher’s ability to conduct complementary therapy research that will inform and translate to oncology-nursing practice. CONCLUSIONS: The specific areas outlined in this abstract are intended to increase an investigator’s likelihood of long-scale funding. Funding: NIH 1RO1 CA 104883-01A1.

909 Adaptation of Interpersonal Psychotherapy for Depression Disorder on Oncology Patients Rodrı´ guez Vega Ba, Palao A´a, Hospita Aa, Die´guez Mb, Ferna´ndez Liria Ab

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a

Psychiatry, La Paz University Hospital, Madrid, Spain; bPsychiatry, Prı´ncipe de Asturias University Hospital, Alcala´ de Henares (Madrid), Spain Interpersonal Psychotherapy (IPT) was established as a psychotherapy treatment for Depressive Disorder (1, 2). Afterwards it has been made suitable for other psychiatric disorders needs. The variety of problems to which IPT has been applied testifies to the therapeutic versatility of this modality (3, 4, 5). Regarding Oncology field, IPT adaptations using phone calls have been reported as efficient treatments too. This study is included on a more wide one (FIS PI n 050737 and FIS PI n8 052062) about the efficiency of psychotherapy interventions on Oncology. OBJECTIVES: The purpose of this study is to describe the main components of IPT for Depression Disorders on oncology patients. METHOD: The sample was 20 oncology patients with colon or breast cancer who were diagnosed of Depression Disorder. They were randomized to combined treatment (pharmacological treatment and IPT) or just pharmacological treatment. On combined treatment group, patients were videotaped and interviews were discussed for the research team. IPT components to be changed in order to use this treatment on oncology patients were established. RESULTS: Try to build patient’s role supporting feelings expression. More common interpersonal problem areas were grief and role transition. Get relatives/caregivers involvement in treatment through structured interview. Emotion regulation, using special techniques, must be part of treatment. Flexible setting, as using phone calls for example. Take into account therapist emotions and their own grieves. DISCUSSION: Our clinical experience support psychotherapy treatment for depression using IPT with oncology patients.

910 Overtreatment in Psychooncology Bonsignori M, Romeo M, Belbusti V, Nocchi M, Galeazzi G Department of Oncology, Istituto Oncologico Marchigiano, Ancona, Italy It is hard to talk about overtreatment in a discipline that reclaimed for years its importance. Yet the intimacy of the patients may sometimes be injured by the presence of an operator, because of too much distance or involving. It also sometimes

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happens that some questionnaires containing important questions are administered to the patients and their caregivers without a restitution or without a clear view to answer to the psychological needs expressed. Sometimes the quality assistance index became so important to justify excessive clearness in the dialogue between psychologist and patients. The main problem is probably related to mourning, anticipated mourning, an pathological mourning, and complicated grief; the psychologist is sometimes requested at the first grief expression, such has weeping. Moreover if the psychologist has been request by the doctor, the patient feel even more uneasy. The presence of children represents another commonplace, that frequently brings about the requests of a Psychologist by the e´quipe and by the relatives. When children are involved, people often feel anxiety and therefore request a Psychological help, how many times is this not useful? Overtreatment in Psychooncology is often related to excessive involving or to a mistake in the evaluation. The Psychologist yet accepts to be present because of his willing not to disappoint the family and the operator. This argument requests further discussion.

911 Euthanasia as an Escape from Palliative Care Culture Bonsignori M, Romeo M, Belbusti V, Nocchi M, Galeazzi G Department of Oncology, Istituto Oncologico Marchigiano, Ancona, Italy Recent political and propagandistic opinion poll underlined in Europe and increasing trend, which is in favour of euthanasia for people in advanced state of illness. There is an opinion trend which does not trust in what can be defined as palliative care culture. In Italy the term palliative is often considered as a synonym of ‘non useful’. In our reality there are been no requests in these directions and in the year 2005\2006 n trial of suicide took place. It is worrying that the possibility, the idea of a quick and painless alternative can justify the escape from what instead of culture is perceived as nonsense suffering. As a consequence we risk an increment of refusal of palliative care and the choice of illicit ways of care, as an alternative to euthanasia. Therefore palliative care risk not to be taken into account. The admitting this situation brings about

Copyright # 2006 John Wiley & Sons, Ltd.

a simplistic authorised escape in a psychological chaos, because far from the culture there are no rules. From a psychological point of view it doesn’t matter if the publicity won’t become law, as a matter of fact palliative care are already discredited. Comments: The executive efficacy of palliative care is strictly related to the trust of ill (but not only ill) people in them the quality of assistance and moreover patient’s quality of life depends on the alliance between families and e´quipe in the year 2007 will be proposed in Ancona an encounter about this there.

912 Institute of Theraupetic Continuity Bonsignori M, Romeo M, Belbusti V, Nocchi M, Galeazzi G Department of Oncology, Istituto Oncologico Marchigiano, Ancona, Italy The institute of theraupetic continuity represents for the city of Ancona a cue intervention involving regional hospital and the Istituto Oncologico Marchigiano. A palliative care consultant and a psychologist are present at the moment of recovering and evaluate with the family the possibility of facing home care and of staying in a hospice. Thanks to this project the admissions in hospital by calling to emergency or because of perceived need, and death in hospital diminished. The psychologists evaluated the family composition, the awareness of illness by the patient and by the caregiver, their motivation to home care, and then their compliance towards Istituto Oncologico Marchigiano. The most frequent problems are related to the lack of adults at home to the presence of children, to the lack of awareness about the illness, to the feeling of loneliness. The relatives which don’t accept the advancing of illness tend to bring the patient to hospital as they think there will be further possible cares. Some relatives just prefer home care to hospice, but they refused to see the patient die at home, so they call the hospital when the patient is not conscious anymore. A substitute of caregiver (for example the week-end caregiver) often brings about compliance problems and a following confusion in the assistance. Comments: The analysis of family composition but also of awareness, of motivation and resources, can provide some elements to help the family to live more easily the advanced stage of illness, with the comprehension of the patient’s and of the caregiver’s copying styles.

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Need Evaluation by Oncology Department, Urbino, Italy Lai V, Romeo M, Belbusti V, Graziano F, Mensa` A Department of Oncology, Urbino Hospital, Urbino, Italy

Evaluation of Personality and Motivations in Women Waiting for Mammography in Bari National Cancer Institute Montanaro Ra, Romito Fa, Corvasce Ca, Sirri Lb, Gradi Sb a Psycological Oncology Service, Cancer Institute ‘Giovanni Paolo II’, Bari, Italy; bDepartment of Psychology, University of Bologna, Italy

PURPOSE: Need Evaluation Questionnaire (NEQ) as been administered to 70 patients in Urbino hospital with purpose to underline their main needs, in order to better quality of life and assistance. METHOD: the questionnaire was given to 70 patients subjected to chemotherapy, most of which were in an advanced state of illness. The results were compared with those ones revealed by the same questionnaire in Milan (by Istituto Nazionale dei tumori). RESULTS: The results show high request for psychosocial assistance, while other needs had a lower score. These results seem strictly related to the phase of therapy. Item n.2: ‘I need to get more information about future conditions’ showed the highest percentage, 57% followed by the need of meeting people who lived the same illness experience. Half of patients expressed the need of social assistance that is more insurance and economical information. 45% of patients under chemotherapy would like to feel more useful in the family. 36% expressed the need of a psychologist. The percentage of those ones who asked a higher control over their physical symptoms was lower than expected (24%). If compared to the research carried out in Milan these results show more satisfaction about nurse and medical assistance in all items, even because the questionnaire was administered in Urbino mostly to people in advanced stage of illness while the request of psychosocial assistance is higher in Urbino than in Milan. COMMENTS: The answers mostly depend on the stage of illness and also on other variables which are to be examined by means such as caregiver burden inventory for the relatives. Some needs are constant through the stages of illness (such as uncertainty about future, social assistant)while nurse and medical needs become less important in this stage than psychological needs. The journey of ill people is not just medical so it is necessary to create a sort of containing where patients can express their fundamental needs and then be informed about the e´quipe. It is also important to stand out the need before discharge or at the beginning of home care assistance.

Copyright # 2006 John Wiley & Sons, Ltd.

PURPOSE: Aim of the study is to describe personality aspects and motivations in women who practice mammography and are members of LILT, the Italian League Against Cancer. METHODS: Our sample was constituted by all consecutive women members of LILT who report during six weeks to Bari National Cancer Institute for a preventive mammography. A face to face structured interview was conducted to investigate motivations for prevention. The following questionnaires were administered: ISEL, Interpersonal Support Evaluation List; and the Italian Version of SQ, Symptom Questionnaire. RESULTS: Preliminary sample include 72 women, aged 33 to 72. 53% of women are motivated to mammography by periodic prevention, 25% by familiar history, 18% by finding a nodule. Younger working women, with higher instruction feel more supported than others. Women who practice prevention since 40, even if feel stressed, seem to be more self-esteemed. It results also that women who practice also PAP Test have lower levels of Depression. Younger is the age women begin prevention, lower are Depression and Somatic Symptoms. CONCLUSIONS: Results are still preliminary: it appears that women who have more self esteem and good mood, start prevention at younger age and make a more complete prevention. We would further investigate if these women use a problem-focused coping.

915 Major Risk Information Communication Themes Concerning Young Men Experiencing Cancer Chemotherapy-Induced Infertility Rosberger Za,b,c,e, Achille Mc, Robitaille Ra,c, Chan Pd, Di Dio Pa,b,e a Psychology Division, SMBD-Jewish General Hospital, Montre´al, Canada; bPsychosocial Oncology Program, McGill University, Montre´al, Canada; c Department of Psychology, Universite´ de Montre´al, Montre´al, Canada; dDepartment of Urology,

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McGill University Health Centre, Montre´al, Canada; eDepartment of Psychology, McGill University, Montre´al, Canada PURPOSE: Concerns about survival in young men receiving chemotherapy for testicular (TC) or lymphatic cancers (LC) are potentially complicated by additional worries about relationships and ability to have children, as they are at risk for permanent (18–30%) or temporary infertility. Understanding factors contributing to effective patient/HCP communication regarding illness, treatment and sperm banking prior to treatment is vital. METHODS: Twenty-one survivors (1–10 years) of TC or LC (median age 25 years) and nineteen HCPs were interviewed in depth regarding their communication experiences using a semistructured questionnaire format. Interviews were transcribed and analyzed for major communication themes using the Miles and Huberman (1984) framework. RESULTS: Six major risk communication themes emerged. (1) Illness and survivalmost patients top concerns were illness, treatment and survival; (2) Patient attitudes toward sperm banking-9/21 patients felt that sperm banking was not important; (3) Comfort level discussing infertility-18/21 patients, but only 10/19 HCPs reported comfort; (4) HCPs’ communication style (suggestive versus directive)-of 15 who banked sperm, 8 were ‘directed’ and 7 were ‘suggested’, while all those who failed to bank sperm were only ‘suggested’; (5) Patient’s satisfaction with care-13/ 15 who banked sperm in short term reported satisfaction, but this dropped to 8/15 at long term follow-up; (6) Patients level of social support} presence of parents (younger men) or spouse facilitated discussion. CONCLUSIONS: HCPs should be trained to recognize that patients are largely open and comfortable discussing both illness and infertility concerns after diagnosis, but that a sensitive, directive, and evolving discussion should ensue over time. Acknowledgements: This study was supported by an operating grant from the Institute of Human Development, Child and Youth Health of the Canadian Institutes of Health Research, and a studentship to the third author from the National Cancer Institute of Canada with support from the Canadian Cancer Society.

916 Beyond Traditional Treatment. Art as Therapy

Copyright # 2006 John Wiley & Sons, Ltd.

Rosselli M, Bellotti L, Milloni D, Perfetto R, Senzi G Dipartimento di Medicina Interna Azienda Ospedaliero-Universitaria di Careggi, Firenze, Italia The purpose of this study is to appraise cancer patients’ perception of the hospital environment before and after placement of nature photographs in their treatment area. The supposition is that viewing nature photographs positively influences patients. Six hundred patients from five cancer centers throughout Italy (Ancona, Messina, Perugia, Terni, Venezia) are participating in this study The methods used are four. The Test of Perception of the Hospital Environment (Bellotti L., Rosselli M., 2005) consisting of a questionnaire and 17 images which was constructed and validated, for this study, since there seems to be no evidence in scientific literature of an instrument to assess the perception of the hospital environment. The present study includes three other tests: SF-36 (Short Form 36 Health Survey Questionnaire), TCI-R (Temperament and Character Inventory} R), and HADS (Hospital Anxiety and Depression Scale). The results of this experimental phase were the construction and psychometric analysis of the Test of Perception of the Hospital Environment. To analyze its validity and reliability the questionnaire was administered to 120 patients at Careggi University Hospital, Florence (60 cancer patients and 60 internal medicine patients as the control group). Conclusions: this first exploratory stage indicates that naturalistic images, perceived through the test, evoke a positive experience in the patients. This indicates that viewing nature photographs could have a positive impact on cancer patients, as will be assessed in the further stage of the study.

917 Construction and Use an Electronic Diary in a Group Cognitive Behavior Therapy (CBT) for Breast Cancer Patients Rouby P, Boinon D UPO-DISSPO Institut Gustave Roussy, Villejuif, France BACKGROUND: The use of the group Cognitive Behavior Therapies (CBT) for breast cancer patients has significantly increased during the last decade. However the format of this type of group raises two kinds of limits: (i) the short term of the therapy (an average of 10 sessions); (ii) the

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necessity to address a wide range of thematic (recurrence of fear, loss of self-esteem, pain, tiredness). We assume the easy access to electronic diary and the communication between both therapists and patients might be a way of making therapies more efficient in the involvement. PURPOSE: Study the qualitative benefits of using an electronic diary with respect to the appropriation of CBT techniques. METHODS: An electronic diary (CBT tools) has been sent to each group member. Patients were thus able to send by mail the tools (monitoring thoughts/disputing, solving problem) used when experiencing difficult emotional situations. RESULTS: The major parts of group members have used the electronic diary. Personal involvement of each member in the regular and frequent use of the CBT strategies between each session has revealed successful. DISCUSSION: This involvement, allowing a better comprehension of CBT technique has highly improved the therapeutic alliance. Furthermore, therapists have experienced a better perception of issues raised by patients along with their difficulties. Having this electronic diary at our disposal before session helped target therapists psychological interventions and to better address patient’s preoccupations an realities. The assessment of this qualitative result requires an investigation on a larger population.

cancer that initiate radical oncological treatment. The study is longitudinal, being the women evaluated in three times: pre-treatment (T1), in the middle of the treatment (T2) and posttreatment (T3). Medical and sociodemographic variables are evaluated, and also Coping Strategies (brief version COPE), Quality of Life (EORTC-QLQ-C-30) and Emotional Distress (HAD). A sample of 60 women (N ¼ 60) is being collected. RESULTS: Final results are not still available. (1) The results obtained in T1 of total sample (N ¼ 60) will be presented. (2) The available data to date in T2 will be presented. CONCLUSION: We consider that the results obtained will be useful in psychological intervention. The evaluation of strategies of coping we will allows us to change maladaptive coping strategies and to promote adaptive coping strategies, enhancing the quality of life and increasing mental adjustment of cancer patients.

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INTRODUCTION: The available literature in oncological patients shows that the variables Health Locus of Control and Optimism influence in the election of strategies of coping that cancer patients use in the different stages of the illness (diagnosis and treatments). PURPOSE: The principal aim of the present study is to examine the relationship between Optimism and Health Locus of Control with the strategies of coping in women recently diagnosed of breast cancer that have not initiated oncological treatment yet. METHOD: Sixty women recently diagnosed of breast cancer that have not initiated oncological treatment yet [being the treatment radical (not palliative)] are assessed in a cross-sectional study. The variables evaluated are: level of Optimism, Health Locus of Control, Strategies of Coping and Quality of Life. RESULTS: All the results are not still available but the preliminary data seem to indicate that being an optimistic person and having a internal health locus of control improve the election of active coping strategies and problem-focused strategies, enhancing patients Quality of Life.

Relationship between Coping and Quality of Life in Breast Cancer Patients Rubio Ba, Sirgo Aa, Torres Ab, Creus Jb, Pelegrı´ Ab a Psycho-oncology Unit, Oncology Department, University Hospital, Sant Joan, Reus, Spain; b Oncology Department, University Hospital, Sant Joan, Reus, Spain INTRODUCTION: Diverse studies have analyzed the impact that some strategies of coping have on the mental adjustment and quality of life of cancer patients, showing that active coping strategies and problem-focused strategies improve the adaptation to the illness. PURPOSE: The principal aims of the present study are: 1. To analyze the strategies of coping used by women recently diagnosed of breast cancer and its relation with the quality of life and the mental adjustment in different stages of the disease. 2. To examine if the strategies of coping vary through the different times of evaluation. METHOD: The sample is composed of women recently diagnosed of breast

Copyright # 2006 John Wiley & Sons, Ltd.

919 Influence of Health Locus of Control and Optimism on Coping in Breast Cancer Patients Rubio Ba, Sirgo Aa, Merino Sb, Creus Jb, Pelegrı´ Ab a Psycho-oncology Unit, Oncology Department, University Hospital, Sant Joan, Reus, Spain; b Oncology Department, University Hospital, Sant Joan, Reus, Spain

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CONCLUSION: Results show the importance to assess the attributions showed by the breast cancer patients with respect to their illness, as well as their level of optimism, in order to promote the development of an internal health locus of control and active coping through the psychological intervention.

920 Social Self-perceptions of Children Undergoing Treatment for Cancer Rutherford CGa, Vannatta Ka,b, Gerhardt CAa,b, Noll RBc a Center for Biobehavioral Health, Columbus Children’s Research Institute, Columbus, USA; bDepartment of Pediatrics, The Ohio State University, Columbus, USA; cChild Development Unit, Children’s Hospital of Pittsburgh, Pittsburgh, USA PURPOSE: To compare the social self-perceptions of children with cancer and comparison peers and investigate the accuracy of children’s self-perceptions by examining the congruence of self and peer-reports of social behavior. METHODS: Children, age 8–15, were recruited while undergoing treatment for cancer (53% leukemia, 29% lymphoma, and 18% non-CNS tumors) at a pediatric hospital in the USA. School assessments were completed for 95 children with cancer and 95 comparison classmates matched for gender, race, and age. These children and available classmates completed the Revised Class Play (RCP) and a self-report RCP, yielding Popularity-Leadership, Prosocial, Aggressive-Disruptive, and SensitiveIsolated behavior scores. RESULTS: Children with cancer described themselves as less aggressive than comparisons; however, group differences were not found on other behavioral dimensions. Correlations of self and peer-report on the RCP were similar for the cancer and comparison samples. However, significantly lower means and correlations were found for girls with cancer than comparison girls on the Popular-Leadership scale. Congruence on the Popular-Leadership and Prosocial scales was higher for older children, but there were no differences related to gender. CONCLUSIONS: Children with cancer maintain age appropriate self-perception skills of social behavior. However girls undergoing cancer treatment may underestimate, relative to peers, their level of popularity and leadership. Further research should examine if girls with cancer provide lower self-reports of popularity and leadership in

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other samples and if these self-perceptions are associated with maladjustment or low self-esteem.

921 Addressing Spiritual Distress in Cancer Care: A Model for Engaging and Screening Patients, and Integrating Spiritual Care Specialists in a Busy Clinic Rutledge Ra, Morrison Db a Department of Radiation Oncology, Dalhousie University, Halifax, Canada; bSpiritual Care PEI Cancer Treatment Centre, Charlottetown, Canada PURPOSE: Spirituality is becoming more widely recognized as integral to the treatment of the whole person. Evidence shows cancer patients wish more recognition of their spiritual needs as part of the healing process. Medical practitioners are frequently reluctant to enter that space for several reasons}their own lack of comfort in the spiritual/religious arena, an absence of skills and knowledge in spiritual assessment, and time factors. This presentation provides practical suggestions and a team model to address these concerns. METHODS: A Canadian collaboration of an oncologist and spiritual care provider will describe their practice for spiritual care of cancer patients, including (a) appropriate language for front line oncology staff; (b) screening questionnaires for spiritual distress and the practical experience of a home-grown questionnaire; (c) indications for referral to spiritual care specialists; (d) a model integrating spiritual care specialists into the assessment and treatment process. The initial findings by the oncologist are shared when he records the responses of 33 consecutive breast cancer patients to the question, ‘Are you comfortable talking about your spirituality or religion?’ RESULTS: Of the 33 cancer patients, 14 responded in a positive manner, 2 complained cancer interfered with their spiritual life, 7 said ‘yes’ but did not elaborate, 8 justified their position, and only 2 responded in a neutral or negative manner. CONCLUSION: Experience from screening for spiritual distress, piloting a screening questionnaire and working within a functioning team shows integrating spiritual care into the oncology clinic is not only possible but recommended.

922 A Cancer Counselling Service}What Does the Consumer Want? Ryan MF, Kerrins ET, Abell EJ

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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Cancer Control Programs, The Cancer Council South Australia, Adelaide, Australia PURPOSE: To respond to consumer demand for access to counselling services on more than one occasion. METHODS: To meet and assess the counselling needs of people with cancer who request such a service via contact with the Cancer Helpline, a pilot counselling service was implemented over an 8 week period. The pilot included the adoption of an internationally recognised tool to assess the level of distress people were experiencing. Following this, an evidence based triaging framework was adopted and used to inform the next phase, the referral process. RESULTS: 71% of people who contacted the Helpline during the 8 week pilot identified themselves as having moderate to extreme distress in the week prior to calling and including the day of the call. Of these, almost half related their distress to emotional issues. Worry and fear were the dominant concerns, followed by sadness, nervousness and depression. As a result of the pilot The Cancer Council South Australia now routinely offers counselling as a psychosocial support service. CONCLUSIONS: Psychosocial care is an important component of the healing process for people with cancer. ACKNOWLEDGEMENTS: National Comprehensive Cancer Network, Jenkintown, PA, USA.

923 The Use of the ‘Draw and Write’ Technique to Explore What Primary School Children Think About Health, Cancer and Cancer Care Ryan KJa, Rowa-Dewar Na, Kearney Na, Gibson Fb a Cancer Care Research Centre, University of Stirling, Stirling, UK; bInstitute of Child Health, Great Ormond Street Hospital for Children, London, UK PURPOSE: To provide services which genuinely meet the needs of children their views must be sought. This study gathered information from 199 children in Scotland on their knowledge of cancer and cancer care, and their understanding of healthy and unhealthy behaviours. The children, aged 8–11 years old, were from five primary schools selected to include affluent and deprived areas, within rural and urban locations. METHODS: The popular ‘draw and write’ technique was used to elicit children’s views. Children were asked to complete three tasks which included independent and group work: (1) to write or draw

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anything they knew about cancer, (2) write or draw anything they thought of as healthy and unhealthy and, in small groups with the help of a facilitator, (3) design a spider diagram of what a nice hospital would be like, and what people in the hospital could do to make a child who has cancer feel comfortable and cared for. Results: A reflexive approach was used to develop coding frames and themes. PRELIMINARY RESULTS: Suggest that there are many consistencies in children’s views, such as an association between death and cancer, and they can possess considerable knowledge of unhealthy and health behaviours, although this does not necessarily influence their behaviour. Some differences were found between children from different geographic areas. CONCLUSIONS: Young children can provide very detailed accounts about their views and knowledge regarding health and cancer. Full results from the study will be presented, focusing on the method and findings.

924 Short-term Effects of a 2-day Workshop on Communication Skills: A Study Among Oncology Nurses Sabato S, Rossi E, Rossetti G, Magri V, Grassi L Section of Psychiatry, Psycho-Oncology Unit, University of Ferrara, Ferrara, Italy INTRODUCTION: Communication skills are a cornerstone in cancer care. Several studies have examined the effects of different kind of workshops on communication both among physicians and nurses. The present study aimed at evaluating the effects of a 2-day workshop directed to nurses involved in cancer care, within a Community Psycho-Oncology Program in Ferrara (Italy). METHODS: 141 nurses participated in the workshop consisting of 2 modules (12 hours) and involving formal teaching (large-group presentations), interactive sessions (discussion of videoclips taken from movies dealing with cancer) and practice (exercises and role-play in small groups). Before and after the workshop, participants were given the following instruments: Maslach Burnout Inventory (MBI), Psychosocial Belief Scale (PBS), Self-Confidence in Communication Skills (SCCS), Expected Outcomes of Communication (EOC). RESULTS: Participants showed an improvement in their confidence in communication with cancer patients (SCCS) (53.66  14.11 vs 62.23  13.6, p50:001), a reduction in negative expected

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outcome of communication (EOC) (5.35  0.93 vs 5.86  1, p50:001), an improvement of psychosocial orientation towards patients (84.81  11.73 vs 77.7  12.2, p50:001), a reduction in burnout scores, specifically emotional exhaustion (17.42  10.8 vs 14.72  10.2, p50:001) and depersonalization (5.1  4.5 vs 4  3.9, p50:05). DISCUSSION: The training method used in this study showed positive short-term effects on several variables related to communication in cancer care. Routine training of nurses and consolidation of communication skills is mandatory in cancer settings.

925 A Model of Teamwork as a Means of Helping Multi-disciplinary Staff in Cancer Care Sadeh-Tassa Da, Drory Ma, Dori Na, Schneebaum Sb a Social Work Services, Tel-Aviv Medical Service, Tel-Aviv, Israel; bBreast Health Center, Tel-Aviv Medical Center, Tel-Aviv, Israel BACKGROUND: Health care professionals in cancer care also require help in coping with intense emotions, ongoing stress and burnout. For the last 8 years the hospital teamwork unit has facilitated short-term teamwork with patients, families and staff. In 2001, the first cancer related hospital team requested the unit’s intervention for coping with work stress and ramifications on staff relations. PURPOSE: To demonstrate the contribution of teamwork intervention with staff for coping and maintaining resilience and professional motivation in cancer-care. METHOD: Cognitive and psychoeducational group intervention focusing on communication skills, empowerment and building resilience. RESULTS: 10 nurses, 3 social workers, 1 doctor and 2 administrators working in cancer care have participated in the group work course for teamwork facilitators. 7 oncology units’ staff have participated in short-term team intervention and reported a reduction of stress, improvement in working atmosphere and acquirement of coping skills. There has been a heightened awareness in teamwork as an intervention technique in most cancer units. Multi-disciplinary teamwork leadership with cancer patients and families has risen from 6 groups in 2001 to 18 in 2005. CONCLUSION: The model of teamwork has stimulated awareness for other professional staff in sectors previously unfamiliar with the technique. Multidisciplinary staff has acquired skills as group facilitators. By working through the implication

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of long term cancer care on themselves and their team, staff learned to utilize teamwork for the benefit of their work with patients and families. ACKNOWLEDGEMENTS: The Authors wish to express their gratitude to the Israeli Cancer Association for the assistance and maintain and publishing the above detailed project.

926 Physical Functioning and Psychological Distress Before Hematopoietic Stem Cell Transplantation Among Adult Recipients from Different Types of Donor in Japan Sakamoto N, Fukuo W, Yoshiuchi K, Kikuchi H, Akabayashi A Department of Psychosomatic Medicine, The University of Tokyo, Tokyo, Japan PURPOSE: The aim of this study was to investigate quality of life (QOL) and mood states of Japanese adult patients just before hematopoietic stem cell transplantation (HSCT) among recipients from different types of donor because psychological and physical burden might be different among them. METHODS: Patients with hematological malignancy who received HSCT were asked to complete Medical Outcome Study Short Form-36 (SF-36) and Profile of Mood States (POMS) before HSCT. The mean scores of SF-36 and POMS subscales were compared among allogenic-related, allogenic-unrelated and autologous transplantation recipients using an analysis of variance and Tukey’s multiple comparison test. RESULTS: 93 male (M ¼ 39:1 years, SD ¼ 11:0) and 54 female (M ¼ 37:5 years, SD ¼ 12:6) patients completed SF-36. The mean scores of all SF-36 subscales were lower than the national norm. ‘Physical Functioning’, ‘Mental Health’, ‘Vitality’ and ‘Mental composite scale’ of related-transplantation recipients were significantly lower than those of unrelated-transplantation recipients. 121 male (M ¼ 39:2 years, SD ¼ 11:9) and 74 female (M ¼ 38:6 years, SD ¼ 12:6) patients completed POMS. The mean scores of ‘Total Mood Disturbance’ and ‘Fatigue’ were significantly higher in related-transplantation recipients than in unrelated-transplantation recipients. CONCLUSION: Related-transplantation recipients experienced more psychological distress and less physical functioning before HSCT than unrelated-transplantation recipients. Therefore, it may be important to support the

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patients before HSCT in consideration of the types of donor.

927 Psychological Distress, Sleep and Desire for Death in Advanced Cancer Patients Mystakidou Ka, Parpa Ea, Tsilika Ea, Sakkas Pb, Galanos Aa a Department of Radiology, Areteion Hospital, School of Medicine, University of Athens, Pain Relief & Palliative Care Unit, Athens, Greece; b Department of Psychiatry, Aeginition Hospital, School of Medicine, University of Athens, Athens, Greece PURPOSE: Desire for hastened death has been reported in the literature as being common in advanced cancer patients. Wishes for hastened death have been reported in 8.5%–22% of palliative cancer patients. The aim of this study was to evaluate the prevalence of clinical characteristics and risk factors for hastened death in advanced cancer patients. METHODS: The final sample consisted of 102 terminally ll cancer patients attending a Palliative Care Unit. Patients completed the Schedule of Attitudes towards Hastened Death (SAHD), a sleep quality measure, the Pittsburgh Sleep Quality Index (PSQI), a depression inventory, the Beck Depression Inventory and a hopelessness scale, the Beck Hopelessness Scale (BHS). RESULTS: From demographic-clinical characteristics only patients´ performance status (ECOG) was significantly associated with SAHD (x2 ¼ 8:62; p ¼ 0:003); SAHD scores were significantly higher in patients with moderate and poor performance status compared with those with good performance status. Strongest associations were observed between SAHD with depression and hopelessness (r ¼ 0:468; p50 :0005; r ¼ 0:678; p50:0005; respectively). In the prediction of SAHD the contribution of ‘hopelessness’ (p50:0005), ‘depression’ (p50:0005), ‘use of sleeping medication’ (p50:0005), and ‘sleep quality’ (p ¼ 0:001) was high (59% of variance). CONCLUSIONS: Depression, hopelessness and sleep quality appeared to have a statistically significant relationship with desire for hastened death. Health care professionals finding desire for death in advanced cancer patients should not only consider depression and hopelessness, but also other factors such as poor sleep quality in their diagnostic formulations in order to provide the appropriate treatment.

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928 A Specialist Nurse as a Resource for Family Members to Patients with Brain Tumours: An Action Research Study Spetz Aa, Henriksson Ra, Salander Pb a Radiation Sciences-Oncology, Umea˚ University Umea˚, Sweden; bSocial Welfare, Umea˚ University Umea˚, Sweden There is very limited research available on supportive care services desired by and useful for family members to patients with malignant brain tumours. The present study is part of a project where a specialist nurse function was implemented for these patients and their family members. PURPOSE: The purpose of the study was to identify how the family members made use of the specialist nurse function. To identify what they asked for when they contacted the nurse is a way of understanding the family members’ exposed position and thus to learn how to provide better support to the benefit of the family. METHOD: Sixteen consecutive patients were included and the specialist nurse registered field notes, i.e. all contacts, telephone and personal meetings, between herself and the family members during the whole course of the disease}who contacted whom, about what and with what outcome. RESULTS: Forty family members related to the 16 patients contacted the specialist nurse. The content of the field notes reflected a process from talking about the sick partner and medical issues to talking about oneself and own needs and finally to reveal the importance of the relationship to the specialist nurse per se. CONCLUSIONS: Presently the analysis of the results is not concluded but it seems as the specialist nurse’s competence, availability and willingness to assist provided the family members with a ‘secure base’, which lessened their exposition. The contributions from a ‘helping relationship’ and increased autonomy by leaning-processes will be discussed.

929 The Communication Needs of Those Affected by a Oncological Terminal Cancer Salazar HC Psychologie Hospital, Vila Franca de Xira, Portugal The main four pillars of palliative care are symptom control, adequate and efficacious communication, family support and team work

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(Doyle, 1987). The act of communication is an important issue of patient care process, demands great dedication and planning, and ‘is unfortunately administered in sub-therapeutic doses. . ..’ (Buckman, 1998). PURPOSE: To identify the communication needs of those affected by a terminal cancer, and was performed at the Oncological Unit in a Portuguese hospital. The participants were 9 selected advanced terminal cancer patients, which were interviewed. The interviews were videotaped and then transcript. The contents were analyzed, and then organized under main areas, categories and subcategories. RESULTS: Suggest that the communication needs of these group of patients are multiple and complex, with special emphasis for the illnessrelated and daily routines issues. The main communicators are female elements from the family or from the patient’s social context. Health professionals are not among the main communicators, but if some questions related to the future, hope and the illness occur, then the role of the professionals as communicators is questioned by these patients. The health professional’s attitudes develop under a continuum, from negative to very positive ones, very similar to what happens from the patients perspectives. CONCLUSION: Due to the size of the group, we know they cannot be generalised but are important in the Portuguese context of palliative care. Further studies are needed for better understanding of communication needs in terminal patients.

930 Disease-related Knowledge of Long Term Survivors of Childhood Cancer Samardakiewicz MEa, Kowalczyk JRa, Budziski Wb a Department of Pediatric Hematology and Oncology, Skubiszewsky Medical Academy, Lublin, Poland; bDepartment of Medical Psychology, Medical Academy, Gdan´sk, Poland INTRODUCTION: The pediatric oncologist became aware of the importance of the proper way to present the information on the disease nature, treatment and possible side effects to a child with cancer. In former time, it was not customary in Polish hospitals to provide a patient with details of diagnosis. The aim of the study was the recognition of the level disease-related knowledge presenting by the survivors. PATIENTS AND METHODS: In total 122 survivors (median age at the study-12.03 yrs) diagnosed 1985–1995

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entered the study. All studied children thought about themselves as informed on their illness. They were asked in the open-ended questions to explain the reasons of their admission to the oncohematology ward. RESULTS: The children’s answers were categorized into 5 groups: 1. description of adequate medical diagnosis, 2. description of the clinical symptoms 3. a general description of the situation, 4. other reasons, and 5. ‘I do not know’. Forty percent of survivors presented the adequate level of disease-related knowledge (category: 1 and 2). Almost 29% children revealed an inappropriate level of knowledge (3 and 4 category). More than 30% of survivors answered ‘I do not know’, and were classified as presenting the behavior with the tendency to avoidance. CONCLUSIONS: 1. Forty percent of survivors revealed the acceptable level of knowledge on their disease. 2. Children with low disease-related knowledge were recognized as a risk group of follow-up adjustment. 3. Survivors with avoidant behaviors required a psychological intervention programme.

931 Building Capacity to Deal with Psychosocial Aspects of Patients with Cancer in The Primary Care: A Formative Evaluation of An Experience In Southeast of Brazil Rezende SNa, Santiago SMb, Andrade MGb, Salerno VLb a Psychiatry and Medical Psychology, State University of Campinas, Campinas}SP, Brazil; b Social and Preventive Medicine, State University of Campinas, Campinas}SP, Brazil The health policy in Brazil concerning the cancer care has privileged the high technology centers, although with insufficient integration with the health system. It generates difficulties to reach assistance and comprehensive care. The need of qualifying and humanizing the oncological care has guyed the development of new proposals which intend to integrate the primary level to the cancer care net. This level can have a strategic role identifying and attending the psychosocial needs of patients and their families, mainly when they live far from the specialized health centers. The purpose of this study was to conduct a formative objective-oriented evaluation of a educational project developed in a region with 800 thousand inhabitants, Southeast Brazil, addressed to the primary care. The results showed that profes-

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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sionals working in the primary level feel insecure to conduct oncological cases, mostly concerning psychological aspects related to patients and their families. Building multiprofessional capacity at that level, emphasizing psychodynamic features of patients and care providers, including their social representation of cancer, contributed to reduce prejudice and to improve the participation of primary level in the comprehensive care.

932 Posttraumatic Stress Disorder (PTSD) in Patients with Gastrointestinal Cancer Santos G, Santos Z Psychiatry, Coimbra University Hospital, Coimbra, Portugal PURPOSE: The physical and psychological impact of cancer and cancer treatment clearly constitute traumatic experiences for a subset of patients. A number of investigators have reported the presence of stress-or trauma-related symptoms in cancer survivors. However PTSD was not eligible for diagnosis because having a life threatening illness did not meet the required definition of a high magnitude stressful event in the DSM III. The diagnostic criteria for PTSD contained in the DSM IV underline the psychological experience of the person who takes part in. Such events include being diagnosed with a cancer disease. This research proposes to study the prevalence and characteristics of PTSD in cancer patients. METHODS: We studied a sample of 25 adult patients with gastrointestinal cancer submitted to chemotherapy in the Oncology Day Unit of the Coimbra University Hospital using a brief demographic questionnaire and the Structured Clinical Interview for DSM-IV for PTSD assessment. RESULTS AND CONCLUSIONS: We mention the results and some conclusions.

933 Evaluating the Impact of a Telephone Based Peer Support Service for People Affected by Breast Cancer: A Case Study of Breast Cancer Care’s Peer Support Service Scanlon KA, Tilki SS Policy and Research, Breast Cancer Care, London, England PURPOSE: To examine people’s expectations, experiences and potential positive outcomes from receiving telephone based peer support.

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METHODS: A combined quantitative and qualitative methodological approach was adopted. Between November 2005 and January 2006 to participate in a semi-structured telephone interview three weeks after they first contacted the service. Although 54% (n ¼ 97) verbally consented to a follow-up interview, only half of these (n ¼ 49) were contactable. All 180 clients were sent a post evaluation questionnaire three months after their first contact. RESULTS: Data collection and formal analysis is ongoing. Key themes emerging from preliminary analysis of the qualitative interviews include: that some clients are uncertain about what to expect from the service; that matching peer supporters and clients appears to be appropriate in most cases; that the majority of clients felt able to communicate with their peer supporter and felt reassured and supported following a peer support call. CONCLUSIONS: Clients appear to want to be matched, as closely as possible, to a peer supporter with the same diagnosis, treatment type, age and family circumstances. This has implications for volunteer recruitment and retention. Short-term follow-up with clients was found to be beneficial in identifying further information and support needs. We hope the study’s findings will provide health professionals and the public with evidence of the benefits of peer support for people affected by breast cancer.

934 A Study Investigating the Potential Benefits to Young Women (aged 18–45 years) with Breast Cancer Participating in the Younger Women’s Forum}A Psycho-educational Intervention Scanlon KA, Tilki SS Policy and Research, Breast Cancer Care, London, England PURPOSE: To examine expectations, experiences and changes in quality of life among young women affected by breast cancer participating in the Younger Women’s Forum (YWF). METHODS: The study uses a combined quantitative and qualitative methodological approach. All participants attending a YWF during October 2005–June 2006 were invited to take part in the study and written informed consent obtained. Participants were asked to complete a questionnaire incorporating the FACT-B quality of life instrument one month prior to attending the YWF and three months post YWF. Participants were also asked

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to complete an immediate programme evaluation, and invited to participate in a focus group discussion six months after they attended a YWF. Ethical approval was obtained by Middlesex University. RESULTS: Data collection and formal analysis is ongoing. Preliminary findings will be presented on people’s experiences of the YWF, impact on quality of life, and key themes relating to people’s perceptions of the long-term benefit of attending the YWF. Immediate programme evaluations already suggest that the YWF offers women a valuable opportunity to meet other young women with breast cancer, reducing their feelings of isolation and providing reassurance that their feelings are ‘normal’. CONCLUSIONS: The findings from our study will have implications for researchers, health professionals and others working in psycho-oncology about the benefit of psycho-educational programmes in promoting the quality of life of young women affected by breast cancer.

935 ‘Knowing What to Do’: What the Palliative Care Team Needs to Know About Difficult Families Schembri G, Bruggeling M, Bordin F, Bellaveglia M, Welshman A Palliative Care Unit, Fondazione Sue Ryder Onlus, Rome, Italy In our ‘Hospice at Home’ service, the understanding between the Palliative Care team and the oncological patient’s family is of crucial importance for guaranteeing quality of care. Identifying family functioning and personality traits of the caregiver during initial psychological interview facilitates Palliative Care professionals to form effective relationships with family members. Passive observational studies on families and caregivers throughout care and bereavement follow up demonstrated the following: Closed family behaviour (poor cohesion, sharing o emotions, social support and coping) creates for the team more difficulties, requiring more nursing/psychological interventions compared to medical interventions; Multiproblematic families, demonstrating a prevalence of psychosocial liability}DSM 4R (65%), create barriers for effective domiciliary care; ‘Difficult’ caregivers present analogous personality traits (as defined by the 16PF): Schizothymia (64%), Low Self Esteem (85%), Mood Liability (85%) contributing to poor collaboration; Identi-

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fying and supporting families with interpersonal and/or psychological problems hence resulting at risk for pathological bereavement, contained pathological grief within 11%. CONCLUSIONS: Informing and guiding the Palliative Care team at meetings of caregiver personality structures and family behaviour enhances greater awareness of family dynamics together with team members defence mechanism, as well as the acquisition of psychological tools aimed at improving therapeutic alliance with various families.

936 Self-reported Attention and Memory Dysfunctions and Their Correlations with Objective Test Data in Patients Scheduled for Allogeneic Haematopoietic Stem Cell Transplantation (HSCT) Scherwath Aa, Mehnert Aa, Schirmer La, SchulzKindermann Fb, Koch Ua a Institute of Medical Psychology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany; bBone Marrow Transplantation Unit, Hamburg-Eppendorf University Medical Center, Hamburg, Germany BACKGROUND AND PURPOSE: Numerous cancer patients report cognitive dysfunctions following systemic treatment. As in this research field the use of neuropsychological tests becomes common, only a few studies considered self-report data to assess these treatment-related side effects and analyse associations with objective test data. Due to recent study results suggesting pre-treatment cognitive impairment in cancer patients, prospective studies including baseline measurement of self-perceived and objective cognitive functioning are needed. This study contributes to the research on self-perceived attention and memory dysfunctions and their associations with corresponding neuropsychological test parameters in HSCT patients. METHODS: In an ongoing prospective multicenter study patients with haematological malignancies scheduled for allogeneic HSCT fill out self-report questionnaires measuring cognitive functioning in the domains of attention (Questionnaire of subjective attention deficits, FEDA) and memory (Questionnaire for assessing subjectively experienced memory performance in everyday life, FEAG) prior to as well as 3 months and 1 year following transplantation. In addition, at each time point, study participants undergo objective neuropsychological testing. RESULTS:

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Baseline data from one study center will be presented. Preliminary results of n ¼ 42 subjects indicate that a subgroup of patients report attention and memory problems prior to HSCT with prevalence rates of 31% and 17%, respectively. Few, but significant correlations primarily between self-reported attention deficits and both objective attention and memory parameters with effect sizes in the medium range (0.32–0.43) were observed. Further associations with demographic, medical and psychological variables will be discussed. This research is funded by the Deutsche Jose´ Carreras Leuka¨mie-Stiftung e.V.

937 Genetic Polymorphism of Serotonin Transporter, Monoamine Oxidase and Response to SSRI Antidepressant Drugs in Terminal Cancer Patients Schillani Ga, Capozzo Mb, Vecchi Rb, Conte MAb, Giraldi Ta a Department of Biomedical Sciences, University of Trieste, Trieste, Italy; bHospice Casa di Cura Pineta del Carso, ASL 1, Trieste, Italy The serotonin transporter (SERT) and monoamine oxidases (MAO) play a crucial role in monoaminergic transmission, they contribute to mood regulation, and are the molecular target of antidepressant drugs. 5-HTTLPR and VNTR polymorphisms have been identified in the promoter region of SERT and MAO-A genes, and were shown to interact with stressful life events, leading to the development of mental disorders. The aim of this study is to examine the role of these polymorphisms in the development of psychological suffering in terminal cancer patients and in their response to treatment with SSRI antidepressants. 53 terminal patients with various tumours (30 females, 23 males, average age ¼ 71; range ¼ 48–95) admitted to the Hospice, were considered. The patients were assessed psychometrically using the Hospital Anxiety and Depression Scale (HADS) and Mini-Mental Adjustment to Cancer (Mini-MAC) scales, at admission and after 14 day of treatment with sertraline or citalopram: the patients were also genotyped for 5-HTTLPR and MAO-A VNTR. The results obtained indicate that these polymorphisms are not associated with differences of the score of the psychometric scales used before drug treatment. On the contrary, sertraline reduced the HADS depression score in all the patients, whereas Citalopram was effective

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only in the patients with the highly functional SERT genotype. Moreover, sertraline significantly increased MAC fighting spirit in the patients wit highly functional SERT genotype. The MAO-A genotype and the other concomitant drug treatment did not cause any significant effects on psychological dimensions considered.

938 Anxiety, Depression and Mental Adaptation in Cancer Patients}Role of Serotonin Transporter and Monoamine Oxidase Polymorphism Schillani Ga, Malagoli Mb, Tuveri Gb, Giraldi Ta a Department of Biomedical Sciences, University of Trieste, Trieste, Italy; bStrutura Complessa di Oncolgia Azienda Ospedaliera Universitaria, Trieste, Italy Serotonin transporter (SERT) and monoamine oxidases (MAO) play a crucial role in monoaminergic neurotransmission, in mental disorders and in the mechanism of action of clinically used antidepressant drug. Two polymorphisms, 5HTTLPR for SERT and MAO-A VNTR, have been identified in the promoter region of these genes and influence their transcriptional activity. The aim of this study is that to characterize a sample of 25 breast cancer patients, admitted to the Unit of Clinical Oncology of the General Hospital of Trieste, for anxiety and depression using the Hospital Anxiety and Depression (HADS) and for Mental Adaptation to Cancer using mini-MAC scales. The patients were also characterized for the 5-HTTLPR and MAO VNTR polymorphisms of their genotype, as well as for their MAO phenotype. The results obtained indicate that 5-HTTLPR polymorphism and MAO phenotype do not display any significant correlation with the score of psychometric scales employed. On the contrary, the examination of the scores of MAC and HADS sub-scales show that the value of anxiety, as determined using HADS, is significantly higher in the patients with the genotype conferring low functional MAO activity (homozygous with 3 repeats, and heterozygous with 3–4 and 3–3.5 repeats). Theses results require confirmation by the consideration of a higher number of patients, and seem to encourage further research aimed to study the relationships between genetic polymorphism and difficulties in mental adaptation to cancer as well as the prediction of the choice of an effective drug therapy.

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939 Mental Adaptation to Cancer, Depression and Blood Platelet Monoamine Oxidase Activity in Breast Cancer Patients Schillani Ga, Giraldi Ta, Grassi Lb, Malagoli Mc, Tuveri Gc a Department of Biomedical Sciences, University of Trieste, Trieste, Italy; bSection of Psychiatry, Department of Medical Sciences of Communication and Behaviour, University of Ferrara, Ferrara, Italy; cStruttura Complessa di Oncolgia, Azienda Mista Ospedaliera}Universitaria, Trieste, Italy The psychological adaptation to cancer was determined in a group of newly diagnosed breast cancer patients, after the communication of diagnosis and surgery, using the Mental Adjustment to Cancer (MAC) and Hospital Anxiety and Depression scales (HADS). The analysis of regression indicates that MAC hopelessness-helplessness positively correlates with HADS depression, and negatively with MAC fighting spirit; HADS anxiety displays a positive correlation with MAC hopelessness-helplessness and anxious preoccupation. Monoamine oxidase (MAO) activity was examined in blood platelets, and displays a positive regression coefficient with HADS depression score. The role of HADS anxiety and of MAO activity is further supported by the follow-up of the patients. In spite of the small number of subjects, MAO activity as a single covariate in Cox analysis is a marginally significant risk factor for survival; the model constructed for multivariate analysis considering MAO activity and the scores of the psychometric scales used indicates HADS anxiety as a significant risk factor. Further research may support the presently reported results, indicating MAO activity as a biological marker of difficulties in mental adaptation to cancer, and as a risk factor for the survival of the patients.

940 Quality of Life in Palliative Cancer Patients Under Immunotherapy with Dendritic Cells Schimitzek Ca, Malina Ja, Huber JCa, Imhof Ma,b, Steiner Gb a Gynaecological Endocrinological Department, Medical University of Vienna, Vienna, Austria; b Cell Danube AG, Krems, Austria Quality of life in palliative cancer patients under immunotherapy with dendritic cells. PURPOSE:

Copyright # 2006 John Wiley & Sons, Ltd.

Aim of therapy in palliative cancer patients should be stabilization of disease and patients’ quality of life and reduction of symptoms. Immunotherapy with dendritic cells is nearly side-effect free and can stabilize the disease. PATIENTS AND METHODS: 22 metastasized gynaecological cancer patients in palliative situation were included in a phase I/II GMP-conform clinical application trial of dendritic cell immunotherapy. The patients underwent first a leucapheresis followed by apheresis. The gained monocytes served as precursor cells for the in vitro production of the autologous antigen loaded dendritic cells for vaccination. Vaccination took place 9 times every 3 weeks at the Gynecological Endocrinological Department of the University Hospital of Vienna. Inclusion criteria were gynaecological tumor, palliative situation, Karnofsky-Index >70%, informed consent. Results: Quality of life, evaluated by EORTC-Quality of Life-Questionnaire, was assessed on an average of 7.5  4.5 vaccination visits. We only found a light flu feeling in one patient once and fever WHO scale 1-2 in 9 patients at some time points. Although our patients formed a very heterogeneous sample according to age (mean ¼ 53:7  13:8) and diagnosis the general health status significantly increased after the first two vaccination visits and further enhanced or stabilized for 55% of the patients. The medical progression together with the quality of life characteristics of three patients will be presented. CONCLUSION: Dendritic cell therapy is safe. Quality of life is individual.

941 An Educational DVD to Prepare Patients for Chemotherapy: Effects on Anxiety, Information Needs and Self-efficacy Schofield PEa, Carey Ma, Bavarelli Ca, Jefford Ma, Aranda Sa,b a Supportive Care Research Group, Peter MacCallum Cancer Centre, Melbourne, Australia; bNursing, University of Melbourne, Melbourne, Australia PURPOSE: Based on meta-analyses concerning the preparation of patients for potentially threatening medial procedures we developed a DVD to prepare patients for chemotherapy and assist them to self-manage side effects. It was hypothesised that patients who watched the DVD (vs. those who did not) would report: (1) higher self-efficacy related to coping with treatment; (2) lower

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anxiety; (3) fewer unmet needs; and (4) higher satisfaction. Also, it was hypothesised these effects would be stronger in those receiving curative rather than palliative treatment. Methods: Quasiexperimental design using a historical control group (n ¼ 100): Cohort 1 (usual care) recruited before the release of the DVD and cohort 2 (DVD plus usual care). Prior to commencing chemotherapy, all patients completed reliable and valid measures. Analyses of variance were performed with two factors: (1) cohort (DVD, no DVD) and (2) treatment intent (cure, palliation). RESULTS: Participants who received the DVD were significantly more satisfied with health information received than those who did not. Patients treated with palliative intent who also received the DVD reported significantly lower levels of self-efficacy with respect to ‘seeking social support’ and ‘managing fever’ compared with palliative patients whom did not receive the DVD. CONCLUSIONS: While the DVD did not reduce pretreatment anxiety, it is a highly acceptable resource; increased satisfaction with health information received and did not increase anxiety. Hence, it is safe to give to patients prior to face-toface chemotherapy education. Intensive pre-treatment education is recommended, particularly for palliative patients to enhance their confidence in coping with treatment.

942 Psychosocial Interventions as a Component of Routine Breast Cancer Care}Who Participates and Does it Help? Schou Bredal Ia, Ka˚resen Ra, Srensen Ea, Ekeberg Øb a Surgical Department, Ulleval University Hospital, Oslo, Norway; bDepartment of Acute Medicine, Ulleval University Hospital, Oslo, Norway PURPOSE: The aim of the study was to assess the effectiveness of psychosocial intervention when it is offered in the hospital setting as a component of routine breast cancer care. METHOD: Women who participated in the hospital support-groups following surgery were compared with non-participants. The Hospital Anxiety and Depression Scale and the European Organization for Research and Treatment of Cancer Quality-of-life Questionnaire were used to measure emotional distress and quality-of-life at time of diagnosis and after 12-months. The General Life Orientation Test-Revised was used to measure optimism.

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RESULTS: Of 165 participants, 87% reported that they had been invited to participate, and 66% participated. Participants were significantly more optimistic (p ¼ 0:002), less depressed (p ¼ 0:03), had better role (p ¼ 0:05) and cognitive (p ¼ 0:01) functioning at baseline than non-participants. The salient predictor for participating in supportgroups was optimism. No significant difference was found between the prevalence of anxiety and depression caseness at baseline, but after 12months, the prevalence of anxiety caseness was significantly lower among the participants than non-participants (19% vs 34%, p ¼ 0:04). CONCLUSION: Psychosocial intervention as a component of routine breast cancer care appears to have a long-term clinical beneficial effect upon anxiety. For depression and quality-of-lie, the study is inconclusive. Self-selection may prevent pessimists, who are at risk for adverse outcome to participate in support-groups. ACKNOWLEDGEMENTS: This study was supported by a grant from The Norwegian Women’s Public Health Association.

943 Multidisciplinary Psychosocial Pilot Study in a University Hospital Decoene Ea,d, Schrauwen Wb,d, Van Hauwaert Ac,d a Nursing Department, University Hospital, Ghent, Belgium; bMedical Oncology, University Hospital, Ghent, Belgium; cSocial Service, University Hospital, Ghent, Belgium; dPsycho-Oncology Team, University Hospital, Ghent, Belgium BACKGROUND: Although the field of psychooncology offers unique opportunities for multidisciplinary collaboration, there is a variety of healthcare providers from differing specialties with difficulty in collaboration and integration. AIMS: This pilot study will describe the process used to survey healthcare providers as to their perception and knowledge in different psychosocial interventions and who performs them. The aim of the psychosocial care project is to improve linkages and better coordination of care amongst all health care professionals and to differentiate better between them. METHODS: All healthcare providers working with cancer patients at UZ Ghent participated in a survey exploring these issues. The questionnaire was developed at our clinic and consists of (1) a list of psychosocial interventions and (2) responsibilities of different healthcare providers towards these interventions. Healthcare

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providers were asked to link these two items from their own point of view. PROGRESS: The interdisciplinary panel of PONt will assemble an indicative picture of treatment provision, psychosocial pathways, support service utilisation, perceived gaps in service provision. The results are important to differentiate in potential interventions and in rethinking who is in the best position to coordinate supportive interventions. OUTCOMES: A final report will be submitted to the MOC (multidisciplinary Oncology Commission) on completion of the project, in September 2006.

944 Predictors of Survivors’ Long-term Adjustment to Cancer in the 8 years Following Diagnosis Schroevers MJa, Rooij Ma, Ranchor AVb, Sanderman Rb a Department of Psychology, University of Leiden, Leiden, Netherlands; bDepartment of Health Sciences, University of Groningen, Groningen, Netherlands PURPOSE: The aim of this longitudinal study was to compare cancer survivors with healthy references in terms of changes in their functioning in the 8 years following diagnosis. The study also examined the role of demographic variables and psychosocial resources on the course of functioning. METHODS: The functioning of cancer survivors (n ¼ 206) and healthy references (n ¼ 120) was examined at 3 months, 9 months, 15 months, and 8 years following diagnosis. First, it was examined whether it is possible to distinguish distinct trajectories of functioning over time. Secondly, we examined factors that are associated with the different trajectories, i.e. a previous diagnosis of cancer, demographic characteristics, and psychosocial resources (e.g. neuroticism, selfesteem, social support, coping styles). RESULTS: Will be presented. CONCLUSIONS: More insight into predictors of long-term cancer survivorship may identify survivors at increased risk of longterm problems and pinpoint areas in which interventions should be developed.

PURPOSE: To evaluate the effectiveness of a pilot group intervention designed to address social skill deficits in child brain tumor survivors. METHODS: Nineteen survivors of childhood brain tumors aged 9–18 years participated in 3 ageappropriate, manualized, group intervention programs (10 males). Each group consisted of 82 hour weekly sessions targeting social skills such as: Friendship Making and Managing Teasing. Survivors and parents completed the Social Skills Rating System (SSRS; Gresham and Elliott, 1990) and the Child Behavior Checklist (CBCL; Achenbach, 1981) at baseline, pre- and pot-intervention and 6 months later. RESULTS: Parents reported a significant improvement in social skills (SSRS) from pre to post intervention (t ¼ 3:00; p50:01). Children did not report changes in social skills at any time. There was a trend for parents to report decreased social problems (CBCL) at post intervention, but social problems subsequently increased and were significantly higher at followup than at baseline (t ¼ 2:748; p50:05). Children did not report significant changes in social problems, but a marked decrease was noted at follow-up. Parent and child social skills ratings differed significantly at each time period except follow-up (t ¼ 2:64; p50:05; t ¼ 4:59; t50:00 1; t ¼ 3:87; p50:001; respectively). CONCLUSIONS: Results provide preliminary support for the effectiveness of the social skills program for survivors. Parent outcomes suggest benefits are not maintained 6 months post intervention, while children show continuous improvement. The discrepancy between parent and child report warrants further investigation.

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Cognitive Functions and Treatment-related Distress in the Course of High-dose Therapy and Allogeneic Stem-cell Transplantation: Results of a Prospective Study in Patients with Hematological Malignancies Schulz-Kindermann Fa, Zander ARa, Mehnert Ab, Scherwath Ab, Schirmer Lb a Bone Marrow Transplantation, University of Hamburgn Medical School, Hamburg, Germany; b Insitute of Medical Psychology, University of Hamburg Medical School, Hamburg, Germany

A Pilot Social Skills Group Intervention Program for Survivors of Childhood Brain Tumors Schulte F, Al-Khalili A, Barrera M Psychology, The Hospital for Sick Children, Toronto, Canada

PURPOSE: In the course of high-dose chemotherapy neuropsychological complications are observed in a significant portion of patients. Remarkably, studies show that cognitive dysfunction may be already present before the onset of

Copyright # 2006 John Wiley & Sons, Ltd.

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therapy. The aim of the present study was to prospectively evaluate the specific effects of treatment modalities and treatment related psychological distress on cognitive functions. METHOD: Patients treated with high-dose therapy and allogeneic stem cell transplantation were assessed before admission (T0) and three months after transplant (T1) with a standardized neuropsychological test battery and the Cancer Treatment Distress Scale (CTXD; Syrjala 2005). RESULTS: 39 patients at T0 and 19 patients at T1 filled out questionnaires and could be tested with the entire test battery. At both time-points most neuropsychological test results were in the normal range (compared with population norms). Nevertheless at T0 and T1 percentages of impairments, defined as z5 ¼ 1:4; ranged from 5% to 26%. Regarding differences between assessments, alertness worsened from T0 to T1. Treatment specific distress was higher before admission (p ¼ 0:001), significantly correlating with reaction time, selective attention and reasoning before, but not after medical treatment. No further significant interactions with medical variables could be observed. CONCLUSION: Regarding cognitive performance in the course of high-dose therapy the influence of treatment related specific distress should be considered. ACKNOWLEDGEMENT: The study was funded by Deutsche Jose´ Carreras Leukaemie Stiftung.

947 A Cancer Specific Scale of Social Support for Patients and Relatives Segrestan Ca, Rascle Na, Gelie Fa, Trouette Rb a Laboratoire de psychologie EA 3662 Universite´ de Bordeaux2, Bordeaux, France; bService de radiothe´rapie et d’oncologie me´dicale Hoˆpital St Andre´ }CHU de Bordeaux, Bordeaux, France PURPOSE: The aim of this study is to develop and validate a cancer-specific social support scale. METHODS: A pilot study was carried out by means of semi-structured interviews with 20 cancer patients (all types of localizations and stages) and 20 partners of cancer patients. Content analysis of interview data suggested the existence of five dimensions of social support: emotional, instrumental, informational, distractive and negative support. Based on these results, a 20-item scale was developed. The scale was administered to adult French-speaking cancer patients and

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patient’s family members (e.g. partner, adult children, parents), attended to at several French departments of oncology. The scale was also integrated to a few related studies. RESULTS: Results concerning construct validity (factorial structure, internal consistency, test-retest reliability) will be developed. Concomitant validity with other social support scales (SSQ-6, MOS Social Support Survey, QRI) will be presented. Finally, correlations with scores of extraversion (NEO-PIR), quality of life (SF-12), coping (WCC and MAC) and anxiety and depression (HADS) will be discussed. CONCLUSIONS: In the domain of oncology, this new instrument is the first scale evaluating received social support but also satisfaction with and sources of support. In addition, it enables assessment among patients and among patients’ relatives. It should be useful for the understanding of cancer-related perceived social support and its relations with other psychosocial variables. ACKNOWLEDGEMENTS: This study is generously supported by the Fondation de France.

948 The Role of Psychosocial Factors in the Adjustment to Breast Biopsy and in the Development of Breast Cancer Segrestan Ca, Gelie Fa, Bussieres Eb a Laboratoire de psychologie EA 3662, Universite´ de Bordeaux2, Bordeaux, France; bInstitut Bergonie´, Bordeaux, France PURPOSE: The aim of this study was to identify predictors and transactional processes explaining the adjustment to breast biopsy and to cancer diagnosis. Also, the role of psychosocial factors in the development of breast cancer was examined. METHODS: A semi-prospective study among 64 women admitted for breast biopsy was realised. Sociobiographic, medical and psychosocial factors were measured after breaking to the patients their need for a biopsy (T1). Transactional processes (perceived stress, perceived control, perceived social support and coping) were assessed the day prior biopsy (T2). Criteria (state-anxiety, depression and quality of life) and coping strategies related to cancer were assessed one (T3) and four (T4) months after surgery. RESULTS: Statistical analyses suggested the existence of a general dimension of bad adjustment. Breast cancer group means of emotion-focused coping (T2), social support (T2) and general bad adjustment (T3)

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were significantly higher than those of the control group. Two antecedents (age and trait-depression) and five transactional variables (thinking health depends on luck, thinking family/friends and medical staff do not control health, behavioural troubles and worry about surgery, search for social support, and helplessness/hopelessness) predict bad adjustment one and four months post-biopsy. Specific coping strategies adopted one month post-treatment remain stable three months later. Social support availability (T2) moderates the link between age (T1) and bad adjustment (T4). lighting spirit (T3) also attenuates the depression (T1) impact on adjustment (T4). CONCLUSIONS: Study contributions and limits are discussed.

naires sent) and we just start the semi-structured interviews. Preliminary results will be presented and discussed. CONCLUSIONS: These quantitative and qualitative data should allow to improve the quality of the announce to teenagers about the risks concerning fertility and the possibility of sperm cryopreservation. Our wish is to realise a document adapted to adolescents which would both help the teenagers and the pediatricians.

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This research has been conducted on patients who are in the oncological DH in Rovereto in order to estimate their suffering and psychosocial distress as a result of the previous research conducted on 387 patients. AIM: To present data on the prevalence and the intensity of total pain in relation to analgesic therapies and the sexual gender. METHOD: The Brief Pain Inventory and the Distress Valuation Questionnaire have been used in order to conduct the research. They have been administered on the first day of every beginning treatment cycle to 203 people: 52.2% females and 47.8% males, medium age ¼ 64:84: The most frequent neoplastic localizations: 26.6% colon rectum, 20.7 breast, 8.4% lung; 47.8% M1 and 36.9% M0. No analgesic therapy has been prescribed to the 53.7% of the patients; fans has been prescribed to the 14.8% of the patients, weak opioid to the 10.8% and strong opioid to the 5.4%. RESULTS: The 20.7% of the patients declares to have perceived an ‘unusual pain’ on the day of the test. The medians of the items of BPI (in the last 24 hours) correspond to 0 whereas the variable ‘pain’ of QVM corresponds to 2.00. About the 34% of the patients declares a value superior to 5 on the worst pain scale, about the 26.7% on the medium pain scale. CONCLUSION: From the statistic researches we can say that the patients who are administered weak opium are those who obtain superior mean rank in almost every item of BPI, even though they express a greater relief because of the medicines that they have taken. Also to the 47.8% of the women an analgesic has been prescribed (against the 23.7% of the ale patients). There is a good adherence of patients to therapies.

Sperm Cryopreservation for Adolescents with Cancer: Study of Pediatric Practises and Experience of Patients Dubois Ca, Delage Ma, Pacquement Ha, Laurence Vb, Seigneur Ea a De´partement d’Oncologie Pe´diatrique Institut Curie, Paris, France; bDe´partement d’Oncologie Me´dicale Institut Curie, Paris, France BACKGROUND: Banking sperm aims at preserving fertility in the event of potentially gonadotoxic treatment. It must therefore be proposed to all pubescent teenagers suffering from cancer. A multidisciplinary approach must be carried out to improve the conditions to obtain information and consent and carry out sperm collection. PURPOSE: To understand better the difficulties linked to the question of possible side-effects on fertility and the need to propose sperm cryopreservation of each adolescent newly diagnosed with cancer, we conduct a study to compare the usual French medical practises on the one hand, and the reactions of young men, survivors of a cancer occurred at adolescence, on the other hand. METHODS: A questionnaire was mailed to all the French pediatricians working in onco-hematology units. A semi-structured interview was also conducted with former patients, who agreed or not to bank sperm. The main issues were: conditions of information about sperm cryopreservation, the reasons of their choice, the influence of their parents, their concerns about parenthood, their suggestions to improve sperm collection conditions. RESULTS: The answer rate from pediatricians is about 67% (52 of 78 question-

Copyright # 2006 John Wiley & Sons, Ltd.

950 Valuation of Suffering and Psychological Distress in Oncological Patients in Day Hospital Selmi S, Marchesoni M Unit of Psychology, Hospital of Rovereto, Rovereto (TN), Italy

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951 Physical and Emotional Distress in Oncological Patients in Day Hospital Selmi S, Marchesoni M, Endrizzi G Unit of Psychology, Hospital of Rovereto, Rovereto (TN), Italy The study has been conducted in order to estimate the suffering and the psychosocial distress of the patients in the oncological day hospital in Rovereto. AIM: To present some of the most relevant statistic relations between the expression of emotional and physical problems and the sexual gender, the primary seats and the illness stage and analgesic medicines prescribed. METHOD: The QVM has been used together with the BPI. They have been administered on the first day of every beginning treatment cycle. The sample is made up of 203 people, 2.2% females, 47.8% males, medium age 64.84 years. The most frequent neoplastic localizations: 26.6% colon rectum, 20.7 breast 8.4% lung; 47.8% M1 and 36.9% M0. No analgesic therapy has been prescribed to the 53.7% of the patients; fans has been prescribed to the 14.8% of the patients, weak opium to the 10.8% and strong opium to the 5.4%. RESULTS: The variables of the QVM which have obtained major median on a scale from 0 to 10 are: fatigue (5.00), sadness (3.00) anxiety (3.00) fear and pain. There is a meaningful relation between the sexual gender and most of the investigated problems. The expression of physical problems is conditioned mostly by the neoplastic localization and the illness stage. The neoplastic seat is extremely related with fear. CONCLUSION: The sexual gender and the analgesic therapy have strong relations with fear, sadness, fatigue whereas illness stage and localization with pain and fatigue. One must pay particular attention to the meaningful relation between neoplastic seite and fear.

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Shapiro (1994) identified two dimensions of the coping response to such losses: positive versus negative, and assertive versus yielding. Studies suggest cancer patients who balance positive yielding (e.g. acceptance) and positive assertive (e.g. active) coping efforts experience better QOL. We investigated potential endocrine and immune pathways by which coping may be related to lung cancer outcomes. METHODS: Non-small cell lung cancer patients (n ¼ 56) provided self-reports of coping, functional status, and quality of life. Overnight urinary catecholamines, diurnal salivary cortisol, and pro-inflammatory cytokine levels were assessed. Bivariate correlations identified relevant medical and demographic control variables. Subsequent hierarchal regressions examined relationships between variables of interest. RESULTS: Active coping was significantly associated with functional well-being and lower endocrine activation. Acceptance predicted lower proinflammatory cytokines. Cortisol elevation was related to poor functional well-being and overall QOL. The effect of active coping on functional well-being was reduced (beta 0.389 versus 0.297) and lost significance when cortisol was entered (Baron and Kenny, 1986; Holmbeck, 1997). CONCLUSIONS: Results demonstrate interrelationships between coping, endocrine and immune function and quality of life. The crosssectional design and multicollinearity issues preclude directional conclusions. However, these data suggest future longitudinal research should examine glucocorticoids and inflammatory mediators as potential biological pathways by which coping might affect lung cancer outcomes. ACKNOWLEDGEMENTS: This research was supported by the Kentuck Lung Cancer Research Board.

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Coping with Lung Cancer: Biological Pathways and Quality of Life Sephton Sa,b, Weissbecker Ia a Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky, USA; bJames Graham Brown Cancer Center, University of Louisville, Louisville, Kentucky, USA

Psycho-emotional Assessment of Terminal Cancer Patients Serpentini Sa, Dal Sasso La, Busa Fa, Beltramello Cb a Nucleo di Cure Palliative, U.O. Cure Primarie Distretto N. 1, Azienda ULSS N. 3 di Bassano del Grappa (VI), Bassano del Grappa (VI), Italy; b Coordinamento dei Distretti Azienda ULSS N. 3 di Bassano del Grappa (VI), Bassano del Grappa (VI), Italy

PURPOSE: Lung cancer patients often experience a loss of physical function and quality of life (QOL) related to rapid disease progression.

PURPOSE: Aim of the study is to explore psychological and emotional state of terminal cancer patients at the moment of the intervention

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of the Palliative Care Unit of Bassano del Grappa. Generally, in this phase the patients are in hospital and the Unit is activated to define a specific palliative care program, at home or in hospice. METHOD: The instrument used is a semistructured interview, built to assess the psychoemotional experience of the terminal cancer patient. RESULTS: From July 2004 to December 2005 the Psychological Service of Palliative Care Unit assessed 91 patients (M: 54, F: 37 mean age: 70.6 range age: 40–93). 68.2% of patients result vigilant, 18.2% conscious, 13.8 confused or unconscious. Interactive abilities are spontaneous in 74.7%, mediated from family in 11%, following stimulation in 14.3%; the communication is untruthful in 40.7% of pts while is truthful in 11.1%. Concerning awareness of cancer: 18.7% of pts are aware, 27.15% not aware, 23.1% suspicious, 19.8% borderline and 11% aren’t valuable. Concerning awareness of terminal stage: 61.5% aren’t valuable, 14.3% aren’t aware and only 4.4% is aware. Finally, 58.3% show depression symptoms and 44% anxious symptoms. The Psychology Service of Palliative Care Unit charged 49.5% of patients assessed. CONCLUSIONS: The initial assessment of the terminal cancer patients indicates a vulnerable psychoemotional state, particularly critical factor results the awareness of being ill and in the terminal stage. Understanding the emotional suffering of the patient permits to plan a more adequate health care program in order to support a ‘good dying’.

Patients were eligible to participate in this study if they met the following criteria: both sex; affected from faecal incontinence for rectal cancer and underwent to surgical, chemotherapy, radiotherapy and physiotherapy treatment; able to understand and complete questionnaires. Instrument used are: (1) EORTC QL-C30, (2) EORTC QLC38, (3) FAECAL INCONTINENCE SCORE, (4) SYMPTOMATIC SCALE. In Rehabilitation Service of ‘Azienda Ospedaliera of Padova’ were chosen 19 case history. Questionnaires were send through mail with a letter explaining the study. RESULTS: Out of 19 eligible patients, 12 returned questionnaires. 4 were woman and 8 were men. EORTC QL-C30: physical functioning mean 76.67 (  13.484), role functioning mean 69.44 (  29.158) and cognitive functioning mean 69.44 (  29.158). EORTC QL-C38: sexual functioning mean 19.44 (  15.625), sexual enjoyment mean 40.00 (  27.889). FIS score: incontinence including uncontrolled passage of flatus and stool 63.63%, frequency and urgency 78.3%. Symptomatic scale: used of napkin 66.7%, used of medicine to decrease the number of bowel movements 58.3%, fractionated defecation 58.3%. CONCLUSION: The results underline the positive impact between multimodal and physiotherapy treatment concerning functional and symptomatic aspects. There are some problems regarding sexual sphere and bowel function. To confirm the validity of these dates we need other studies.

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Retrospective Evaluation of Quality of Life Patient’s Underwent to Treatment for Rectal Cancer Serpentini Sa, Dal Sasso Lb, Gazzola Mc, Zanetti Ld, Capovilla EDe a Dip. di Scienze Oncologiche e Chirurgiche, Clinica Chirurgica II Azienda Ospedaliera/Universita` di Padova, Padova, Italy; bFacolta` di Psicologia Universita` degli Studi di Padova, Padova, Italy; c CdL Fisioterapia, Facolta` di Medicina Universita` di Padova, Padova, Italy; dServizio di Riabilitazione Azienda Ospedaliera/Universita` di Padova, Padova, Italy; eIstituto Oncologico Veneto}Servizio di Psiconcologia}Azienda Ospedaliera/Universita` di Padova, Italy

Psychosocial Problems Among Lung Cancer Patients Shahrokni Aa, Clark Ka, Loscalzo Ma, Zabora Jb, BrintzenhofeSzoc Kb a Community Outreach UCSD Moores Cancer Center, La Jolla, USA; bNational Catholic School of Social Service, The Catholic University of America, Washington, DC, USA

PURPOSE: To asses the quality of life and faecal continence for rectal cancer after multimodal treatment (surgery, chemotherapy, radiotherapy) associated with physiotherapy. METHODS:

Copyright # 2006 John Wiley & Sons, Ltd.

BACKGROUND: Patients coping with cancer report elevated levels of distress linked to physical, psychological and social morbidity. Previous studies on psychosocial problems in cancer patients have shown the highest distress is among patients with lung cancer. Specific triggers of this elevated distress in patients with lung cancer are not well understood. METHOD: Lung cancer patients (151) who were recruited from Johns Hopkins Cancer Institute, from 1998 to 2002,

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completed BSI-18 and Problem Check List (PC). Socio-demographic characteristics were collected from patients’ clinical files. RESULTS: Fatigue (36.40%) and pain (30.50%) were two most common problems encountered by lung cancer patients. Pain was significantly associated with general distress (r ¼ 0:26; p50:01), somatization (r ¼ 0:35; p50:01) and depression (r ¼ 0:22; p50:01). Transportation problems were significantly associated with depression (r ¼ 0:21; p50:01) and somatization (r ¼ 0:23; p50:01). 44.55% of patients had level of general distress at or above a level of serious distress that warranted therapeutic interventions. Problems with managing emotions and pain significantly predicted general distress (p50:01), accounting for 13% of the variance. Problems with managing emotions and applying for medical insurance/assistance significantly predicted depression (p50:01), accounting for 16% of the variance. Marital status and pain accounted for 18% of the variance in somatization (p50:01). CONCLUSION: These findings support that almost half of patients with lung cancer patients will develop significant distress over the course of their treatment. Recognizing social and environmental factors like transportation and insurance on patients’ distress is another finding of this study.

956 Theoretical Accounts of Cognitive Changes in Breast Cancer Shapiro JLa, Metzger RLa, Denver Jb a Department of Psychology, University of Tennessee at Chattanooga, Chattanooga, USA; bDepartment of Psychology, Louisiana State University, Baton Rouge, USA Many women undergoing chemotherapy for breast cancer report feelings of mental slowness, memory problems, and difficulties with attention. This phenomenon, termed the ‘chemobrain effect,’ can negatively impact quality of life for patients and long-term survivors. It is therefore becoming increasingly important to understand both the changes that occur and the mechanisms that may be driving those changes. Neuropsychological testing has identified several small global areas of cognitive decline as a result of chemotherapy as well as more specific effects on verbal memory performance. However, it is not clear how these

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cognitive deficits come about. Several researchers have explained these deficits in terms of the direct neurotoxic effect of chemotherapy, while others have attempted to explain the effects in terms of estrogen concentration. A third explanatory mechanism that has been offered is that chemotherapy related deficits are due to impaired immune function. Although researchers have explored the impact of neurotoxicity on cognition at great length, the roles of estrogen and immune dysfunction are not well understood. The purpose of this paper is to explore the role of estrogen and the immune system in cognitive deficits observed in the chemobrain literature. Although speculative, the theory presented here suggests that both estrogen decline and the neurotoxic effect of chemotherapy are involved in a pro-inflammatory response in cancer patients that can negatively impact cognition. Further, we propose that estrogen and immune system accounts predict that some cognitive deficits will appear prior to treatment onset, a finding that is beginning to appear in the literature.

957 Is VEGF Related to Psychosocial Factors in Patients with Colorectal Cancer Sharma Aa, Sharp DMb, Greenman Ja, JRTa, Walker LGb a Academic Surgical Unit, University of Hull, Hull, UK; bInstitute of Rehabilitation, University of Hull, Hull, UK PURPOSE: VEGF and psychosocial factors have been shown to have prognostic value in colorectal cancer. The aim of this study was to investigate the relationship between psychosocial variables and VEGF in patients with colorectal cancer. METHODS: A consecutive series of eligible patients undergoing elective resection for colorectal cancer were invited to participate. Standardized measures of various aspects of quality of life were administered 5–12 days before, and 6–8 weeks after, surgery and blood samples were obtained. Solid phase ELIS was used for VEGF analysis. RESULTS: One hundred and four patients with colorectal cancer were recruited. A significant correlation was found between preoperative VEGF level and pre-operative depression (r ¼ 0:227; p ¼ 0:03), cancer-related concerns (r ¼ 0:273; p ¼ 0:009) and positive affectivity (r ¼ 0:219; p ¼ 0:05). Linear regression showed that cancer-related concerns was an independent

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predictor of preoperative VEGF levels (p ¼ 0:02). Preoperative cancer-related concerns, global quality of life and pre-operative depression were correlated with post operative VEGF (r ¼ 0:381; p ¼ 0:001; r ¼ 0:264; p ¼ 0:005; r ¼ 0:333; p ¼ 0:003). Linear regression showed that HADS depression (p ¼ 0:005) and cancer-related concerns (p ¼ 0:002) were independent predictors of postoperative VEGF levels. Post-operative VEGF was significantly correlated with postoperative anxiety (r ¼ 0:249; p ¼ 0:02), depression (r ¼ 0:289; p ¼ 0:01), and functional wellbeing (r ¼ 0:242; p ¼ 0:03). Linear regression showed that anxiety (p ¼ 0:048), depression p ¼ 0:013) and functional wellbeing (p ¼ 0:046) independently predicted postoperative VEGF-A levels. DISCUSSION: Various psychosocial factors, particularly cancer-related concerns and depression, appear to be related to pre-operative and postoperative VEGF level in patients with colorectal cancer. Future prognostic studies involving VEGF should assess psychosocial variables and include these in a multivariate analysis of outcomes.

duced menopause with no period in the past 3– 24 months (M ¼ 9:5; SD ¼ 4:2). Participants completed a measure of menopause preparedness and seven daily menopausal symptom logs. ChiSquares were used to compare participant symptom data to published data on symptom prevalence in natural menopause. Regressions were used to examine the relationships between the hypothesized predictor variables and overall symptom reports. RESULTS: Comparison of symptom prevalence indicated that participants had significantly higher rates of vasomotor symptoms, sleep disturbance, and mood symptoms than have been reported in natural menopause. Age, preparedness, time since last period, and time between chemotherapy initiation and cessation of menses were not found to predict symptoms. CONCLUSIONS: Findings suggest chemotherapy-induced menopause may produce more symptoms than natural menopause. Implications and future directions will be discussed.

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Intrusive Thoughts and Affect When Your Wife Has Breast Cancer: Does Support or Constraint From the Patient Moderate the Association? Sheridan MAa, Sherman MLa, Pierce Tb a Department of Psychology, University of Missouri-Kansas City, Kansas City, MO, USA; b Department of Psychology, Universite’ Laval, Quebec City, Quebec, Canada

Chemotherapy-Induced Menopause: Examination of Symptoms Sheridan Ma, Zolton La, Sherman MLa,b, Shook Jb, Belt RJc a Department of Psychology, University of Missouri-Kansas City, Kansas City, USA; bCancer Institute, St. Luke’s Hospital, Kansas City, USA; c Kansas City Cancer Centers, Kansas City, USA PURPOSE: At diagnosis, 20–30 percent of women with breast cancer are premenopausal. Women treated with chemotherapy may experience menopause years earlier than women experiencing natural menopause. Although women experiencing chemotherapy-induced menopause report symptoms similar to naturally menopausal women, it is unclear if the groups differ in symptom prevalence. This study examines symptoms of chemotherapy-induced menopause. The prevalence of reported symptoms was expected to be greater compared to published reports of natural menopause. Additionally, it was hypothesized that age, preparedness for menopause, time since last period, and time between chemotherapy initiation and cessation of menses would predict menopausal symptoms. METHODS: Participants included 30 women with breast cancer, ages 31–52 (M ¼ 44:1), who experienced chemotherapy-in-

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PURPOSE: Understanding mechanisms of distress in spouses of women with breast cancer may help facilitate psychological adjustment in both patients and spouses. Research suggests intrusive thoughts of a traumatic event are more strongly related to psychological distress among individuals feeling socially constrained in attempts to discuss their experience than among those not feeling constrained. Based on such findings, we hypothesized the association of intrusive cancerrelated thoughts with positive and negative affect (PA; NA) in spouses of women with breast cancer would be moderated by spouse perceptions of support and constraint from the patient. Specifically, intrusions would be most strongly associated with PA and NA in spouses reporting higher levels of constraint and lower levels of support from the breast cancer patient. METHODS: Male spouses (N ¼ 102; mean age ¼ 54:4; SD 9.1; 94.1% Caucasian) of women with breast cancer completed self-report measures of social

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support, social constraint, intrusive thoughts, PA, and NA. Hierarchical multiple regressions were used to test parallel models predicting PA or NA through the interaction of intrusive thoughts with social support or constraint, after controlling for age and/or education and the appropriate main effects. RESULTS: Results of this cross-sectional study indicated none of the interaction terms to be significant (ps>0.17) after accounting for covariates and main effects. CONCLUSIONS: The relationship of intrusive thoughts with affect did not differ by level of support or constraint from the patient. These findings differ from previous studies and potential explanations will be discussed.

960 Are Sphincter Saving and Nerve-sparing the Main End-points of Rectal Cancer Patient Quality of Life? Pugliese Pa, Pietrangeli Ab, Perrone Ma, Cosimelli Mc, Giannarelli Dd a Service of Psychology, Regina, Elena Cancer Institute, Rome, Italy; bDepartment of Neurology, Regina Elena Cancer Institute Rome, Italy; c Department of Surgery, Regina Elena Cancer Institute, Rome, Italy; dBiostatistical Unit, Regina Elena Cancer Institute, Rome, Italy PURPOSE: To evaluate over time Quality of Life (QoL) and sexual functioning in rectal cancer patients submitted to total mesorectal excision with nerve-sparing and sphincter saving after neoadjuvant chemo-radiotherapy. METHODS: 75 patients (55 male, 20 female) were studied prospectively, mean age 61 years (range 24–72) and were evaluated with EORTC QLQ-C0 questionnaire and QLQ-CR38 module for QoL and with HAD scale for anxiety and depression. Sexual functioning was evaluated with a structured interview in agreement with DSM-IV criteria and with a neurophysiological test, sudomotor skin response. Evaluations were performed at baseline, after neo-adjuvant chemotherapy and 12 months after surgery. RESULTS: At baseline, the sexual interview showed an impairment of sexual interest (males 12%; females 23%), sexual desire (males 27%; females 55%), sexual enjoyment (males 24%, females 45%), frequency of intercourse (males 22%, females 43%) owing to cancer diagnosis. 12 months after surgery the interview showed an improvement of sexual interest, sexual desire, frequency of intercourse

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and the increase of erectile dysfunction (29%) in males}which was estimated organic in 20% of patients by the neurophysiologist}and ejaculatory dysfunction (38%); in females, dyspareunia was shown (23%); the most impaired Quality of Life scales were social functioning (68%), boy image (56%) and defecation problems (23%). Anxiety and depression levels were the same as baseline levels. CONCLUSIONS: Sphincter and nerve preservation is not always the best choice for all patients who need rehabilitation intervention for the medical treatment sequaele.

961 Naming Ability in Women Newly Diagnosed with Breast Cancer Compared to Healthy Controls Foshe KAa, Sheridan MAa, Sherman MLa,b, Neblock Tb, Shook Jb a Department of Psychology, University of Missouri-Kansas City, Kansas City, Missouri, USA; b Cancer Institute, St. Luke’s Hospital, Kansas City, Missouri, USA PURPOSE: Studies of cognitive functioning after systemic treatments for breast cancer (BC) have commonly assumed normal pre-treatment functioning. However, cognitive function may be impacted in newly diagnosed BC patients prior to adjuvant treatment. The present study examines confrontation naming ability in BC patients prior to adjuvant treatment compared to healthy women. We hypothesized women with a recent BC diagnosis (prior to adjuvant treatment) would have a lower mean score on a test f naming ability compared to women without a BC diagnosis. We also expected that this difference might be explained by other cancer-related variables, namely fatigue, depression and anxiety. METHODS: Women diagnosed with early stage BC and healthy women recently receiving a negative biopsy were recruited to participate in a larger study (N ¼ 30). Participants completed the Revised Piper Fatigue Scale, Beck Depression Inventory-II, Beck Anxiety Inventory and a neuropsychological battery including the Boston Naming Test (BNT) as a measure of confrontation naming. Independent t-tests examined group differences on BNT scores, and potential explanatory variables of fatigue, depression, and anxiety. RESULTS: Statistical analysis indicated no significant difference between groups means on the BNT [tð28Þ ¼ 0:203; p ¼ 0:841]. Additionally, no group differences existed on fatigue, depression, or

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anxiety scores. CONCLUSIONS: Results of this study suggest no significant difference on naming ability between healthy women and BC patients prior to adjuvant therapy. This study implies further longitudinal research is warranted to determine whether changes in naming ability occur due to systemic adjuvant therapy for early-stage BC.

healthy controls. Consistent with prior studies, reported cognitive symptoms were associated with fatigue, depression, and anxiety. Longitudinal study is indicated to examine changes in perceived cognitive function and associations with fatigue, depression, and anxiety over time.

963 962 Perceived Cognitive Difficulties in Breast Cancer Patients Prior to Adjuvant Treatment Compared to Age-Matched Healthy Controls Sherman MLa,b, Sheridan MAa, Peterson SLa, Roth JLa, Foshe KAa a Department of Psychology, University of Missouri-Kansas City, Kansas City, MO, USA; bThe Cancer Institute, St. Luke’s Hospital, Kansas City, MO, USA PURPOSE: Cross-sectional data suggest some women experience cognitive difficulties following systemic breast cancer treatment. It is unknown, however, whether cognitive difficulties might also be perceived earlier in the cancer experience, even prior to adjuvant treatments. This study compares cognitive symptoms reported by women recently diagnosed with breast cancer (BrCA), prior to adjuvant treatment, and age-matched healthy women (Control). Additionally, relationships of perceived cognitive difficulties with fatigue, depression, and anxiety are examined. METHODS: Thirty-five participants completed Cognitive Symptom Checklists assessing attention/concentration, memory, language, visual processes, and executive functions, and self-reports of fatigue, depression, and anxiety. Independent t-tests explored group differences on symptoms in each cognitive domain, as well as fatigue, depression, and anxiety. Correlations of fatigue, depression, and anxiety with cognitive symptoms were also examined. RESULTS: BrCA and Control group means were not significantly different for symptoms in any cognitive domain. Surprisingly, the Control group reported slightly more cognitive symptoms, with a trend for statistically greater memory symptoms (p50:09). The groups did not differ on fatigue, depression, or anxiety. With little exception, these latter variables were significantly related to symptoms in each cognitive domain (rs ¼ 0:270.68), but with different subgroup patterns. CONCLUSIONS: Before adjuvant treatment, women with breast cancer perceived cognitive difficulties comparable to age-matched

Copyright # 2006 John Wiley & Sons, Ltd.

Correspondence of Significant-other Observations and Self-Perceptions of Cognitive Difficulties Sherman MLa,b, Peterson SLa, Sheridan MAa, Foshe KAa, Zolton La a Department of Psychology, University of Missouri-Kansas City, Kansas City, MO, USA; bThe Cancer Institute, St. Luke’s Hospital, Kansas City, MO, USA PURPOSE: While attention to cognitive function in women treated for early stage breast cancer is increasing, there is a paucity of research examining whether cognitive difficulties experienced by some women can be observed by others close to them. The purpose of this study was to explore whether cognitive difficulties perceived by healthy women or those beginning treatment for breast cancer are also observed by a significant-other (SO). METHODS: Fie healthy women and seven women with breast cancer completed Cognitive Symptom Checklists of memory, language, and executive functions. An SO of each woman completed a Cognitive Behaviour Rating Scale providing observations of the woman’s memory, language, and higher-order cognitive difficulties. RESULTS: Women with breast cancer were observed to have slightly greater cognitive difficulty than healthy controls, according to SO reports, but this difference was not statistically significant (ps>0.32). Conversely, women with breast cancer reported fewer difficulties, on average, compared to healthy controls in the areas of memory and language. Again, however, these differences were not statistically significant (ps>0.65). The cognitive difficulties reported by women were unrelated to the level of cognitive problems observed by SOs in each respective cognitive domain (rs ¼ 0:02 to 0.13, ps> 0.68). CONCLUSIONS: The cognitive difficulties perceived by women in this study did not correspond to SO observations. This may suggest that SOs are not able to accurately observe cognitive difficulties and/or the types of difficulties being experienced are too subtle to be easily observed by others close to the woman.

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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964 Problematic Support Styles and Psychological Adjustment in Japanese Breast Cancer Patients Shiozaki Ma, Kei Hb, Atsuko Kc, Hiroki Id, Rika Ye a The Japan Society for the Promotion of Science, Tokyo, Japan; bCenter for the Study of Communication Design, Osaka University, Osaka, Japan; c Department of Psychosomatic Medicine, Sakai Hospital, Kinki University School of Medicine, Osaka, Japan; dDepartment of Surgery, Kinki University School of Medicine, Osaka, Japan; e Department of Nursing, Kinki University Hospital, Osaka, Japan PURPOSE: The purpose of this study was to identify problematic support styles from the support styles of significant others for patients, by which the psychological adjustment of Japanese breast cancer patients is hampered. METHODS: The total of 112 post-operation patients in the Department of Surgery of Kinki University Hospital participated in this study with an informed consent. A questionnaire survey by mail was conducted on 108 breast cancer patients (54.63 years old  11.33). The questionnaire included items about patient demographic information, support style from significant others, and the Hospital Anxiety and Depression Scale to assess the patients’ psychological adjustment. RESULTS: Significant others reported by breast cancer patient included husband (N ¼ 77; 71.3%), children (N ¼ 17; 15.7%), father (N ¼ 0; 0%), mother (N ¼ 5; 4.6%), brother (N ¼ 6; 5.6%), and friend (N ¼ 3; 2.8%). To explore problematic support styles of significant others for breast cancer patients, multiple regression analysis by stepwise methods was conducted (R2 ¼ 0:14; p50:01). The analysis revealed that ‘hiding personal worries for patient’s illness’ (b ¼ 0:25; p50:01) and ‘treating me with kid gloves’ (b ¼ 0:22; p50:01) were significant predictors of psychological adjustment of patients, which were considered as ‘protective avoidance’ style. CONCLUSION: Our findings suggest that the protective avoidance in the support of significant others might be problematic for breast cancer patients.

965 Type of CAM Use and Later Mood Disturbance in a Multiethnic Sample of Women with Breast Cancer Shumay DMa, Maskarinec Gb

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a

Psychology, VA Palo Alto HCS, Palo Alto, USA; Cancer Research Center, University of Hawaii, Honolulu, USA b

This longitudinal study explored the relationship between complementary and alternative medicine (CAM) use and anxiety, depression and coping at 3 and 9 months post-diagnosis with breast cancer. Caucasian, Native Hawaiian, Japanese, and other Asian (Chinese, Filipino and Korean) women living in Hawaii (n ¼ 71) were recruited through two clinics and the American Cancer Society. Selfreport questionnaires included the State-Trait Anxiety Inventory, the Center for Epidemiological Studies Depression Scale, the Mental Adjustment to Cancer Scale, a measure of CAM use, demographics and treatment history. Thirty-five percent of participants reached suggested cut-offs for worse psychological functioning on one or more scales. Cross-sectional and repeated measures analysis found no effect for anxiety or depression on CAM use at either time point. In multiple regression analysis, earlier CAM use predicted later anxiety and depression, with the effect varying by category of CAM used. Specifically, greater use at T1 of alternative medical systems predicted significantly worse anxiety and depression scores at T2. In contrast, greater use at T1 of biologically-based treatments predicted significantly better anxiety and depression scores at T2. Greater use at T1 of energy therapies also predicted significantly worse anxiety scores but not depression scores at T2. While not significant, greater use at T1 of mind-body therapies approached significance as a predictor of less anxiety but not depression at T2. The results contradict and expand on previous research looking at emotional distress as a predictor of CAM use.

966 Prostate Cancer: Relationship Between Psychological Distress and Sexual Morbidity after Surgery McKinnon S, Yuen T, Crowe H, Costello A, Siddons H Urology, Royal Melbourne Hospital, Melbourne, Australia PURPOSE: The purpose of this study was to investigate the relationship between sexual function and psychological distress in prostate cancer survivors, and specifically, to evaluate the potential moderating influence of psychological factors, such as sexual self-schema, on this relationship.

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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The current study was a cross-sectional design that assessed the aforementioned relationship among men who have undergone a radical prostatectomy. METHODS: One hundred and twenty nine patients post-radical prostatectomy completed measures of psychological distress, sexual functioning and sexual self-schema. RESULTS: A significant inverse relationship between ability to have an orgasm and psychological distress was found. Sexual self-schema was not found to moderate this relationship. A significant inverse relationship between sexual drive/relationship satisfaction and psychological distress was also found, and sexual self-schema was found to moderate this relationship irrespective of age and time since diagnosis. CONCLUSION: The results suggest that a positive male sexual self-schema is a protective factor for ameliorating the negative impact of a decline in sexual drive and relationship satisfaction on psychological well being post-radical prostatectomy. Men with a positive sexual self may be more resilient to sexually relevant stressors and more able to discuss sexual changes and communicate sexual needs to their partners.

967 From Cancer Patient to Cancer Survivor: Advocacy, Action, Access and Accountability: Using Public Policy to Advance the Delivery of Quality Cancer Care The advocacy continuum begins with self-advocacy and progresses to a level of empowerment that allows individuals to advocate for many others. This presentation highlights how one national survivor-led non-profit cancer advocacy organization is influencing nationwide policy changes to advance the delivery of quality, comprehensive cancer care. NCCS describes comprehensive care to include the integration of psychosocial services and palliative care from diagnosis and for the remainder of life.

968 Specific Clusters of Fear of Cancer Recurrence (FCR) and Nature of Intrusive Thoughts Associated with FCR Simard Sa,b, Savard Ja,b a Laval University Cancer Research Center, CHUQ-L’Hoˆtel Dieu de Que´bec, Que´bec, Canada; b School of Psychology, Laval University Que´bec, Canada

Copyright # 2006 John Wiley & Sons, Ltd.

PURPOSE: Previous studies indicated that 22– 99% of cancer survivors report fear of cancer recurrence (FCR). Although prevalent, FCR is a poorly understood phenomenon. Indeed, there is a lack of comprehension of the multidimensional aspects of this problematic and the nature of FCR. The goals of this study were to evaluate the presence of specific clusters of FCR and explore the nature of intrusive thoughts associated with FCR. METHODS: A medical databank (RAMQ) was used to randomly select a large pool of patients who had been treated for breast, prostate, lung and colon cancer, within the past ten years. Of the 5000 patients received by mail a battery of questionnaires including the Fear of Cancer Recurrence Inventory (Simard et al., in preparation) and an adaptation of the Cognition Intrusive Questionnaire (CIQ), 1986 participants completed the questionnaires. RESULTS: A cluster analysis (k-means method), revealed four distinct clusters of FCR (R2 ¼ 56:1%): Mild FCR, Mild FCRCopers, Moderate FRC and Strong FCR. Percentages of endorsement and odds ratios conducted using the Mild group as a point of comparison obtained for each CIQ item suggest that intrusive thoughts of FCR share several characteristics with worry intrusions. CONCLUSIONS: This study reveals that there are different manifestations of FCR, which vary as a function of FCR severity and the extent to which coping strategies are used. In addition, this study suggests that severe FCR could be treated using similar treatment strategies as those which are used for worries associated with generalized anxiety disorder.

969 Psychological Distress During Diagnostic Procedures Due to Suspicion of Malignant Changes in the Lung Simonic A, Bobnar A Department of Psychology, University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia PURPOSE: The purpose of the study was to examine anxiety and depression in patients hospitalized due to suspicion of malignant changes in the lung. We anticipated that patients later diagnosed with lung cancer will be more anxious and depressive. METHODS: 75 participants (M ¼ 77%; F ¼ 23%; mean age: 65 ys) completed the 12-item HARD scale for anxiety and depression assessment during diagnostic procedures. RESULTS: After diagnosing them, the patients

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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were classified in five groups: patients with non small cell lung cancer (38.7%), patients with small cell lung cancer (9.3%), patients with other types of cancer (13.3%), patients with undefined tumors (22.7%), patients with different benign diseases (16%); and differences in psychological distress were compared. Statistically important differences between groups were proven with the KruskalWallis Test (p ¼ 0:020; 50.05). 31% patients with non small cell lung cancer had minor depression and 28.6% patients with small cell lung cancer had minor to moderate depression. Patients in other groups did not reach the threshold for depressive conditions. CONCLUSIONS: Despite small number of participants in subgroups, differences in psychological distress between groups were found as early as during diagnostic procedures: patients later diagnosed with non small and small cell lung cancer are more anxious and depressive. We believe this mostly results from patients’ more serious physical difficulties and perhaps also from different ways of informing patients about their condition which should be examined in further researches.

970 Systematic Development of An Art Education Program for Outpatient Cancer Parents Singer S, Goetze H, Buttstaedt M, Geue K, Spiehl S Department of Social Medicine, University of Leipzig, Leipzig, Germany BACKGROUND: Several programs were developed for creative work with cancer patients. Most of them are assigned for inpatients. We aimed to design an art education program to support outpatient cancer-parents. METHODS: Qualitative interviews with 28 cancer parents before and after the intervention plus documentation of each session. The interviews were documented on minidisc, transcribed and content analysed according to Mayring. After every four classes supervision was held with an experienced art therapist. She gave feedback about how group dynamics could be understood and suggestions for additional exercises if necessary. Apart from that weekly supervision by a psychotherapist was held both for the group leading artist and the interviewing psychologists. The program was revised according to the participants’ statements and the supervisors’ feedback. RESULTS: The art education program, lasting 22 sessions (group format), is now developed. It can now be used for systematic

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evaluation studies. We would like to present the concept and the final design of the program, experiences with implementation and feedback of participants and supervisors. ACKNOWLEDEGEMENTS: The study is supported by ‘Deutsche Krebshilfe’.

971 Prevalence and Treatment of Mental Disorders in Laryngeal Cancer Patients Singer Sa, Herrmann Ea, Bindewald Ja, Bussian Cb, Matthaeus Ca a Department of Social Medicine, University of Leipzig, Leipzig Germany; bRehabilitationszentrum Brandis, Germany PURPOSE: To assess prevalence and treatment of mental disorders in laryngeal cancer patients after surgery (laryngectomy or partial resection of the larynx). METHODS: All patients who underwent laryngectomy (LE) or partial laryngectomy (PL) within the last two decades at different hospitals (N ¼ 9) were asked to participate in the study. A total of 310 patients were interviewed face-to-face in their houses using the Structured Clinical Interview for DSM (SCID). RESULTS: A quarter of the patients was diagnosed with mental disorders. The most frequently occurring disorder was alcohol dependency, followed by affective disorders. Only two patients of the LE-group and 3 patients of the PL-group were currently receiving psychotherapeutic or psychiatric treatment. CONCLUSION: Only a small fraction of the laryngeal cancer patients suffering from mental illness were receiving appropriate treatment although psychosocial counselling is offered regularly at rehabilitation clinics in Germany. The reasons for that undersupply and possible solutions are to be discussed. ACKNOWLEDGMENTS: Supported by the German Federal Ministry of Education and Research.

972 Project Future Siqueira SHG Ronald McDonald House, Rio de Janeiro, Brazil PURPOSE: The aim of this work is to help in encouraging new attitudes and thoughts, which are capable during a short term to improve the quality of life of adolescents with cancer, lodging at Ronald McDonald House/RJ, who are being

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distanced from their routine activities, such as schooling, family, friends. Over the medium and long term, we help them make plans for the future, by stimulating their self-esteem, thereby strengthening their immunological system, and as a result, influencing the way illness will evolve. METHODS: The activities involve encouraging three types of interest, being based around a professional activity, always chosen by the teenagers themselves: a ‘friendly chat’ with the professional, about his/her career, difficulties and opportunities; a visit to their work place and a film. RESULTS: The primary results still do not give a clear picture about if there can be ascertained a direct relationship with the evolution of the disease. However, there is a notable increase in interest about the issues raised and an enthusiasm for the activities undertaken. Also, some of them begin to dream about taking up their chosen profession in the future. CONCLUSIONS: It is noticeable when considering bringing about a change in the daily routine of these teenagers, it is necessary to use other therapeutic methods instrumental in discovering the possible internal resources which help not only dealing with the disease, but by being able to identify new forms of responding}emotionally and mentally}to what is happening around them in life.

973 Emotional Distress and Related Variables Associated to the Hospitalization Period in a Group of Cancer Inpatients Sirgo Aa, Rubio Ba, Lo´pez Pb, Martı´ n MDb, Guma´ Jb a Psycho-oncology Unit, Oncology Department, University Hospital, Sant Joan Reus, Spain; b Oncology Department, University Hospital, Sant Joan Reus, Spain INTRODUCTION: Cancer patients go through different phases along the cancer illness process. One of the most stressful situations are long periods at hospital, which are related with illness progression, symptoms control, heavy chemotherapy treatment or physical impairment. PURPOSE: The aim of this study is to describe the emotional distress associated to the hospitalization period and to identify variables which are relevant to understand patients´ emotional distress. METHODS: 120 oncology men and women inpatients (N ¼ 120) with different types of cancer were assessed regarding some sociodemographic

Copyright # 2006 John Wiley & Sons, Ltd.

and medical variables, Karnofsky Index, psychiatric history, current psychiatric diagnosis, knowledge about the illness, emotional distress (HADS, distress thermometer), cognitive status (SPMSQ, Pfeiffer), quality of life (EORTC-QLQ-C30), level of optimism (LOT), perceived social support, worries related with the stay at hospital and the illness itself and perceived benefits of the hospitalization period. RESULTS: Oncology inpatients show moderate to high levels of emotional distress related to their physical status, level of optimism, perceived social support and psychiatric history; low Karnofsky Index is correlated with poor quality of life and lower cognitive status; emotional distress is also correlated to worries about the illness and perceived benefits of hospitalization. Some more specific results will be presented and discussed. CONCLUSIONS: Special importance has to be given to oncology inpatients, as professionals we have to take into account the specific characteristics of this group of patients which are related to age, physical impairment and worries about illness progression.

974 Cancer Epidemiology and Prevention: Focus on Alienation Sivashinskiy M Department of Surgery, City Hospital # 40, St. Petersburg, Russia Unprecedented rise of cancer incidence in the developed world still does not have rational epidemiological explanations. Traditional epidemiology of somatic illnesses is usually looking for physical impacts. Due to the lack of suitable theory, societal aspects of cancer epidemiology is rather neglected. It is widely accepted that personality characteristics could affect the incidence and virulence of cancer. All attempts, however, were narrowed to the study of a given individual, with no references to the shaping impact of the diversity of societal relations. Societal relations embodied in the process of labor signify the cornerstone for the maturity of man’s individuality. Analysis of labor relations, therefore, exactly means the analysis of personality. Detailed examination of reciprocal contradictions between abstract and concrete aspects of labor provides us with essential knowledge on the specific personality. The intensity of the above contradictions, namely domination of the abstract activity with its numerous consequences, could be

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expressed by the philosophical term alienation, which means the estrangement of man from his entire being. Currently observed growth of the degree of alienation has reached epidemic proportions and could explain the steady increase of cancer incidence. According to the above speculations the strategy of prevention should be based primarily on dissemination of understanding and general public awareness of existing threats. It gives the affected, mostly alienated population, the opportunity to actively withstand these dangerous trends and cultivate means for defense, e.g. creative capacities. Epidemiological research should switch its attention to alienation, as a factor, exerting influence on the innermost aspects of a human being.

influenced described changes; parts of those factors are the changed demands put upon the patient and her family by cancer and its treatment. The knowledge and recognition of those changes and contributing factors can significantly contribute to more efficient approach to psychological therapy in the contest of comprehensive treatment of breast cancer patients.

975

PURPOSE: An accurate symptom assessment is substantial to assure optimal quality of life for palliative patients. This study compares patient and family caregiver assessments of physical and psychological symptoms in advanced cancer patients. METHODS: A total of 15 patient–family caregiver dyads participated in the study. Within the first three days after admission, patients and their relatives completed independently a demographic questionnaire, a modified standardized Symptom List in Palliative Care (MIDOS), the psychological subscale of the Memorial Symptom Assessment Scale (MSAS-PSYCH) and the Distress Thermometer (DT). Additionally, family members filled out the MSAS-PSYCH and the level of distress for his/her own person. RESULTS: Statistical analyses were computed on individual symptoms as well as different sumscores for pain, physical and psychological symptoms (Mann-Whitney-U-Test). The agreement was higher for physical than for psychological symptoms. Family caregivers rated 2 of the 6 psychological symptoms assessed in the MSASPSYCH scale (‘feeling irritable’, ‘worrying’) significantly higher than patients. A statistical trend in overestimating was found for following MSAS items: ‘feeling sad’ and ‘difficulty concentrating’. Additionally, comparisons between congruent and non-congruent rather dyads were analysed in relation to family caregivers’ distress. Descriptive statistics showed for the psychological sum-score (MSAS-PSYCH) that family caregivers in the non-congruent dyads had higher distress levels than congruent family members. CONCLUSIONS: These findings suggest that the assessment of psychological symptoms and the consideration

Breast Patients}Some Aspects of Family Functioning Skufca Smrdel AC Department of Psycho-Oncology, Institute of Oncology, Ljubljana, Slovenia PURPOSE: Our aim was to investigate changes in the life of the early breast cancer patients’ families from the viewpoint of the patient experience in the fields of cohesion between the family members, communication concerning cancer and experience of the disease, redistribution of family roles, partnership and employment status. Subjects: Early stage breast cancer patients, aged 30–65 years, receiving primary treatment at the Institute of Oncology Ljubljana. METHODS: The study was qualitative and longitudinal, patients were included at the beginning of treatment and six months after treatment completion. We used partially structured interview, Likert scale, evaluated by nonparametric statistical methods. RESULTS: The results suggest that during and after treatment of an early breast cancer there are significant changes in the fields of cohesion between the family members, cancer communication experiencing the disease and redistribution of family chores. The patients were identifying that the direction of changes is in large part dependent from family functioning before the appearance of the cancer. They recognised connection with some other phenomena (communication pattern of conspiracy silence, normalization of life after the treatment completion). The employment status is importantly influenced due to medical situation of the patients. CONCLUSIONS: Different factors

Copyright # 2006 John Wiley & Sons, Ltd.

976 Symptom Assessment in Palliative Care: A Comparison of Terminal Cancer Patients and Their Family Caregivers Zloklikovits S, Ladinek V, Andritsch E, Samonigg H Department of Oncology, Medical University, Graz, Austria

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of distress for both patients and family caregivers should become more important in palliative symptom management.

977 Social Program ‘Onco In Concert’ and The SelfEsteem of the Professionals from a Public Service of Clinical Oncology in Brazil Zanon CCS, Franc¸a BAL, Campos ERC, Lima MBBP, Lima C Department of Internal Medicine, State University of Campinas, Campinas, Brazil INTRODUCTION: The Clinical Oncology Service of our University Hospital has a purpose of working as a reference service for assistance of cancer patients for all of the east side of Sa˜n Paulo state with around eight million citizens. For this purpose we needed extra financial support for the improvement of our service area. PURPOSE: Since we did not receive help from the government, and with the purpose of maintaining our objective and to avoid a depression state in our staff, we tried to obtain financial resources using social programs. METHODS: We conducted the program entitled ‘Onco in Concert’, with the participation of students, medical doctors, nurses, social assistants, professors, artists, musicians, and other volunteers from the community. RESULTS: In 2005, the show ‘The wizard of Oz’ and the ‘Guitar Orchestra of Tatuı´ ’ in the theatre of the University, and a concert of the Campinas Philharmonic Orchestra in a Private Social Hall of the city. An art auction was also performed at an Art Gallery of the city. We have earned enough financial support to start the renovation of our clinical area this year. In addition, it is of fundamental importance to mention that the social program carried out also helped us to raise the wellness and self-esteem of the staff evolved a result of immeasurable value for our service. CONCLUSIONS: We conclude that beautiful cultural events may help public services to obtain financial recourses for objective purposes, and also to increase the self-esteem of the professionals of the area.

978 Depression and Anxiety in Slovenian Breast Cancer Patients Snoj Za, Primic A˚akelj Ma, Milan Lb

Copyright # 2006 John Wiley & Sons, Ltd.

Institute of Oncology, Ljubljana, Slovenia; bUniversity Psychiatric Hospital, Ljubljana, Slovenia

a

BACKGROUND: Depression and anxiety are the most frequent psychiatric disorders in cancer patients. Despite high prevalence, they often remain undetected and therefore untreated. The aim of this study was to find out the proportion of undetected and untreated cases of depression and anxiety in breast cancer patients and to identify the characteristics of this particular group of cancer patients. METHODS: The study was carried out at the Institute of Oncology, Ljubljana. In the period from September till December 2004, 314 consecutive breast cancer patients, who were treated at least six months before their follow up visit in the out-patient department participated. They were asked to fill in the Hospital Anxiety Depression Scale (HADS). All patients in whom anxiety or depression symptoms were found were invited to psychiatric diagnostic interview. Standard statistical methods were used for data analysis. RESULTS: The mean age of patients was 54 years, ranging from 29 to 84 years. More than half of the patients (56.7%) were younger than 50 years. Among them, 35.5% of patients had symptoms of depression and 56.7% of anxiety. In 108 (42.5%) patients, depression and anxiety were undetected and consequently untreated. CONCLUSIONS: The percentage of patients with undiagnosed and untreated anxiety and depression was considerably high in our group. The detection of depression is a key point in the medical care of cancer patients. These conditions do not only deteriorate their quality of life but also impair the patient’s ability to participate in the exhausting treatment process and so influence the disease outcome. More care should be given to detection and treatment of these conditions by medical oncologists and family doctors in order to improve outcome of cancer patients.

979 Parents Orientation: A Facilitated Condition to Children Adaptation in a Hospital Context Zoe´ga Soares MRZ, Dupont SL Psicologia Geral e Ana`lise do Comportamento, Universidade Estadual de Londrina, Londrina, PR, Brazil Professionals of health must identify parents and children difficulties to implement effective

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strategies to children adaptation in a hospital context. In the present study, parents orientation is presented as a strategy that helps children to have a better adaptation in that context. Hospitalization can be hard even for the parents, once they observe painful and unpleasant procedures, without being prepared for them. It is clear that parents support is a necessity in hospitals. Parents without orientation can have difficulty to deal with some children pattern behaviors during hospitalization (as anxiety, apathy, sleep and food disorders). Some strategies can be implemented in a hospital context, in a simple and possible way. Allowing the parents to stay with their children during anaesthesia can relieve the effects of children anxiety. Instructions given to parents can help them to remember some information, to increase routines adhesion, to recognize some symptoms and to manage them properly and to reduce the problems when going home. The instructions should be specific, clear and concrete. In this way, through orientation, parents should be aware of the importance of supporting their children in this situation. The relation established between them in the hospital can help to establish other social relations and to obtain children cooperation, it will contribute to body and mental health, as well for their individual welfare.

980 Efficacy Assessment of a Psycho-Educational Program for Cancer Patients and Family Caregivers Solari F, Costa P, Franchi R, Tansini G, Zanaletti F Dipartimento di Oncologia, Azienda Ospedaliera, Casalpusterlengo (LO), Italy PURPOSE: Psycho-educational programs enhance in cancer patients and their family the illness adaptation process. For this purpose 13 group meetings focused on clinical and psychosocial aspects were activated. METHODS: 201 people participated in this project: 160 (79.60%) as patients, caregivers and volunteers, and 41(20.40%) as health professionals. All attendees were administered a satisfaction questionnaire purposely designed for project efficacy evaluation; 168 questionnaires were filled in: 147 (87.5%) by patients and relatives, and 21 (12.5%) by professionals. Results were analyzed using: 1. Kruskal Wallis test applied to questionnaires 2. Mann– Whitney test to compare the participants’ satisfaction degree with the satisfaction level perception

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attributed by professionals to the public. RESULTS: Participants Appreciation: the three macro-themes resulted equally appreciated. Highappreciation frequencies of tested variables are: Utility: 85%; Improvement of personal knowledge: 57.1%; Doubt removal 52.4%; Worries reduction: 42.9%; Family relationships improvement: 50.3%. Comparison between professionals and participants questionnaires-Statistical significances: Utility: Highly significant difference (U ¼ 1007:00; p50.01); Improvement of Personal Knowledge: Significant difference (U ¼ 1097:00; p50.05); Doubt Removal: Trend to significance (U ¼ 1170:00; p ¼ 0:053). CONCLUSIONS: Results confirm that patients and caregivers need to be involved in psycho-educational interventions, perceived as highly effective. Above significances prove a professionals difficulty in perceiving patients’ demands, even in a team highly oriented to meet their emotional needs. Education of health professionals becomes a priority in order to develop services capable of understanding the multidimensionality of patients and caregivers.

981 The Cancer Experience among Hispanic-Americans: Psychosocial Issues that may Affect Cancer Outcomes Soler-Vila Ha,b, Penedo Fc a Epidemiology & Public Health, Miller School of Medicine, University of Miami, Miami, FL, USA; b Epidemiology & Public Health, School of Medicine, Yale University, New Haven, CT, USA; c Psychology, University of Miami, Miami, FL, USA PURPOSE: According to US Census projections, Hispanic-Americans (HA) will make up 25% of the US population by 2050. However, psychosocial factors related to HA’s observed lower adherence to medical protocols and poorer cancer outcomes are understudied. We reviewed the literature in order to (a) recognize psychosocial factors that characterize the cancer experience among HA; and (b) study the association between social support and adherence to treatment and follow-up protocols in this population. METHODS: We searched MEDLINE, CINAHL, and PsycINFO databases for relevant articles published in the last ten years in English or Spanish with the following keywords (plus variations): anxiety, attitudes/beliefs, coping, depression, distress/stress, efficacy, optimism, perception,

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psychosocial, religion/faith/spirituality, social support, and treatment. RESULTS: Compared to non Hispanic U.S. Whites, HA reported higher levels of (a) anxiety from family- and work-related demands; (b) lack of social and instrumental support; and (c) fear, and actual rates, of abandonment by partners (mainly husbands). We argue that these factors may contribute to the lower levels of adherence to treatment and post-treatment protocols also reported by HAs in the literature. CONCLUSIONS: Findings from the limited available work underscore the need to address the association between social and instrumental support and adherence to treatment and post-treatment follow-up protocols. These findings may have implications for ethnic minority subpopulations in other countries and help design interventions aimed at increasing adherence to medical protocols and reducing ethnic disparities in cancer outcomes. ACKNOWLEDGEMENTS: Research supported by National Cancer Institute initiative: Redes En Accio´n: The National Latino Cancer Research Network (Junior Investigator Fellowship).

982 Neuropsychological Assessment in Pediatric Oncology Souza MSa, Perina EMa, Morais MICRb, Mastellaro MJc, Aguiar Sc a Mental Health Department, Boldrini’s Children Hospital and State University of Campinas, Campinas, Brazil; bNeurology Department, Boldrini’s Children Hospital and State University of Campinas, Campinas, Brazil; cOncology Division, Boldrini’s Children Hospital, Campinas, Brazil INTRODUCTION: Children and adolescents who have undergone oncological treatment may develop neuropsychological sequelae. A program was created to offer systematized neuropsychological assistance to children and adolescents with cancer, bearing in mind their difficulty of socioeducational reinsertion during and after oncological treatment. OBJECTIVES: (1) To assess the neurocognitive performance of patients with brain tumor especially before and after surgery; (2) To assess learning difficulties in patients with cancer off-therapy; (3) To propose strategies which contribute for their socioeducational reinsertion; (4) To refer patients to rehabilitation centers; (5) To systematic neuropsychological revaluation. METHOD: Interview with parents/patient and psychological and neuropsychological tests such

Copyright # 2006 John Wiley & Sons, Ltd.

as: WISC-III (Wechsler Scale), RAVLT, CFTRey, FAS/ANIMAIS-COWA, Concentrated Attention (CA), Trail Making Test (TMT), Stroop Test, Wisconsin Card Test and HTP. The Neuropsychological Assistance Program takes place in the Mental Health Service at Boldrini’s Children Hospital. RESUTLS: Adequate assessment which correlated tumor’s location with cognitive functioning and respective impairment, allowed the assistance of 27 patients with brain tumor. Social reinsertion contributed for a significant improvement in their quality of life. CONCLUSION: Early intervention and accurate assessment of late neuropsychological sequelae for patients being treated for brain tumor, contributed for their return to school and to the rehabilitation centers referrals.

983 Learning Difficulty: Emotional Disorder or Neurocognitive Deficit? Souza MSa, Perina EMa, Morais MICRb, Mastellaro MJc a Mental Health Department, Boldrini’s Children Hospital and State University of Campinas, Campinas, Brazil; bNeurology Department, Boldrini’s Children Hospital and State University of Campinas, Campinas, Brazil; cOncology Division, Boldrini’s Children Hospital, Campinas, Brazil INTRODUCTION: Over the past 20 years, there has been significant increase in the number of children and adolescents who survived after being treated from cancer. Those who received cranial radiotherapy and intrathecal chemotherapy showed worse neurocognitive and emotional sequelae which compromise the quality of life. This report describes the case of an adolescent with difficulties both in learning and adapting to society. PURPOSE: Using neuropsychological assessment as an instrument for diagnosing possible neurocognitive and emotional sequelae resulting from the oncologic disease and its treatment. METHOD: Male adolescent, 17 years, diagnosed with ALL in the first year of life, having undergone radiotherapy and chemotherapy. Clinic interview was carried out along with the application of tests: WISC-III (Wechsler Scale), RAVLT, CFT-Rey, FAS/ANIMAIS-COWA, Boston Naming Test, Concentrated Attention (CA), Trail Making Test (TMT) and HTP. RESULTS: Patient presented medium superior IQ and preserved cognitive functions. However, he showed delayed response in tasks

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requiring attention with visual search and motor component. Concerning the existent psychological aspects, the patient’s low self-esteem and a strong bond between the patient and his mother compromised his full development which was then made possible by the therapy. CONCLUSION: The neuropsychological assessment was important for diagnosing the absence of relevant cognitive sequelae, showing that the patient’s learning difficulties were related to psychological aspects. Therefore, psychotherapy was necessary for strengthening of his egoic structure and psychosocial development.

is a support group differing from others due to its interdisciplinary configuration and its global view of the patient. It takes not only physical aspects into consideration but also social, emotional and spiritual aspects.

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Currently, the evaluation of life quality has been one of the necessary points in the breast cancer clinical trials. Quality of life is the measure of satisfaction that includes emotional aspects, social wellbeing, life style, economic situation, etc. Involving personal systems of values, expectations and cultural perspectives. The aim of this study was evaluate the quality of life in women with and without Lymphedema post-breast cancer surgery. 23 women were evaluated with breast cancer, of which 7 had been developed Lmphedema. All participants were free from active cancer and had been treated more than one year ago. The SF36: (Medical outcomes Study 36-Item Form Shorts health Survey) was used to evaluate the quality of life. The results showed similar mean scores in both group, but in Lymphedema group QoL scores were lesser than group without Lymphedema. The highest deficits in Lymphedema’s women were founded in role, physical functioning and body pain. Comments: SPONSORED BY CAPES.

GALA}Support Group to the Laryngectomized Souza Festugato M, Martins VB, Santana MG, Macedo TL Liga Feminina de Combate ao Caˆncer Hospital Santa Rita, Porto Alegre, Brazil PURPOSE: Cancer is a disease which brings around emotional and social impact to patients and their relatives. It is hard to cope with all the information about the disease and elaborate on painful emerging feelings, such as, fear, anger, denial, guilt, depression and anxiety. Larynx cancer, one of the commonest in head and neck, often requires total laryngectomy causing definitive tracheostomy and loss of laryngeal voice. One of the resources to help at this point is the participation in support groups. GALA is an operative group of mutual help, open, somatic and homogeneous. The group meets once a week at Hospital Santa Rita and is coordinated by phonoaudiologists, psychooncologist and physiotherapist. OBJECTIVE: To demonstrate the importance of support groups, interdisciplinary work and their influence in general rehabilitation. METHODOLOGY: Initially, orientation is given and doubts are cleared out concerning medical treatment and physical rehabilitation with the performance of Physiotherapy (posture and respiratory functions) and Phonoaudiology (voice and speech). Afterwards, patients bring issues concerning their lives, families and difficulties. Psychooncology permeates the group evolvement by turning meetings into instances of exchange, learning, growth, support and less suffering. RESULTS: There has been improvement in communication, in postural and respiratory functions. As for emotional state, levels of stress, anxiety and depression have been considerably diminished. CONCLUSION: GALA

Copyright # 2006 John Wiley & Sons, Ltd.

985 Quality of Life in Breast Cancer: Comparison Between Women with and Without Lymphedema Souza CB, Alegrance FC, Tardin JM Department of Health Psychology, Methodist University of Sa˜o Paulo, Sa˜o Bernardo Campo, Brazil

986 Coping Strategies in Breast Cancer: Comparison Between Women with and Without Lymphedema Souza CB, Alegrance FC, Tardin JM Department of Health Psychology, Methodist University of Sa˜o Paulo, Sa˜o Bernardo Campo, Brazil The aim of this study was evaluation and comparison of the Coping Strategies used by patients with and without Lymphedema postbreast cancer surgery. 17 women with breast cancer were evaluated, of which 5 have developed Lymphedema. All participants were free from active disease and had been treated more than one year ago. The Coping strategies were measured by Coping Strategies Inventory, development by

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Folkman and Lazarus (1985). The results showed that the most positive coping strategies used, in both group, were Positive Evaluation, which mean of 19.6 from free Lymphedema group and 16.2 from Lymphedema’s women. In both, Social Support was the second more used strategy. All mean scores of coping strategies were lesser from lymphedema patients. Highest deference between groups was in Social Support and Acceptance. COMMENTS: SPONSORED BY CAPES.

987 Burnout}The Actualized Version of the Chiron’s Myth in Daily Oncology Practice Souza CAM Department of Radiation Oncology, Hospital do Cancer do Ceara, Fortaleza, Brazil PURPOSE: This review links the Chiron’s myth to the actual oncologists stress and is illustrated with some passages of semi-structured interviews between three doctors of both sexes, with minimum experience of three years in the oncology field, working at the Hospital do Cancer do Ceara (Brazil). METHODS: The material for this review was taken from oncology periodicals and internet. The three interviews were done among specialists from Hospital do Cancer do Ceara with minimum three years of experience in radiation therapy and oncology surgery. RESULTS: Like the myth, the oncologist is ejected by his career choice, stigmatized by the disease he treats. The professionals delay the reward favoring the daily practice becoming dissatisfied with their routines and relationships. Since medical school, there are many stressors and after the specialization, it becomes worst reflecting the inability to tell bad news and support the patients with limited life expectancy. One female surgeon spoke about the difficulty of giving the cancer diagnose to a patient, specially the young ones. The professionals had different ways of feeling the stress but almost the same strategies to neutralize it favoring the family support and spiritual practice. CONCLUSIONS: Psychological intervention and attitudes preventing the burnout syndrome must be stimulated and the work of the psycho oncologist is fundamental to integrate the staffs and support them in facing the daily activities.

988 Information Helps to Live Spinelli N, Vitalone C

Copyright # 2006 John Wiley & Sons, Ltd.

Associazione Volonta` di Vivere, Padova, Italy A lot of people, most of which unfortunately young, suffer from several cancer conditions and some of them are destined to a sad fate although giant steps in medical research. Being young persons make themselves feel untouchable and often underestimate signs and symptoms, because of both inadequate information and exclusion of young people from cancer’s risk social categories. Therefore making information is a primal instrument as well as enables cancer treatments during precocious period by playing a fundamental role in terms of prevention and precocious clinical diagnosis. Manual ‘Information helps to live’ produced by association ‘Noi e il CancroVolonta` di Vivere’ of Padua serves the purpose informing especially young social category and it is essentially given out to fourth and fifth classes of the Secondary schools. Matters are described by Medicine University of Padua teachers, in order to making aware about prevention relevance and thereby guaranteeing an adequate knowledge about cancer-related problems. The manual is patterned in four essential points: (1) prevention and precocious clinical cancer diagnosis (in senology, gynaecology, urology and dermatology fields), (2) strategies and technical behaviours helping in reducing stress, (3) correct nutrition education, (4) relevance of physical exercise.

989 Communication in Radiotherapy (RT): A New Questionnaire on Information and False Belief Spiota E, Duglio E, Aggero I, Musso M, Bottero G Polo Oncologico, Azienda Ospedaliera Santi Antonio e Biagio e C. Arrigo, Alessandria, Italy INTRODUCTION: Literature analysis shows a lack of instruments and data about information received before or during radiotherapy treatment. Psychoncological focusing was, and until today is, on chemotherapy and oncologist communication but what about radiotherapy patients? OBJECTIVE: Aim of this study is to understand the level of information and the emotional response of patients in a Radiotherapy Department. A new questionnaire and HADS will be used. SAMPLE: The questionnaire was administered to 21 women operated for breast cancer. The age sample mean is 59.95 (DS 12.172, min 36, max 88), only 3 women received a mastectomy, 18 a conservative

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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treatment. MATERIAL AND METHODS: Questionnaires have been administered at four different times: T0 before the first RT examination, T1 after that, T2 during the first RT day, T3 in the middle T4 at the end cycle. HADS was administered to assess psychological distress. RESULTS: The study is still running. Information don’t change from T0 to T1 but when patients were asked to grade the intensity of their beliefs, three questions showed a significant change: concern about touching their children and the fear to grow bald decrease ðp40:05Þ while the fear and awareness to stay alone in the radiotherapy room increase ðp40:05Þ: HADS don’t show significant change but the subjective feeling to be anxious, aroused and gloomy had meaningful change (p40.05). CONCLUSION: From T0 to T1, people don’t change their information: even if we don’t find distressed person, they feel something wrong and this has to be taken into account.

990 Family-oriented Counselling for Women with Breast-cancer Stammer Ha, Sohn Ca, Marme´ Ab a University Hospital for Women, University of Heidelberg, Heidelberg, Germany; bUniversity Hospital for Women, University of Tu¨bingen, Tu¨bingen, Germany Social support especially from family and friends is an important factor in women’s adjustment to breast cancer. Mainly younger women may be concerned about the impact of breast cancer on their partner and children including practical issues such availability of childcare. There is also evidence that coping of the women affects the whole family. In line with the aims of Medical Family Therapy (McDaniel et al., 1992), the central concerns of our family-oriented psychooncological intervention design are to strengthen the ability to cope with the given state of the disease, independently of the likelihood of somatic measures being successful; reduce potential (family) conflicts about handling medical treatment; improve communication with one another and with the doctors; provide support in managing any changes that may be necessary in life-style and plans for the future. This means from the first contact we are interested in the family of our patient. In our diagnostic interview we do a genogram to get an overview of the family situation and potential burdens. If it might be helpful

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we give the opportunity for Couple or Family meetings. We will illustrate our counseling model on specific cases from our women’s hospital.

991 Evaluation of Brain Tumour Story Books Morse Sa, Stargatt Rb,c, Stewart Hd a Speech Pathology, Royal Children’s Hospital, Melbourne, Australia; bPsychology, Royal Children’s Hospital, Melbourne, Australia; cMurdoch Children’s Research Institute, Melbourne, Australia; d Social Work, Royal Children’s Hospital, Melbourne, Australia PURPOSE: There is little information about the process of diagnosis and treatment of brain tumour in young children. A series of storybooks was written to provide age appropriate information to children. The aim of this pilot study was to determine whether these books were helpful to children and families undergoing diagnosis and treatment of brain tumour. METHOD: At this point in time ten families with children with brain tumours have been offered the books and asked to complete a questionnaire about their use. RESULTS: Nine completed questionnaires were scored. Responses to each question were rated on a five point Likert Scale. 100% of the books were read by mothers, 88% by the children, 44% by fathers and 33% by extended family members. 100% of mothers found the books more helpful than other sources of information for themselves, found it helped the family understand what was happening and would recommend it to other families. 77% reported that they improved communication about the illness within the family and that they helped the child understand more. 88% of parents found it helped them to plan for the treatment period, 66% reported they felt more in control. 57% of parents of the children who read the books reported that it helped the child express their feelings. CONCLUSIONS: The Story books were predominantly read by mothers and children. Mothers reported they found the books were very helpful to them and their children in terms of the information they contained, improvement in communication and expression of feelings.

992 Decisions at the End-of-life: Does Information and Discussion Help? Stein Ra, Sharpe La, Clarke Sb, Boyle Fc, Dunn Sd

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a

School of Psychology, University of Sydney, Sydney, Australia; bSydney Cancer Center, Concord Repatriation General Hospital, Sydney, Australia; cMedical Oncology, Mater Hospital, Sydney, Australia; dDepartment of Psychological Medicine, Royal North Shore Hospital, Sydney, Australia PURPOSE: Living with advanced cancer, where treatments are being administered with palliative intent, brings with it a number of treatment decisions. Whilst there has been considerable research on decision-making about treatment options in cancer, an area that has been neglected is the decisions facing people toward the end of their life. One such decision involves not-forresuscitation (NFR) orders. The aim of this study was to examine the efficacy of a structured intervention on the decision-making of patients with advanced cancer. METHODS: A randomised controlled trial was conducted with 141 patients living with advanced cancer. Participants were randomly assigned to an intervention group or control group (no intervention). The intervention consisted of a pamphlet plus discussion with a clinical psychologist. Patients who received the intervention were compared with the control group on a range of measures including mood, quality of life, and preferred level of involvement in decision-making and understanding and preferences for resuscitation. Outcome measures for the caregivers of patient participants were also obtained, including caregiver burden and coping and caregiver and patient communication. RESULTS: Complete results from the study will be presented at the conference. CONCLUSIONS: Our preliminary results suggested that information and discussion about end of life decisionmaking will not have adverse psychological effects on patients or carers and may even improve psychological outcomes, including better communication between patients and families. ACKNOWLEDGEMENTS: This research has been funded by the Patricia Ritchie Psychooncology Scholarship and the Cancer Institute NSW Research Scholar Award.

993 Fatigue, Sleep, Mood and Performance Status in Patients with Multiple Myeloma Coleman EA, Coon SK, Richards K, Kennedy R, Stewart B, McNatt P, Lockhart K, Anaissie E, Barlogie B

Copyright # 2006 John Wiley & Sons, Ltd.

University of Arkansas for Medical Sciences, Little Rock, AR, USA PURPOSE: To describe fatigue, sleep, mood and performance status and the relationships among these variables in patients newly diagnosed with multiple myeloma. METHODS: Data were obtained from 178 patients (77 females, 101 males) before they started an intensive treatment protocol. Assessments included hemoglobin, fatigue with the Profile of Mood States (POMS) and Functional Assessment of Cancer Therapy-Fatigue (FACT-F), sleep with the Actigraph, mood with the POMS, and performance status with the six-minute walk test measuring aerobic capacity and the dynamometer measuring muscle strength. Data analysis consisted of descriptive statistics and Pearson correlations. RESULTS: 71% of females and 53% of males had hemoglobin below 12 g/dl. Hemoglobin was negatively correlated with fatigue and mood disturbance. Average sleep efficiency was 84% for females and 77% for males. Sleep efficiency was positively correlated with aerobic capacity and negatively correlated with fatigue. Aerobic capacity was positively correlated with muscle strength and negatively correlated with fatigue. Correlations were significant at the 0.05 level. CONCLUSIONS: Over half the patients were anemic before starting chemotherapy and this affects their quality of life. Sleep disturbance probably also increases fatigue and may impair functional performance. Increased muscle strength may improve aerobic capacity. Interventions are needed to decrease fatigue, improve sleep and functional performance. ACKNOWLEDGEMENTS: The National Institutes of Health (NIH) [Grant #5 R01 NR00893702] and Ortho Biotech Clinical Affairs, LLC, Bridgewater, NJ, USA.

994 The Impact of Psychological Interventions on Breast Cancer Patients. A Romanian Pilot Study Zarie Ga, Oprean Cb a Ambulatory Service City Hospital, Timisoara, Romania; bOncomed Clinic, Timisoara, Romania PURPOSE: The purpose was to delimitate and to understand the psychological factors which concurs to decrease the quality of life in oncological patients and to counteract them by group psychotherapy. In Timisoara at oncological clinic ‘Oncomed’ since November 2005 a therapy group

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for breast cancer patients was developed. METHODS: It is a randomized controlled ongoing study. The index group received psycho-social intervention, and the control group psycho-educational materials. OBJECTIVES: Primary endpoint: to evaluate the influence of the psychological therapies to cancer patients; secondary endpoint: to research the psychological profile of the oncological population. Instruments of investigation consists in: clinico-demographic information; the results were collected through applying of the following questioners: SCL-90 (Symptom Cecklist-90); 16-PF- Catell Test; HRS-D (Hamilton Rating Scale for Depression; HRS-A (Hamilton Rating Scale for Anxiety); SLE (Stressful Life Events) questionnaire; Quality of Life Scale-WHO 1996. RESULTS AND CONCLUSIONS: After six months of psychotherapy we found: a 50% reduction of anxiety and depression in index group while in the control group the levels remain high; a significant improvement of the quality of life in index group and no change in control group. Psychological profile reveals: high levels of group dependence, conscientiousity and control; a high level of SLE 24 months anterior to illness; increased levels of paranoia; high levels of anxiety and depression.

995 Short Term and Long Term Emotional Impact of One-stop Diagnosis for Breast Zenasni Fa, Dauchy Sa, Auguste Pb, Vielh Pc, Andre´ Fb a Psycho-oncology Institut, Gustave Roussy, villejuif, France; bOncology Institut, Gustave Roussy, Villejuif, France; cBiopath Institut, Gustave Roussy, Villejuif, France BACKGROUND: Studies concerning one-stop diagnosis mostly examined the impact on costs and satisfaction with care. However, the psychological impact of such a procedure has been insufficiently explored (Harcourt et al., 1999). PURPOSE: In order to organize psychological support for these patients, to describe emotional state and distress before the day-diagnosis, immediately after, and two days later, and to identify potential traumatic impact at three months. METHOD: A prospective study was conducted with 279 women who completed a survey before the day-diagnosis. We assessed emotional states (valence, arousal, and dominance) using the SelfAssessment-Manikin (Bradley and Lang, 1994).

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Distress was evaluated using the Distress-Thermometer (Holland, 1999; Dolbeault, 2003). At three months, we evaluate impact of diagnosis on stress using the Impact-Event-Scale (Brunet et al., 2003). RESULTS: 247 patients (88.3%) accept the interview after diagnosis. 61 and 32% of patients returned the questionnaire at two days and three months, respectively. Immediately after the diagnosis announcement, 42% of new cancer diagnosed patients reported distress compared to announcement of mildness (8.3%) or delayed diagnosis (21%) (p50.0001). Predictors of emotional states occurring immediately after announcement of diagnosis are: (1) emotional states before one-stop diagnosis, (2) type of diagnosis, and (3) being accompanied. At two days, only emotional valence significantly improved. Post traumatic stress at three months is significantly linked to emotional valence and distress occurring after diagnosis (r ¼ 0:30 and r ¼ 0:25). CONCLUSION: The day of diagnosis, specific attention should be paid to these dimensions.

996 Daily Walking Predicts Health-related Quality of Life (QoL), Immune Functioning, and Cortisol Level in Women with Breast Cancer Suh Sa, Peterson LJa, Emery CFa, Andersen BLa, Frierson GMb a Department of Psychology, Ohio State University, Columbus, OH, USA; bThe Cooper Institute, Dallas, TX, USA PURPOSE: Breast cancer survivors who engage in physical activity after diagnosis and treatment may experience enhanced QoL, better immune functioning, and decreased stress hormones. Data for this study were collected as part of a randomized clinical trial investigating the effects of a psychosocial intervention. METHOD: Participants were 227 women (90% Caucasian, mean age 50, 54% postmenopausal) with regional breast cancer. Assessments following surgery and prior to adjuvant therapy (Baseline; Time 1) and at 12 months (Time 2) included physical activity, health-related quality of life, natural killer cell lysis and salivary cortisol. A daily walking score was computed in METS units using a 1-day retrospective self-report of physical activity. RESULTS: Participants reported a significant increase in daily walking between Time 1 and Time 2. A series of linear regression analyses were conducted with daily walking as a predictor of QoL, natural killer cell

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activity, and salivary cortisol levels. Results indicated that the amount of daily walking at baseline predicted better overall physical functioning (b ¼ 0:369; p ¼ 0:037), social functioning (b ¼ 0:661; p ¼ 0:046), and higher natural killer cell activity (b ¼ 0:295; p ¼ 0:031) at 12 months. Increases in daily walking from Time 1 to Time 2 predicted lower levels of salivary cortisol (b ¼ 0:001; p ¼ 0:045) at 12 months. CONCLUSION: These results provide further evidence that engaging in daily walking post-surgery may be associated with longer-term benefits at 12 months, including better QoL, better natural kill cell activity and decreased cortisol levels for women with breast cancer.

997 Burnout in Cancer Staff: The Contribution of Sense of Control Taylor C, Surgenor LJ, Horn J Department of Psychological Medicine, University of Otago, Christchurch, New Zealand INTRODUCTION AND PURPOSE: Cancer health care professionals are widely understood to be at a greater risk of work-related ‘burnout’ involving emotional exhaustion, depersonalisation, and reduced sense of accomplishment. Burnout can directly effect patient care, and contribute to staff turnover. Historically self-care strategies and advice to increase resilience to burnout have included increasing personal control. However, the research regarding the role of psychological control largely has been limited to exploring the narrow construct of ‘locus of control’. Using a multidimensional measure, this study reexamines the relationship between burnout and psychological control. METHODS: Using a cross-section survey design, frontline cancer/ haematology nurses and radiation therapists ðn ¼ 65Þ completed a questionnaire booklet assessing levels of burnout along with sense of control, control motivation, domains of control, and methods by which to gain control. RESULTS: On multivariate analysis, different aspects of psychological control contributed to different aspects of burnout. Namely, inadequate/loss of self-control contributed significantly to levels emotional exhaustion, whereas high levels of active control exerted by others contributed to depersonalisation. No aspect of psychological control was significantly associated with sense of accomplishment. CONCLUSIONS: These results

Copyright # 2006 John Wiley & Sons, Ltd.

suggest that any presumed relationship between psychological control and ‘burnout’ may be specific to the aspect of burnout under investigation. Implications are that, by tailoring staff self-care interventions to specific symptoms, control-based coping strategies and mechanisms could be refined and in turn increase their effectiveness.

998 A Prospective Longitudinal Study of the Relationship of One’s Actual Experience of Breast Cancer and Medical Effects: Results at 6 Years Follow Up Surugue Pa, Gateau Cb, Lecourt Ec a Department of Psychology, University Rene´ Descartes Paris 5, Paris, France; bPsychoanalyst, Paris, France; cLaboratory of Research of Clinical Psychology and Psychopathology, University Rene´ Descartes Paris 5, Paris, France PURPOSE: Prospective, exploratory, longitudinal, 6-year long study involving 36 female breastcancer patients, at different stages of the disease. The research investigates one’s actual experience of breast cancer and medical effects. METHOD: It was conducted on patients undergoing semi annual follow up medical visits and participating in several face-to-face interviews plus monthly group meetings. These groups were semi-open, heterogeneous and non-committal, centred on initiating dialog around the patients’ breast cancer disease, which thus became an invitation to achieve a psychological work by and through the group. RESULTS: The analysis identified three categories of life experience. To six women cancer became a ‘meaning-bearing event’. They transformed this ordeal into a personal growth experience. Their prognosis improved, in comparison with relevant statistical data. For 14 women cancer ‘triggered a personal search’, they managed to express a previously unknown pain and they allowed themselves to actualize a potential and to act upon it. For 16 other women, cancer remained ‘an accident to be forgotten’. CONCLUSIONS: A psychological work facilitated not only with discussion groups but as well spontaneously seems to have a reorganizing role and to influence the evolution process. In particular, through a pain apparently exclusively organic, the psychological work seems to enable women to express aspects of their life that go beyond breast cancer organic problems.

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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999 Developing a Comprehensive Cancer Support Service Svolos G Cancer Support & Psycho-Oncology Service, Sydney Cancer Centre, Royal Prince Alfred Hospital, Sydney, Australia PURPOSE: In 2003 a working party was set up to develop a model of psychosocial care for the patients of the Sydney Cancer Centre. This presentation will describe the development of this new model, the implementation and the outcomes achieved. METHODS: Three aspects of the model have now been developed}Psycho-oncology Service, Cancer Information and Support Centre, and the Cancer Support Volunteer Service. Funding was obtained from multiple sources (government and donations) and currently employs four staff}a coordinator, a clinical psychologist, oncology social worker, information and support officer and 65 volunteers. RESULTS: Patients and family now have access to a coordinated range of support services. The Cancer Information and Support Centre has provided a focal point for patients to gain information about services and to be referred as required for counselling and other psychological interventions. The Psycho-Oncology Service provides a specialist counselling and therapy service for patients and families. The volunteer service has enhanced the environment for patients by providing a warm friendly greeting, a cup of tea and someone to talk to if required. Working together with Nurse Care Coordinators, Psychiatrists, Psychologist and Social Workers the service is continuing to develop referral pathways and appropriate screening mechanisms. This presentation will include a discussion of successes and barriers encountered in developing this service. CONCLUSIONS: The service is to be formally evaluated in 2007. We continue to look for funding to employ a psychiatrist to complete the team.

1000 End of Life Care}The Patient Story Swetenham K, Myhill K Southern Adelaide Palliative Services Repatriation, General Hospital, Adelaide, South Australia PURPOSE: A small qualitative research project titled ‘patient stories’ was undertaken to gain an understanding of the patient experience in a

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specialist inpatient palliative care unit. Largely this was undertaken to assess whether our patients did in fact experience holistic care and to gain an understanding of what it is like to be facing the end of one’s life. METHOD: Semi-structured interviews and patient stories (narrative text) underpinned the study. Thematic analysis by way of thematic mapping was utilised. Themes were verified by the co-author and then categorised in order to formulate an action plan. RESULTS: Themes of loneliness, isolation, fear and control, and anxiety emerged. Patients identified that they wished to remain engaged in the living world and that admission to a specialist unit often meant that families were focused on the dying whereas the patient wished to remain focused on the living. This contributed to the loneliness that they experienced. CONCLUSION: Dying is lonely due to the fact that it is a unique experience for each and everyone of us. By setting goals that allow patients to remain engaged in the living world reduces fear and anxiety and allows them some control in the last chapter of their life. Utilising complementary care and the volunteers we have generated an approach that focuses on meeting basic human needs via touch therapy and reminiscence back to a time in life where the individual was experiencing good health. An awareness of these themes has enabled the whole interdisciplinary team to structure all encounters with patients in a manner that addresses those needs the patent identifies as most important.

1001 Bereavement Help-seeking Following a Palliative Death-a Cross-sectional Randomised Population Survey Allen Ka, Swetenham Ka, Currow Da,b, Hegarty Mb, Abernthy Aa,b,c a Southern Adelaide Palliative Services Repatriation, General Hospital, Daw Park, South Australia; b Department of Palliative and Supportive Services, Flinders University, Bedford Park, South Australia; c Division of Medical Oncology, Duke University Medical Centre, NC, USA PURPOSE: Bereaved people have increased morbidity and mortality in the years following their loss. Research has focused on diagnosing complicated grief and the efficacy of grief interventions. Little is known of current patterns of bereavement service use. This study examines the prevalence and nature of bereavement help-seeking among

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the population who in the last 5 years experienced an ‘expected’ death and the characteristics of the people who used these services. PARTCIPANTS AND METHODS: In a randomised cross-sectional state-wide population-based survey, 2985 people were interviewed face-to-face in South Australia in 2004. Respondent demographics, type of grief help (if any) sought, and the circumstantial characteristics (palliative care service use, illness type, level and duration of care, patient comfort in the last 2 weeks of life, and ability to ‘move on’ with life) were collected. Univariate and multivariate regression models were created. RESULTS: There were 1045 people who in the last 5 years had experienced an expected death of someone close to them. Twelve percent sought help for their grief. The most common type of help sought was from trusted family members/friends; 1.7% sought help from a grief counsellor, 1.6% sought help from their spiritual advisors, 1.2% of people accessed a doctor or a nurse. Only 1% of people perceived unmet needs. Those who sought professional help provided higher levels of care for the deceased and identified themselves as less able to ‘move on’ with their lives after the death. CONCLUSIONS: Only 4% of people experiencing bereavement after an expected death access professional support. This figure provides a population baseline helpful in future service planning.

1002 Childhood Cancer and Cure: Reflections on the Mother–Child Relationship Sylos MDa, Perina EMb, Mastellaro MJc, Aguiar Sd a Laboratory of Mental Health, State University of Campinas, Campinas, Brazil; bMental Health Department, Boldrini’s Children Hospital, Campinas, Brazil; cContinuous Education Department, Boldrini’s Children Hospital, Campinas, Brazil; 4 Oncology Department, Boldrini’s Children Hospital, Campinas, Brazil Studies related to the familial dynamic and the relationship between the parents and childhood cancer survivors have shown difficulties of adaptation for the family in the end of the treatment, indicating predominance of protective attitude of the parents as a result of an intensive fear of relapse. OBJECTIVE: To understand and to think over the mother–childhood cancer survivor relationship. METHOD: This study was based on

Copyright # 2006 John Wiley & Sons, Ltd.

psychological assessment carried out with children and adolescents and their mothers in the Clinic After the End of Therapy (CATT). 30 semidirected interviews were analyses having been carried out separately by both the mother and the child. RESULTS: Through the analyses of the data, we could observe that super protective feelings of the mother towards the child as well as ambivalent feelings may lead to conflicts as at the same time the bond between the mother and child was still very intense. The child was also searching for his/her emotional growth in order to constitute his/her own identity. Several times, the mother, even unconsciously, has difficulties in accepting the rupture of the symbiotic relationship. Along with this personal history, the fact of having a survivor of cancer, may lead to some sort of psychological perturbation as depression and anxiety. CONCLUSION: This evaluation has proved to be of great importance for the understanding of emotional effects of the treatment and cure as well as the repercussions on the familial dynamic. This psychodynamic considerations have made possible to think over the preventive interventions.

1003 A Culturally and Linguistically Diverse Cancer Information and Support Education Program Otmarich G, Tait C Cancer Support Programs, The Cancer Council, South Australia, Adelaide, Australia PURPOSE: Three research studies conducted for The Cancer Council South Australia found that there was a lack of basic cancer related information available to culturally and linguistically diverse (CALD) communities in South Australia. There were also limitations of the current methods of information and service delivery available to CALD communities and there were difficulties associated with CALD groups accessing appropriate information. METHODS: A CALD community education project was developed to address these identified needs. The Cancer Council South Australia recruited and trained ten bicultural educators from Chinese, Bosnian, Italian and Arabic speaking backgrounds. The educators were trained to provide information about cancer and cancer support services in a way that was sensitive to the cultural beliefs and the linguistic needs of the community. The training ran one day a week over a period of 8 weeks. RESULTS:

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The ten bicultural educators graduated from the education program and are now delivering culturally appropriate and sensitive information about cancer and cancer support services to their communities. In the course of the training the educators views and feedback provided valuable insights into the differing cultural perspectives on cancer related issues such as palliative care and family support/care. CONCLUSION: Evaluation of the CALD community education program has indicated the need to develop the training further to incorporate education about cancer prevention and early detection as well as differing cultural perspectives.

1004 Psycho-Oncology: Elaboration of Resources to Gather Information on Patients Submitted to Chemotherapy Zoe´ga Soares MR, Trista˜o Casanova L General and Behaviour Analysis Psychology Department, State University of Londrina, Londrina, Brazil Nowadays cancer is considered an illness with behavioral mediation, which requires the psychologist to be a part of the treatment team. PURPOSE: The objective of the research was to gather information and find out the needs of children submitted to chemotherapy treatment in order to develop playful-educational techniques that can subsidize future interventions in the health context. METHOD: One-to-one interviews and non-systematic observations took place at the chemotherapy center, together with the medical team, patients and their families. Play therapy was also used with the children. RESULTS: The results show that there was lack of available information accessible to the parents and children besides the fact that there was also lack of communication between the medical team and patients/family. From the data analysis a routine guide was developed as well as an activity book. The guide describes the routines, the characteristics and phases of the treatment, possible intercurrences, precautions to be taken, and some general information. In the activity book there is information and activities related to the illness and its treatment. CONCLUSIONS: Although they have not been tested yet, it is noticed that there is a need for the development of material that can be used as support for health professionals when it comes to informing parents and

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patients, preparing them or the procedures as well as making it easier for the child and his/her family to adapt to the context of the chemotherapy treatment.

1005 Health-related Emotional Distress in Chronic Illness Tempia Valenta Pa, Sciacca Ea, Lazzarotto Ea, Grisoglio Ca, Rossi Rb a Polo Oncologico, ASL 12, Biella, Italy; bCentro D’Ascolto, Fondo E Tempia, Biella, Italy PURPOSE: The objective of this study was to investigate the significance of emotional distress connected to chronic illness as cancer, cardiovascular diseases, diabetes, BPCO, and chronic renal insufficiency. This study had compared the results between different typology of organic disease in hospital-tested patients. METHODS: The screening data were obtained for all patients in-hospital who suffered of chronic illness in the over specified areas. Hospital patients were interviewed with Hospital Anxiety and Depression Scale for evaluating anxiety and depression. RESULTS: Have been tested 234 patients in Cardiology, Diabetology, Nefrology and Pneumology units and 500 patients in Oncology unit. For the first group the incidence of over-threshold anxiety is about 46% of patients and the incidence of depression is about 50%. In the oncological group 19.2% of patients scored as probable cases of anxiety and 43.4% of patients scored as probable cases of depression. CONCLUSIONS: Subjects who are distressed because of chronic illness in the hospital are at high risk of adverse psychological as anxiety and depression. The discrepancy emerged between the first and the second group is probably due to the organizational order of Oncology Unit in which, from various years, there is a Psychoncology Unit for the treatment of anxiety and depression in patients and relatives and for burnout prevention in the medical staff. Our findings strengthen the argument for in-hospital identification and treatment of patients with depression and anxiety in all the shapes of chronic illness taken in consideration during the present study.

1006 Can the NEQ be Used as an Instrument of ‘Customer Satisfaction’? Tempia Valenta Pa, Lazzarotto Ea, Grisorio Ca, Rossi Rb

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a

Polo Oncologico, ASL 12, Biella, Italy; bCentro D’ascolto, Fondo E. Tempia, Biella, Italy

PURPOSE: In January 2002 the Mental Health Department, the Oncologist Department and the Psychoncologic Centre of Biella Hospital instructed a research plane as concern oncologic patients in Day-Hospital, inserted to an MHD’s former project about chronicity. METHODS: Evaluation focused patients’ requirements by submitting them the NEQ (Needs Evaluation Questionnaire, Tamburini 2000). NEQ was proposed to 500 oncologic patients on chemotherapy, underlining essential necessities to their esteem. RESULTS: NEQ is considered valuable advisor for evaluation of four specific research topics: information, communication, assistance, care/relation. It is to be underlined how some specific necessities of the patient are enhanced by a conditioning status of cancer diagnosis inducing to acquaint necessary information to take hold of the situation and restore some stability. CONCLUSIONS: We have noticed patients interest over certain vague items such as the need of being comforted by doctors, a more sincere relation with them even the necessity of speaking to a psychologist. NEQ does not allow to clearly focus the cause to such requirements (the process to healing or other information regarding their status). Moreover some items aren’t discriminating despite fulfilment of related needs (at the question ‘I need to speak to a psychologist’ the affirmative answer doesn’t exclude that patient is making psychological talks and he wants to continue) without neglecting personal meanings given by the patient to different terms. To conclude NEQ in spite of this is a good research instrument that can be used to evaluate ‘customer satisfaction’ connected to our organization.

1007 Anxiety, Depression and Quality of Life Among Patients and Significant Others at the PsychoOncology Out Patient Clinic, Uppsala, Sweden Thale´n-Lindstro¨m A, Eriksson K, Granat A, Pedersen I, Johansson B Department of Oncology, Uppsala University Hospital, Uppsala, Sweden The Psycho-oncology out-patient clinic at Uppsala University Hospital provides Individual Support (IS) for cancer patients and significant others. Specially trained nurses conduct the IS. The

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sessions focus on psychosocial problems due to cancer. The number of sessions is based on individual needs. PURPOSE: To evaluate the effect of IS on anxiety, depression and quality of life. METHODS: EORTC QLQ-C30 and HADS were completed by patients/significant others before the first ad two weeks after the final session. RESULTS: A number of 83 (55%) of those who completed HADS before the IS (n ¼ 151) reported ‘moderate/severe’ anxiety and 40 (26%) ‘moderate/severe’ depression. There was a decrease in proportion of patients with ‘moderate/severe’ anxiety from 55 to 23% (n ¼ 30213) and with ‘moderate/severe’ depression from 21 to 15% (n ¼ 1128), among those who completed the HADS before and after the IS (n ¼ 55). There was a statistically and clinically significant increase in Emotional function (EF ¼ 48:4270:3) and global quality of life (QL ¼ 51:4268:2) between pre- and post-treatment (n ¼ 46). However, the interpretation of the results must take into account the large number of patients that did not complete the post-treatment measures. CONCLUSIONS: Individual support conducted by specially trained nurses at a psychosocial out patient clinic may increase psychosocial wellbeing among patients with cancer and significant others.

1008 Validation of Screening Instruments to Detect Distress in Cancer Patients in Kerala, India: A Report Thekkumpurath Pa, Narayanan Da, Kumar Mb a Palliative Medicine, Institute of Palliative Medicine, Calicut, India; bLiaison Psychiatry, Becklin Centre, Leeds Mental Health Trust, Leeds, UK Psychological problems are common in cancer patients. Current evidence suggests a prevalence of 30–40% of such problems in cancer patients. Distress is a useful concept used to describe these emotional difficulties that lie in a continuum. Early detection, comprehensive assessment and management of psychological distress have been shown to have a significant impact on the overall Quality of life of these patients. Screening questionnaires are now widely used in the Western population to aid this. Unfortunately there are no such valid and reliable questionnaires available in many languages. PURPOSE: The ongoing study examines the validity of Malayalam translations of three screening instruments, The Brief

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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Symptom Inventory-18 (BSI-18), The General Health Questionnaire-12 (GHQ-12) and Distress Thermometer (DT) in detecting Distress in a Malayalam speaking population of cancer patients in Northern Kerala, India. METHODOLOGY: The questionnaires administered to a consecutive sample of 200 cancer patients attending Palliative care centers in North Kerala are compared to a standard psychiatric interview conducted by a trained psychiatrist in a blind fashion to examine the concurrent validity by looking at the sensitivity and specificity of the above tools. RESULTS: The report will discuss methodological issues, issues related to choice of screening questionnaires, preliminary results and experience of conducting such a study in a relatively new and developing Palliative care setting in India.

1009 Routine Screening for Distress in Newly Diagnosed Rural Cancer Patients. Does it Lead to Better Outcomes for Patients and Multidisciplinary Care? Thewes Ba, Butow Pa, Stuart-Harris Rb a Medical Psychology Research Unit, University of Sydney, Sydney, Australia; bDepartment of Medical Oncology, The Canberra Hospital, Canberra, Australia PURPOSE: Currently there is little published data on the use of the Distress Thermometer as a screening tool in Australian oncology clinics. This study aims to prospectively investigate the utility and feasibility of the introduction of a routine standardised psychological screening program for distress amongst newly diagnosed patients: This study provides important pilot data on the acceptability and utility of the Distress Thermometer within the Australian setting patients at Australian rural oncology clinics. The impact of a routine screening program on the following outcomes will be explored: (a) rates of referral to psychosocial services pre- and post-introduction of a routine psychological screening program; (b) staff satisfaction with the screening program; (c) staff perceptions of the impact of screening on multidisciplinary team care; and (d) patient attitudes towards routine psychological screening. METHODS: This study aims to recruit 150 newly diagnosed cancer patients aged 18 years or more, with no history of metastatic disease. Outcome data will be collected using patient and staff selfreport questionnaires and analysis of referral

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patterns. RESULTS: Data collection for this study will commence shortly, and preliminary results will be presented. CONCLUSIONS: This study provides important pilot data on the acceptability and utility of the Distress Thermometer within the Australian setting.

1010 Ethnic Identity: Associations with Emotional Distress}the 6th Vital Sign Thomas BCa, Carlson LEa,b, Bultz BDa,b a Department of Psychosocial Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada; bDepartment of Oncology, University of Calgary, Calgary, Alberta, Canada PURPOSE: Several authors have noted variations in access to care and treatment outcomes in the context of ethnicity. Literature of late, however, has questioned the categorisation of ethnicity, particularly in the context of acculturation and descendents of immigrants, as opposed to new immigrants. Very little research of this nature exists. We present an overview of the role of ‘ethnicity’ as a risk factor for distress}the 6th vital sign. METHODS: Binary logistic regression was run on the data of a large representative sample of Canadian cancer patients to identify the predictors of distress (Brief Symptom Inventory-18) as well as disease status (recurrent or primary disease). Variables entered in the analysis included the patient’s gender, income, education status, cancer site, and self-defined ethnic identity. Utilisation of psychosocial resources by the various ethnic groups was also studied. RESULTS: Patient reported ethnicity (specifically those who considered themselves immigrants}not Canadians), gender (male, except those with prostate cancer), and low-income status were predictors of distress. However, on a note of caution, patient reported ethnicity was the only variable that seemed to predict an increase in risk for disease recurrence. Despite differences in distress levels amongst ethnic groups, rates of utilisation, of available psychosocial resources were similar across groups. CONCLUSIONS: There is growing evidence that the construct of ‘ethnicity’ has a significant impact on patient behaviour and treatment outcomes. However, ethnicity in a multicultural society needs to be studied as a construct that may include factors like personal meaning and acculturation.

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ACKNOWLEDGEMENTS: This study was funded from an independent grant awarded to Drs Carlson and Bultz from the Zero in on Cancer Fundraiser, 2002, and the Calgary Satellite Research Centre of the Sociobehavioural Cancer Research Network, funded by the Canadian Cancer Society. Dr Linda Carlson is currently supported by a New Investigator Award from the Canadian Institutes of Health Research.

1011 onTrac@PeterMac: A Multidisciplinary Team Approach to Enhancing the Psychosocial Care of Adolescent and Young Adult Cancer Patients in Adult Institutions Thompson K, Palmer S, Thomas D Peter MacCallum Cancer Centre, Melbourne, Australia BACKGROUND: There has been a marked increase in the incidence of cancer in adolescents and young adults (AYA) within Australia during the past decades. However, progress associated with the provision of specialist care lags behind that of both children and adults living with cancer and AYA with cancer remain a population with significant unmet needs. Thus, cancer during adolescence and early adult life is currently an underestimated, under researched and under resourced challenge that requires focused attention and research to clearly define the challenges and development and coordination of adequate, specialized resources to provide the solutions. PURPOSE: Peter MacCallum Cancer Centre has established a program, onTrac@PeterMac, to develop coordinated, integrated and quality oncology care for AYA with cancer throughout Victoria; the first of its kind in Australia. onTrac@PeterMac, is a multidisciplinary team with a strong psychosocial component, this includes a social worker, psychologist and education advisor with expertise in working with this young population. The psychologist attached to the onTrac@PeterMac team is routinely introduced, whenever possible, with all newly referred patients and works closely with the team social worker to provide support to both patients and families. This preventative approach has resulted in a number of very positive and enlightening outcomes. FINDINGS: The poster will present a case study to highlight the benefits of this unique service and identify the ageappropriate psychosocial interventions applied by the adolescent and young adult team.

Copyright # 2006 John Wiley & Sons, Ltd.

1012 The Psychometric Properties of the Icelandic Version of the Distress Thermometer and Problem List Thorvaldsdottir GHa, Gunnarsdottir Sa,b, Smari Jb, Sigurdsson Fa, Bjarnaso Bb a Landspitali-University Hospital, Reykjavik, Iceland; bUniversity of Iceland, Reykjavik, Iceland PURPOSE: This study evaluated psychometric properties, feasibility, and cut-off points of the Icelandic version of the Distress Thermometer (DT) (a single item in the form of a thermometer ranging from 0 to 10) and Problem List (35 items in five categories: practical, family, emotional, and physical problems, and spiritual/religious concerns). METHOD: After translation and backtranslation 149 cancer patients (50 men, 95 women), mean age 59.06 years (SD: 12.92), receiving treatment at the Landspitali-University Hospital completed demographic questions, DT, HADS and GHQ-30 and 5 questions regarding the DT. RESULTS: Scores on the DT ranged from 0 to 10. Mean scores were, for DT 3.09 (SD: 2.40), HADS 7.30 (SD: 4.86) and for GHQ-30 5.28 (SD: 5.60). No gender differences were found. A significant correlation was between the DT and all categories on the Problem List. A significant correlation was between the DT and HADS (r ¼ 0:45) and GHQ-30 (r ¼ 0:57) and between HADS and GHQ-30 (r ¼ 0:68). ROC-analysis suggested a cut-off point of 3 gives the best sensitivity and specificity on the DT. Sixty-nine (48.3%) patients scored 52 on DT and 74 (51.7%) scored 43. Participants took around five minutes to complete the DT and Problem List and found them easy to understand and complete. CONCLUSIONS: The psychometric properties of the Icelandic version of the DT and Problem List are sufficient and they seem feasible to use.

1013 Psychological Screening and Referral: A Snapshot of a Medical Oncology Department Tiller K Medical Oncology, Prince of Wales Hospital, Randwick, Australia The diagnosis and treatment of cancer is a stressful life event for most people. The majority experience symptoms of psychological distress as part of the adjustment process. A significant

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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minority continue to experience severe psychological distress. PURPOSE: This study explores the prevalence of clinical levels of anxiety or depression in an oncology centre and what percentage of those referred for psychological assessment accepted the referral. Reasons for referrals other than clinical levels of distress are also explored. METHODS: Between October 2004 and February 2006, 343 new patients attending a Medical Oncology Department in Australia were routinely screened for psychological distress using the Hospital Anxiety and Depression Scale. RESULTS: 83 patients were identified with clinically significant levels of psychological distress and referred to a clinical psychologist. Twenty-five accepted the referral, significantly more females than males (X2 ¼ 8:12; p ¼ 0:004). During the same time frame, an additional 103 patients were referred for psychological assessment. Referrals were mostly made by medical oncologists (47.7%), breast nurse (28.1%), oncology nurses (6.3%), geneticist (4.7%), and surgeons (3.9%). Most common presenting problems were: adjustment to initial diagnosis and treatment effects (20.4%); anxiety (17.5%); adjustment to diagnosis of metastatic disease (11.7%); flat affect (8.7%); adjustment to diagnosis of recurrent disease (7.8%); relationship difficulties (7.8%); and hereditary cancer issues (6.8%). CONCLUSION: Over two thirds of patients with clinically significant levels of psychological distress did not accept a psychological referral. The majority of patients accepting psychological intervention appear to have done so for support adjusting to different phases of the disease trajectory.

1014 Psychosocial Problems and Distress in Cancer Patients Undergoing Chemotherapy Zainal NZ, Ting JH, Koh OH Department of Psychological Medicine, University of Malaya, Kuala Lumpur, Malaysia PURPOSE: This study aims to determine the prevalence of distress and examine the demographic details and also the psychosocial concerns of the oncology patients. METHODS: All the patients who have been diagnosed to have cancer and attending the oncology clinic for chemotherapy were randomly selected to participate in the study. Demographic data was collected and their level of distress was measured by using the ‘Distress Thermometer’ questionnaire. The same

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questionnaire also looked into the psychosocial problems like child care, housing, financial, transportation, employment and family problems faced by these patients. RESULTS: 168 patients participated in this study, of whom 130 were females and 38 were male patients. The mean score was 3.59+/2.67. 73 (43.5%) of the studied patients experienced distress based on the questionnaire. The findings were analyzed using ANOVA. It was found that patients who faced problems with child care were significantly associated with having distress (p50.001). A significant difference in the presence of distress was also found in the group of patients that had problems with housing, financial constraints, transport, work and family. CONCLUSIONS: The results show that there was a significant difference in the experience of distress in the group of cancer patients who were having practical psychosocial problems (i.e. child care, housing, financial constraints, transport, work and family) compared to the group of patients who did not have the above problems. Therefore psychosocial intervention has a definite role in the complete care of the patients.

1015 Spirituality and the Experience of Being a Member of a Family with Hereditary Breast/Ovarian Cancer among Women with BRCA1/2 Mutations Tinley STa, Kinney Ab a School of Nursing, Creighton University, Omaha, NE, USA; bHuntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA PURPOSE: Women with BRCA1/2 mutations have a history of grief and disruptions in family life due to multiple cancer occurrences, stress related to their own heightened risk and concern about the legacy they have passed on to their offspring. Some women have indicated they would not be able to deal with the grief, stress and concerns if it were not for their spiritual convictions. The purpose of this study was to describe the meaning of spirituality and its relationship to the experience of being part of a hereditary breast/ ovarian cancer family among women with BRCA1/2 mutations. METHODS: In-depth interviews were conducted with 16 women and data were analyzed using a hermeneutic phenomenological approach. RESULTS: The overarching theme of the interviews with sixteen women was that of a reciprocal relationship between their

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spirituality and their experiences. Their experiences as members of HBOC families influenced the meaning of their spirituality by intensifying spiritual struggles, strengthening their spirituality and providing models of spirituality. Alternatively, their spirituality influenced the meaning of their experiences by providing sources of support, easing the decision-making process, and being the source of gifts and gratitude. CONCLUSIONS: Study participants saw their spiritual and health needs as being intimately intertwined. Many wanted providers to be sensitive to the importance of their spirituality in dealing with both the pains and the joys of their lives. Also they have expressed an openness, and for some a eagerness, for providers to inquire about their spiritual needs. ACKNOWLEDGEMENTS: American Cancer Society Doctoral Nurse Scholarship in Cancer Nursing DSCN-03-201-03 (Susan Tinley), National Cancer Institute training grant R25 CA093831 (Kathi Mooney, PI), National Human Genome Research Institute, National Institute of Nursing Research, National Cancer Institute 1R01 HG02241 & 1R01 HG02241-02S1 (Anita Kinney, PI).

1016 Tension Between the Public and the Private: How Women who Choose not to Participate in Population-Based Cervical Cancer Screening Reason about Their Decision Blomberg Ka,b, Tishelman Cb,c, Ternestedt BMa,d a Deparment of Caring Sciences, O¨rebro University, O¨rebro, Sweden; bSection for Nursing, Karolinska Institutet, Stockholm, Sweden; cR&D Unit, Stockholms sjukhem Foundation, Stockholm, Sweden; d Ersta Sko¨ndal University College, Stockholm, Sweden The aim of this study is to investigate the manner in which women who choose not to participate in a population-based cervical cancer screening program (PCCSP) reason about their decision. All women between 23 and 60 years of age, residing in Stockholm county council receive an invitation from the regional Oncologic Center (OC) to attend PCCSP at regular intervals. Women actively contacting OC to report that they did not wish to participate in PCCSP were the subjects for the study. Qualitative data was collected through unstructured telephone interviews with 11 women and fax messages from

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86 women. Inductive analysis found that two salient themes are related to the division of responsibility for health maintenance between the individual and society, and the manner in which women described being able to ‘know’ one’s own body. Descriptions include not wanting to know if one has cancer, previous negative experiences in relation to screening that led to feeling self-exposed and insulted, beliefs that a healthy lifestyle protects one from cancer and a standpoint that the screening program represents undesired societal control of private issues. The complexities of relationships between the public and the private will be addressed. Cervical cancer screening can be viewed as a relatively simple routine checkups, but for the individual woman it may also involve a sensitive situation, with the risk of a life-threatening sickness and an intimate physical examination. In order to improve PCCSP, perspectives from women who have chosen not to attend can be essential.

1017 Rehabilitation After Cancer: The Dallund Centre for Rehabilitation Tofte J, Larsen S, Mark K, Piester CB, Kristensen T The Dallund Centre for Rehabilitation of Cancer Patients, Danish Cancer Society, Søndersø, Denmark BACKGROUND: The Dallund Centre was established in 2001 and is the first Danish centre offering rehabilitation as a residential course. More than 2800 patients have participated in the one week course that consists of information, group and individual conversations, physical activity and different cultural arrangements. The staff consists of doctors, nurses, physiotherapists and a social worker and is supplemented by advisers: dietician, vicar, sexologist and musicians. The general aim is to run, document and evaluate the rehabilitation process as well as describing the consequences of cancer and its treatment. METHODS: Internally: Dallund has developed a number of practical instruments describing the patients’ needs and the practice at Dallund and resuming many individual interventions. Externally: The overall effect of a rehabilitation stay at Dallund is evaluated by an external research group (FOCARE) in a prospective, randomised study. RESULTS: The internal projects at Dallund provide 3600 descriptions of the patients or the situations or

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problems related to groups of patients (physical, psychological, work related or mental) before, during and after their stay at Dallund. So far the results from FOCARE shows significant changes in the patients’ lifestyle, quality of life, coping with their illness and in the patients’ tiredness/ fatigue during the first 6 month after their stay at Dallund. Specific and relevant examples from the results at Dallund and the patient’s personal experiences and symptoms before and after Dallund will be presented.

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duration of their sick leaves and their actual vocational state.

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Duration of Sick Leave and Vocational State of Patients at Rehabilitation Tofte J, Larsen S, Piester CB, Kristensen T The Dallund Centre for Rehabilitation of Cancer Patients, Danish Cancer Society, Søndersø, Denmark

The Survey of Complementary and Alternative Medicine Use Behaviour in Japanese Cancer Patients Tokoro Aa, Hirai Kb, Komura Kc, Kuromaru Td, Ohshima Ae a Department of Psychosomatic Medicine, National Hospital Organization, Kinki-chuo Chest Medical Center, Osaka, Japan; bCenter for the Study of Communication Design, Osaka University, Osaka, Japan; cGraduate School of Human Sciences, Osaka University, Osaka, Japan; dDepartment of Palliative Medicine, Hikone Municipal Hospital, Shiga, Japan; eDepartment of Psychooncology, National Hospital Organization, Kyusyu Cancer Center, Fukuoka, Japan

BACKGROUND: Dallund offers a one week residential course in rehabilitation to cancer patients from all over Denmark. Each year approximately 650 patients visit Dallund on average 8.3 months after their last treatment (range 1–107 months, mode 2 months). PURPOSE: To investigate how long time the patients are on sick leave in relation to their illness, treatment and rehabilitation. To identify factors influencing the duration of sick leave and the possibilities for the patients to return to an active working life. METHODS: All patients coming to Dallund during 2005 and in their active working age were asked to fill in a questionnaire concerning their former and present vocational state and information about the duration of their sick leave. 389 patients answered this questionnaire. The patients also received the Dallund Scale, which is a highly structured one page questionnaire qualified to disclose the patients’ need of rehabilitation. The scale contains the possibility of checking 64 different complications (practical, work or family related, psychological, physical or spiritual factors). The data were analysed to locate possible connections between on one hand, the patients’ diagnoses, treatments, complications (from the Dallund Scale), sex, ages and levels of education and on the other hand, their vocational states and the duration of their sick leaves. RESULTS: We suggest that the extent of the patients’ treatments, their vocational states prior to illness, as well as the presence of physical and psychological complications influence the

PURPOSE: Complementary and alternative medicine (CAM) for cancer patients has been rapidly acknowledged in Japan late years. This work aims to clarify the prevalence of CAM users among Japanese cancer patients, and bio-psycho-social factors contributing to their CAM use behaviour. METHODS: Multi-centre questionnaire survey with informed consent was conducted on 1100 cancer patients in three facilities for cancer in Japan from April to August in 2005. The data of 521 patients out of 651 replies were finally used for analysis. The questionnaire included items about the status of CAM use, the Pros and Cons of CAM., MDASI-J, and HADS. RESULTS: One hundred and fifty eight participants (33.54%) were found to use at least one kind of CAM. The most popular type of CAM was ‘Agaricus Blazei Murill’ (37.3%). The most frequent idea about the pros of CAM was ‘boosting physical and immune strength’, while that of the cons was ‘having unpleasant side-effects’. CAM users tended to believe the pros of CAM more strongly than the cons, while non-users tended to recognise contrary (p50.01). CAM use behaviour was not significantly associated with physical condition nor expression and anxiety (p>0.10). CONCLUSIONS: CAM use behaviour was not related to bio-psycho-social factors, so that another approach to CAM would be needed. ACKNOWLEDGEMENT: This work is funded by Grant-in-Aids for Cancer Research from the Ministry of Health, Labour and Welfare, Japan (Grant no. 13–20 &17–14).

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Copyright # 2006 John Wiley & Sons, Ltd.

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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1020 Research on the Communication of Senior Consultant Oncologists with Their Patients and Clinical Teams Using 3608 Feedback Tolosa IL a,b,d, Rose CLa, Skelton JRc, Horne DJa,d a The Cancer Centre, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK; bPsychology, Birmingham & Solihull Mental Health Trust, Birmingham, UK; cDepartment of Public Health and Epidemiology, The University of Birmingham, Birmingham, UK; dPsychology, The University of Birmingham, Birmingham, UK PURPOSE: To develop and implement a 360 feedback tool to audit and improve the communication of senior consultant oncologists with patients, relatives and staff. The aim of the 360 tool is to: Provide each consultant with confidential feedback on their clinical / managerial / team communication skills. Provide direction if consultants wish to embark on further communication skills development. Reflect on researchers’ and consultants’ learning from the pilot study and the impact of this upon further development of 360-degree feedback for clinicians. METHOD: Pilot participants are 2 senior consultant oncologists, 5–8 patients and 5–8 of the consultants’ clinical team. Participants are volunteers selected at random. Qualitative data has been collected and tape recorded from all participants by means of confidential structured interviews conducted in private. Analysis of data was conducted using written summaries and thematic analysis of the interview transcripts. No identifying features of participants or verbatim extracts are contained in the feedback. Verbal and written feedback was presented to the consultants by means of a confidential interview with a senior member of the research team. RESULTS/CONCLUSION: The results include suggestions from participants on specific ways to improve team cohesion, morale and communication pathways. Patients indicated greatest satisfaction when consultants were able to assess and adapt to their specific communication and relational preferences. The impact of this feedback on the Consultants themselves is also covered. Further developments in communication feedback will be discussed.

1021 What Concerns Them Most? Report from the Southern European Psycho-Oncology Study (SEPOS)

Copyright # 2006 John Wiley & Sons, Ltd.

Travado La, Ventura Ca, Martins Ca, Gil Fb, Grassi Lc a Clinical Psychology Unit, Centro Hospitalar Lisboa (zc)}Hospital S. Jose´, Lisbon, Portugal; bPsychoOncology Unit, Catalan Institute of Oncology, Barcelona, Spain; cSection of Psychiatry, University of Ferrara and S. Anna Hospital, Ferrara, Italy PURPOSE: In a previous study by the SEPOS group, cancer patients concerns were correlated to psychosocial morbidity (HADS) and maladaptive coping styles (MiniMAC) and negatively to QoL variables. As part of the SEPOS general investigation the aim of the present study is: (i) to identify the main concerns in southern European cancer patients and its relation to age, sex, cancer site, type of treatment received, and (ii) identify specific concerns with regard to each country. METHODS: A convenience sample of 287 outpatients with a diagnosis of cancer between 6 and 18 months, a good performance status (KPS>80), no cognitive deficits were approached in university or affiliated cancer centres or hospitals in Italy, Portugal and Spain. Each patient was evaluated for concerns about illness (CWI), socio-demographic characteristics and clinical data. RESULTS: Concerns in general were not high in our population. However the most significant ones concern illness, emotional issues and the future. Significant differences were found for CWI-total score only in terms of age, but using descriptive analysis significant differences emerged for specific concerns relatively to all the variables studied and its categories (e.g. 36–45 yrs old are mostly worried with relationship with partner, economical and work-related issues) and for each country (e.g. Portuguese patients were most worried and Italians least). DISCUSSION: A good KPS used as recruitment criterion may have influenced a relatively low rate of concerns in our study. Addressing patients’ specific concerns is an important target in cancer care to meet their needs and develop tailored psychosocial programs. ACKNOWLEDGEMENTS: Project funded by the European Commission Health and Consumer Protection – Commission on Cancer agreement University of Ferrara, Italy SI2.307317.2000CVG2-026.

1022 DVD of Communication Skills for Cancer Care Professionals with Introduction to SPIKES-BBN Protocol Reis Ja, Travado Lb

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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Psychology Department, Independent University, Lisbon, Portugal; bClinical Psychology Unit, Centro Hospitalar Lisboa(zc)}Hospital S. Jose´, Lisbon, Portugal PURPOSE: EDUCATIONAL MATERIAL. Set of 2 DVDs for fostering the understanding and training in doctor–patient communication and relationship skills and assisting the doctor in the task of breaking bad news. This educational material can be used as an individual training or as supporting material for a training workshop program. TARGET POPULATION: Doctors and other health care professionals working with cancer patients and their families. SUMMARY OF CONTENTS: DVD 1- Communication and Relationship Skills for Cancer Care Professionals: (i) Importance and Consequences of a good relationship with your patient; (ii) How does the interpersonal communication work? (iii) Basic skills of communication and relationship (e.g. active listening, paraphrasing and summarizing, encouragements, clarifying, identifying and reflecting emotions, empathic comprehension). DVD 2}Introduction to Breaking Bad News (adapted from S-P-I-K-E-S protocol by R. Buckman and W. Baile): Step 1}SETTING up the Interview with patient, Step 2}Assessing the Patients’ PERCEPTION of the Illness; Step 3}Obtaining the patient’s INVITATION; Step 4}Giving KNOWLEDGE and information to the patient; Step 5}Addressing the patient’s EMOTIONS with empathic responses; Step 6}STRATEGY and Summary. SUPPORT: DVD available in English and in Portuguese. SPONSOR. Novartis-Oncology.

1023 Breast Cancer Patients’ Psychosocial Profile}A Study with a Portuguese Population Travado L, Ventura C, Martins C Clinical Psychology Unit, Centro Hospitalar Lisboa (zc)}Hospital S. Jose´, Lisbon, Portugal PURPOSE: A diagnosis of breast cancer (BC) is still considered for many a ‘death sentence’ in Portugal. Evidence shows that 25–50% of cancer patients will develop psychological morbidity as a consequence of having cancer. We conducted the present study with the purpose of characterizing the psychosocial consequences of BC in Portuguese patients after active treatment. METHODS: A convenience sample of BC treated outpatients from Multidisciplinary Breast Surgery Consulta-

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tion at Hospital S. Jose, were assessed to evaluate anxiety and depression (HADS), QoL (SEPOSVAS), coping style (Mini-MAC), concerns(CWI) and Sense-of-Coherence (SOC). The protocol used was adapted from the SEPOStudy (Grassi et al., 2004). RESULTS: We assessed 110 women (mean age=58.1yrs; level of education=5.8yrs). Psychosocial morbidity was found in 16.1–24.5%, anxiety in 39.1% and depression in 29.1%. Predominant use of Fatalism, Avoidance and Fighting Spirit as coping styles; support from faith and others as most relevant. Concerns were low and about emotional issues, future and the illness. Meaningfulness is the highest SOC component. Concerns significantly correlated with psychosocial morbidity and maladaptive coping (Hopelessness, r ¼ 0:48; Anxious Preoccupation r ¼ 0:51), and negatively with QoL variables and SOC/meaningfulness (r ¼ 0:41). Faith is significantly correlated with psychosocial morbidity (r ¼ 0:26), Hopelessness (r ¼ 0:27), Avoidance (r ¼ 0:42) and support from others with depression (r ¼ 0:21). SOC is negatively correlated with hopelessness. CONCLUSIONS: Portuguese BC survivors’ psychosocial profile allows us to better understand their needs and to develop psychooncology programs accordingly to address them at an early phase as part of standard patient care.

1024 Sense of Coherence and Psychosocial Morbidity} A Comparative Study with Breast Cancer Patients Travado L, Ventura C, Martins C Clinical Psychology Unit, Centro Hospitalar Lisboa (zc)}Hospital S. Jose´, Lisbon, Portugal PURPOSE: Sense-of-coherence (SOC) is a well known construct in Health Psychology, defined by Antonovsky’s in Salutogenic model suggesting that comprehensibility, manageability and meaningfulness are fundamental ingredients in people’s coping process. These define each person’s Senseof-Coherence, a special trend that helps people facing stressful circumstances and be resilient. The present study has been carried out with the purpose of finding out: (a) the relationship between SOC, psychosocial morbidity and adjustment to cancer; (b) differences between those variables for patients in treatment versus posttreatment. METHODS: A convenience sample of 50 BC patients, with good performance status and no cognitive deficits, were assessed to evaluate psychosocial morbidity (HADS), coping style

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(Mini-MAC), QoL and Sense-of-Coherence (SOC-SF). Patients were recruited either from a follow-up Multidisciplinary Breast Cancer Consultation after their active treatments were concluded (group1) or prior to Chemotherapy treatment at Day Hospital (group2), at Hospital S. Jose, Lisbon. RESULTS: 30 patients for group1 and 20 for group2, mean age 57.8+11.1. No significant differences found for age or SOC. Significant differences found for anxiety, depression and total psychosocial morbidity with group2 having higher scores. Significant negative correlations found between psychosocial morbidity, SOC, well-being and Hopelessness. CONCLUSION: Patients facing active treatments, such as chemotherapy, are at higher risk for psychosocial morbidity and thus need extra psychosocial support. SOC is a protective factor and if fostered may help cancer patients deal better with the uncertainty of their lives in the face of their illness.

1025 Breast Cancer: Rapid Evaluation Card of Psychological Risk Trevisan E Psycho Oncology Service, Associazione Volonta` di Vivere, Padova, Italy Calling attention on psychological aspects of breast cancer. Offering prominence to the dimensional aspects of psychological distress. Discriminating psychological disease from psychological disorder. In the construction of this instrument we have integrated the most recent indications offered by the literature, trying also to develop the best balance between the desire of simplicity and a sufficient measuring capacity. The final version has brought us to select nine evaluation scales coherently gathered into three categories: clinical, psychological and private standards. It is resulted an experience maybe unique in the psychooncological setting that can be precious to underline the constructivistic aspects of psychological distress, to discriminate the different gradients and to show up the multifactorial dimensions of it. In fact it was concretizing the compensatory character of the separate index in virtue of which, for example, it isn’t sufficient the presence of a serious clinical condition to produce an emotional resonance so serious. It is a relatively common experience finding out important psychological reactivity in prognostic contexts decidedly favourable and, likewise, moderate psychological reac-

Copyright # 2006 John Wiley & Sons, Ltd.

tivity in presence of high levels of clinical-medical seriousness. So it is confirmed the absolute pregnancy of the constructivist dimension of psychological disease that calls again us with vigour to the necessity to understand the specific significance attributed to this illness from this person in this peculiar moment of her history, it calls again to oneness of this experience.

1026 Measuring Social Difficulties: Clinical Meaning and Utility of the Social Difficulties Inventory (SDI) Wright Pa, Smith Aa, Brown Sb, Brown Jb, Roberts Kc a Psychosocial and Clinical Practice Research Group Cancer Research, Leeds, UK; bClinical Trials Research Unit, University of Leeds, Leeds, UK; cOncology Social Work, Leeds City Council, Leeds, UK Cancer has a substantial social impact contributing to patient distress. National guidelines recommend social care is identified and addressed routinely, achievable only with appropriate clinically meaningful measures. The Social Difficulties Inventory (SDI) covers a range of relevant social issues and demonstrates good psychometrics. PURPOSE: To develop a clinically meaningful SDI scoring system. METHOD: 609 patients completed the SDI of whom 183 were interviewed. Methods: Rasch analysis, using the Partial Credit Model, was applied. Fit to the model was evaluated, as well as local independence and item invariance. RESULTS: Five items (sexual matters, plans to have a family, holidays, where you live and other) did not fit the Rasch model. All remaining 16 items fit, formed a unidimensional scale and accounted for 72% of the variance (independence, domestic chores, personal care, care of dependents, support for dependents, finances, welfare benefits, financial services, work, planning the future, communicating with close/ others, body image, isolation, mobility, recreation). The scale functions equally well irrespective of age, gender, extent and site of disease. Differences in scores are equally spaced, creating an interval scale, allowing 16 items to be added producing a summary index and for changes in scores to be interpreted meaningfully. Comparison of patient and interviewer assessment was good [ICC 0.61, 95%CI (051,0.70)] although interviewer assessment was on average lower than patient assessments [F(1,182)=4.461,p=0.036].

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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CONCLUSION: The SDI provides an overall clinically meaningful social difficulties score in addition to flagging individual items of concern.

1027 Is Lymphoedema Acceptable or Burden? Focus Group Discussions among Breast Cancer Women with Lymphoedema in Japan Horn S, Ingham R, Tsuchiya M Faculty of Medicine, Health and Life Sciences, School of Psychology, University of Southampton, Southampton, UK PURPOSE: The aim of this study was to explore perceptions of secondary lymphoedema among breast cancer (BC) patients with lymphoedema in Japan. METHOD: Two inclusion criteria were predetermined: 1. women with BC having reported arm swelling in a survey (n ¼ 56=165) and 2. the women providing their contact details (n ¼ 14=56). Three focus groups (N ¼ 10) were conducted in Japan using a semi-structured question route covering four main topics: 1. the concept of a good life, 2. arm complications, 3. changes before and after breast surgery and the onset of lymphoedema, and 4. perceptions of present and future life. All group discussions lasted 2 hours and were audiotaped. Written consent was obtained beforehand. ANALYSIS: All audiotapes were transcribed verbatim. Inductive thematic analysis was applied to the transcripts in Japanese. Subsequently, the transcripts were translated into English, and back translation was performed. RESULTS: Five themes were extracted: 1. Physical constraints 2. Emotional responses to lymphoedema, 3. Negative emotional responses to surgeons, 4. Practical and informational support, and 5. Scepticism about efficiency of lymphoedema treatment. CONCLUSION: Most women reported several physical constraints, but some perceived them as acceptable, while others perceived them as a burden. This evaluation was closely related to information provision on risks of lymphoedema by surgeons and comparison to experiences of BC. Although several physical constraints were experienced, unexpectedly, most women reported limited social support.

1028 Sexual Function in Testicular Cancer Patients During the First Year after Diagnosis: A Multi Center Study

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Tuinman MAa,b, Hoekstra HJa, Sleijfer DTa, Fleer Ja, Gritz ERc a University Medical Centre, Groningen, The Netherlands; bComprehensive Cancer Centre, North-Netherlands, Groningen, The Netherlands; c The University of Texas, M.D. Anderson Cancer Centre, Houston, USA PURPOSE: Testicular cancer is most common in young men. Treatment and related psychosocial functioning may cause sexual problems. We longitudinally studied sexual functioning in relation to treatment, relationship status and depression. METHOD: 93 testicular cancer patients (24 treated with orchidectomy only, 69 treated with orchidectomy and chemotherapy +/ additional abdominal surgery) filled in the International Index of Erectile Function (IIEF) and CES-D after orchidectomy (T1) and 3 (T2) and 12 (T3) months later. The IIEF measures sexual functioning in 5 domains. Repeated measures analyses of variance and correlations were performed. RESULTS: Orgasmic functioning and overall satisfaction decreased between T1 and T2 and increased to an above T1 level at T3. Levels of erectile functioning, sexual desire and intercourse satisfaction were higher at T3 than at T1 and T2. Type of treatment was unrelated to sexual functioning. Singles (n ¼ 36) reported worse sexual functioning at all measurement times than committed patients (n ¼ 57), but desire was equal. At T1 depressive symptoms were highest and related to all domains except intercourse satisfaction (r ¼ 0:19 to r ¼ 0:37). Depressive symptoms were only related to overall satisfaction at T2 (r ¼ 0:37) and at T3 (r ¼ 0:24). CONCLUSIONS: Testicular cancer patients reported improved sexual functioning 12 months after diagnosis in four domains, but desire remained stable. Type of treatment was not related to sexual functioning and depression only shortly after diagnosis. Relationship status was important: singles reported more sexual problems than committed men. Perhaps singles are more insecure about their sexuality and need more guidance.

1029 Association of Alexithymia, Coping Mechanisms, and Illness Behavior to the Pain Experience of Cancer Patients Tulipani Ca, Porcelli Pb, Maiello Ea, Cilenti Ga, Todarello Oc

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a

Medical Oncology, IRCCS Casa Sollievo della Sofferenza San Giovanni, Rotondo, Italy; bPsychosomatic Unit, IRCCS De Bellis, Castellana Grotte, Italy; cPsychiatry, University, Bari, Italy PURPOSE: Alexithymia was found to relate to different pain conditions but no study investigated if it is involved in pain experienced by cancer patients. We investigated if alexithymia, coping with cancer, and abnormal illness behavior were associated to pain experience. METHODS: Validated scales for pain (BPI), alexithymia (TAS-20), coping (MAC), and illness behavior (IBQ) were administered to 108 consecutive cancer patients. Two groups of patients with (n ¼ 45; 42%) and without (n ¼ 63; 58%) current pain were compared. RESULTS: Pain was associated to tumor sites and status, poor adjustment to cancer, and higher disease conviction and perception. Global alexithymia was not related to pain whereas the component of difficulty identifying feelings of the alexithymia construct was significantly higher in pain patients compared to pain-free patients (t ¼ 2:88; p50.01), constituted one of the independent predictors of pain (r ¼ 0:37; p50.01), and correlated with quality descriptors of pain (r ¼ 0:33; p50.05). Multiple associations were found between alexithymia, coping mechanisms, and illness behavior. CONCLUSIONS: Difficulty identifying feelings (one of the 3 core components of alexithymia) was however associated to pain, particularly the quality of pain, thus suggesting it might be involved in the way patients describe their pain experience, regardless of the sensory intensity of pain. Cancer patients experiencing pain should be helped to adopt a more adaptive coping with the disease by identifying more accurately the source of their feelings.

1030 Longitudinal Screening about Volunteers’ Psychological Safeguard in Oncology Division in Como and Sondrio (Italy) Tummino Va, Segat Eb a Department of Mental Health, Sant’ Anna Hospital, Como, Italy; bAssociations ‘Tullio Cairoli’, ‘Mantello’, ‘UNIVALE’ Como, Sondrio, Italy PURPOSE: This poster presentation expounds a longitudinal survey regarding 40 volunteers employed in Oncology Division (Day Hospital, ward and Hospice) during 3 (or 2) years of volunteers’ activity and the importance regular supervision

Copyright # 2006 John Wiley & Sons, Ltd.

meetings, grounded on active communication of experiences and problems among volunteers’ experience. The present study would verify the psychological safeguard of volunteers, above all after some years of deeds and recognize the continuance of a strong motivation, a sufficient emotional equilibrium, good reaction capacities, adaptability and relational abilities in the volunteers. METHODS: The psychological screening has been carried out by a self-administrated inventory: LDM, Lifestyle Defence Mechanisms by C. Spielberger and E. Reheiser. Still in a preliminary form, LDM is comprised of two 12items self-report scales: Rationality/Emotional Defensiveness (R/ED) determined by two subscales: rationality and emotional defensiveness, and Need for Harmony (N/H) determined by two subscales: harmonious relations and self-sacrifice. These scales assess individual differences in the frequency that a person engages in rational, nonemotional thought processes and behaviours, and in efforts to achieve or maintain harmonious interpersonal relationships with family and friends. This inventory has been administrated twice: at the beginning of volunteer’s activity, and retested after 3 (or 2) years of attendance in the hospital as volunteer. RESULTS: We find that there aren’t significant differences in the results between test and retest of this inventory. CONCLUSIONS: These results could be explained with the validity of a good initial selection and a positive management of volunteers.

1031 Learning Through Love: A Children’s Tour of a Cancer Hospital Turner LJa, Saban Kb, Borschneck JAa a Department of Psychosocial and Spiritual Resources, Cross Cancer Institute, Edmonton, Canada; bDepartment of Nursing, Cross Cancer Institute, Edmonton, Canada For children, a family member’s health crisis can be a frightening and distressing time. Learning Through Love: A Children’s Tour takes children who are experiencing cancer in their families through a supportive and educative tour of the cancer facility where family members are receiving treatment. It provides children an opportunity to ask questions and learn about treatment thereby dispelling cancer myths, lessening fears, and enabling children to better handle the unknown and uncertainty that comes with cancer. Children,

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accompanied by a parent or family member, are able to visit the same treatment areas where their family members receive treatment. Polaroid photos are taken of the children in the different areas and each child receives a special memory book in which they can paste their photos and record thoughts or feelings about their family’s cancer experiences. This book also contains cancer awareness and prevention, information about nutrition, sun safety, and tobacco use. This multi-disciplinary tour includes brief stops in the Department of Psychosocial and Spiritual Resources, Daycare Unit which provides out-patient chemotherapy, lab medicine, radiation department, X-ray department, hair and wig salon, and the cancer resource library. At each stop, a professional explains the procedures and answers any questions that the children might have. At the conclusion of the tour, families share a snack, have opportunities for discussion, interact with one another, and are entertained by a balloon artist.

1032 A National Approach to the Implementation of Psychosocial Care for Adults with Cancer Turner Ja, Evans Ab, Luxford Kb, Zorbas Hb, Care Ob a School of Medicine, University of Queensland, Brisbane, Australia; bNational Breast Cancer Centre (NBCC), Sydney, Australia PURPOSE: To undertake innovative strategies to implement the Clinical Practice Guidelines for the Psychosocial Care of Adults with Cancer, recognising the perceived lack of skills in eliciting psychosocial risk factors and responding to patient distress identified by health professionals. Strategies also recognise the lack of institutional impetus for integration of psychosocial care (PC) into clinical practice, with performance indicators typically focusing on practical aspects of care. Guideline implementation to date, undertaken by the National Cancer Control Initiative (NCCI), has included interactive workshops and development of a summary card highlighting key aspects of PC. METHODS: To facilitate targeted guideline implementation, the NBCC is developing: a practical checklist and supporting information to assist multidisciplinary teams identify and document psychosocial risk factors and patient distress, and provide a referral framework, a set of psychosocial data items, which could form the basis for clinical services to evaluate PC, identify

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service gaps, and measure improvement, information to empower patients and their families to understand the importance of appropriate PC. RESULTS: These strategies, targeting consumers, health professionals and health services, will be focus tested or piloted at a national level prior to release. CONCLUSIONS: Through a multifaceted approach, the NBCC is providing tailored approaches to educate health professionals and patients with cancer about the importance of appropriate P. Innovative strategies will assist in identifying patients at increased risk of distress and measuring PC implementation, with the aim of promoting institutional changes in provision of routine PC. ACKNOWLEDGEMENTS: The NCCI Psychosocial Implementation Steering Committee.

1033 Factors Associated with the Self-efficacy of Terminally Ill Cancer Patients: Focusing on Nurses’ Response Ueno Ka, Kaneko Fb, Okamura Hb a Institute of Nursing, Faculty of Medicine, Saga University, Saga-City, Japan; bInstitute of Health Sciences, Faculty of Medicine, Hiroshima University Hiroshima-City, Japan PURPOSE: The purpose of this study was to clarify the factors associated with self-efficacy of cancer patients hospitalized in palliative care unit (PCU). The study focused on nurse’s intervention to the patient and the family. METHODS: All of the patients who were hospitalized in PCU during May 6 through November 11, 2004 was the subject of this study. The survey was performed twice. In the first survey, Terminal Cancer Patient Self-Efficacy Scale and Symptom Inventory were used for the patients within 10 days after admission (baseline). In the second survey, three scales which added Nurse’s Response Evaluation Scale to two scales mentioned previously were used two weeks after the first survey was done. RESULTS: Eleven patients out of sixty-five subjects were involved in the final analysis. The results demonstrated that the attitude of nurses toward the patient and the family was a factor associated with self-efficacy of cancer patients. CONCLUSIONS: The research result suggests that nurse’s attitude to the patient and the family, such as listening carefully to them and understanding their hope, plays an important role for the patient to keep hope till the end of life and to live as they wish.

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1034 Oncology Nurses’ Teaching and Support for Suicidal Patients Valente SM Department of Veterans Afffairs, Nursing Research/Education, Los Angeles, USA Teaching patients about their disorder and providing emotional support and advocacy is an important nursing role, but contradictory evidence exists about how often nurses provide these important interventions. AIM: This secondary data analysis examined nurses’ assessments, interventions, education, emotional support, and advocacy for a suicidal oncology patient. This large exploratory, descriptive study of a random sample of oncology nurses’ knowledge of and attitudes to suicide surveyed clinical oncology RNs (n ¼ 1200) from the Oncology Nursing Society and was completed by (n ¼ 454; 37%). METHODS: Instruments included sociodemographic and clinical inventory, 6-tem Vignette, and 7-item Suicide Questionnaire (SOQ) (suicide knowledge, assessment, and skill). Content analysis provided systematic analysis of narratives from the Vignette and SOQ (Downe-Wambolt, 1992; Morse, 1994). Test-retest reliability was above r ¼ 0:90: FINDINGS: Variable knowledge existed about suicide assessment. Nurses reported low levels of skill and knowledge. Nursing assessments, goals or interventions for patient teaching were absent. Few nurses reported providing emotional support and advocacy for suicidal patients. Overcoming barriers to patient teaching, emotional support and advocacy is essential. Nurses reported difficulty in caring for suicidal oncology patients in several areas. Six categories emerged: religious/other values, uncomfortable feelings, inadequate knowledge, personal experiences, and weight of professional responsibility made it difficult for most nurses to care for suicidal patients. Some nurses reported they had no difficulties. Caregiving is also difficult because the patient’s right to choose suicide may conflict with the nurse’s professional obligation to prevent suicide.

1035 Finding a New Balance: a Cancer Rehabilitation Program Vandebroek Aa, Dergent Tb, Verzelen Ab, Chappel Rc, Mertens Lc

Copyright # 2006 John Wiley & Sons, Ltd.

a

Medical Oncology, ZNA Middelheim, Antwerpen, Belgium; bPsycho-Social Support Team, ZNA Middelheim, Antwerpen, Belgium; cPhysiotherapy & Revalidation, ZNA Middelheim, Antwerpen, Belgium Cancer and its treatment is a threatening experience in one’s life. It is associated with possible long-term consequences: e.g. fatigue, lack of energy, changes in self image. A cancer rehabilitation program may help patients finding a new balance in their life once treatment has finished. In the ‘Ziekenhuisnetwerk Antwerpen - Middelheim’ we started such a rehabilitation program and evaluated the outcome. METHODS: The rehabilitation program consisted of a 12-week group program. It was developed for adult cancer patients who finished an anticancer treatment with curative intent. The program combines physical training with psychological support. Four hours a week participants trained by fitness, group sports and aquagym in small groups of eight persons. All physical sessions were supervised by physiotherapists. The aim of the psycho-educative sessions was to inform patients about several aspects (e.g. fatigue, diet, intimacy, stress and coping). These sessions offered a safe place and supportive environment where participants could verbalize feelings associated with the disease and its consequences. All sessions were guided by psychologists. The outcome was measured by the EORTC-QoL, FACT, UCL questionnaires and by a self-developed Likert-like self-reporting scale. RESULTS: Since January 2005, 72 people participated in the program. Repeated measures showed an increased quality of life and a decreased fatigue. The program had a satisfaction index of 95%. CONCLUSION: In our experience a cancer rehabilitation program is an essential part of cancer care after curative anticancer treatment.

1036 Evaluation of a Face to Face Psychosocial Screening Intervention for Cancer Patients: Acceptance and Effects on Quality of Life Bramsen Ia, van der Linden MHMa,b, Eskens FJMc, Aaronson NKd, Bijvank EMb a Medical Psychology, Vu Medical Center, Amsterdam, Netherlands; bMedical Oncology, Vu Medical Center, Amsterdam, Netherlands; cSocial Services, Vu Medical Center, Amsterdam, Netherlands; d Scientific Research, National Cancer Institute,

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Amsterdam, Netherlands; eMedical Oncology, Vu Medical Center, Amsterdam, Netherlands PURPOSE: Screening programs have been developed to increase recognition of psychological distress in cancer patients, so that adequate treatment can be offered to them. METHODS: The current study evaluates a screening intervention for cancer patients that offered patients a faceto-face contact with a psychosocial professional. Patients who accepted the offer were screened based on a structured interview that resulted in a decision whether to refer to psychosocial services. Newly admitted patients to the oncology department were assigned to a usual care group (n ¼ 50) or the screening group (n ¼ 49). A medical record group (n ¼ 89) was also included. At baseline, all patients, except the medical record group, completed questionnaires on mental health and quality of life. Four weeks after discharge, a follow-up measurement was performed by mail. RESULTS: In the screening group, 46% accepted the offer for a face-to-face contact with a psychosocial professional. Overall, 24% was actually referred to psychosocial services, compared to 8 and 16% in the usual care and medical record group. At follow-up, patients in the screening group reported significantly less pain, better physical functioning and role functioning, and better mental health than those in the their groups. CONCLUSIONS: We conclude that the face-to-face screening intervention represents an improvement over the usual, so-called ad hoc, referral procedure. ACKNOWLEDGEMENT: The study was financially supported by a grant from the ‘Platform Vrouwen VU-hulp’.

1037 Changes in Coherence of Speech Across Time in Women at Increased Risk of Developing Hereditary Breast Cancer Van Dooren Sa, Lansbergen-De Vette Ja, Trijsburg RWa, Seynaeve Cb, Tibben Aa,c a Medical Psychology and Psychotherapy, Erasmus MC, Rotterdam, The Netherlands; bFamily Cancer Clinic, Department of Medical Oncology, Erasmus MC, Daniel den Hoed Cancer Centre, Rotterdam, The Netherlands; cCentre of Human and Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands INTRODUCTION: 357 women at increased risk of developing hereditary breast cancer partici-

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pated in a psychological study on effects of regular surveillance, using self-report questionnaires around two surveillance appointments. However, self-reports may reflect opposite conditions (1,2). Coherence of speech, the ability to talk about a subject in a truthful, consistent manner, is used as a measure to identify such opposite conditions. PURPOSE: Examine changes in coherence over time, and explore if coherence was correlated with distress. METHODS: Three structured interviews were held in a random subgroup of 43 women. Two were held after a surveillance appointment (m1, m3), and one halfway two appointments (m2). Raters gave the interviews a numerical (1–9; 4 5=coherent) and a categorical score (free, entangled or dismissive). Self-reported psychological distress was measured with the Hospital Anxiety and Depression Scale and the Impact of Event Scale. RESULTS: mean levels of coherence were m1: 4.6; at m2: 4.2; at m3: 4.9 (p50.03). Intra-individually these scores differed >2 1/2 points in 28% of the women. Percentages of women classified as ‘free’ were: m1: 33%; at m3: 29%; at m4: 56%. At m3 (the home-situation), the majority of the women were classified as ‘entangled’ (63%). Higher levels of coherence of speech (numerical) were correlated with lower levels of intrusion (m1), avoidance (m2, m3) and depression (m2). These results and their implications will be discussed. 1. DudokdeWit A et al. 1998. Am J Med Genet. 2. Shedler J et al. 1993. Am Psychol.

1038 Peer Relationships of Pediatric Brain Tumor Survivors Vannatta Ka, Fairclough Db, Gerhardt CAa, Kupst MJc, Meyer ETd, Patenaude Ad a Center for Biobehavioral Health Columbus Children’s Research Institute & The Ohio State University, Columbus, USA; bColorado Health Outcomes & Dept. of Preventive Medicine and Biometry, Colorado Health Sciences Center, Denver, USA; cDepartment of Pediatrics, Medical College of Wisconsin, Milwaukee, USA; dDepartment of Psychiatry & Division of Pediatric Oncology, Dana Farber Cancer Institute, Boston, USA PURPOSE: Little is known about the social functioning of pediatric brain tumor survivors (BTS). Existing studies are limited by small samples, reliance on caregiver checklists, and failure to include adequate controls. Our multi-

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site study compares survivors to matched controls on peer relationship measures used extensively in developmental research. METHOD: Participants include 120 children; aged 8–15 and 1–5 years post-treatment for an intracranial tumor without active disease, and 120 classmate controls matched for gender, race, and age. Data were collected at schools using Peer Acceptance Ratings, Friendship Nominations, and the Revised Class Play to assess peer, teacher, and self-perceptions of social behavior. Preliminary effect sizes are presented for 81 of 120 classrooms. RESULTS: BTS were described by peers as displaying less LeadershipPopularity (dLP=0.49), more Sensitivity-Isolation (dSI=0.91), and less Aggressive-Disruptive behavior (dAD=0.55) than controls. Teachers described BTS as less Aggressive-Disruptive (dAD=0.40), more Sensitive-Isolated (dSI= 0.37), and more Prosocial (dP=0.53). BTS received lower acceptance ratings (d=0.37) and fewer friendship nominations (d=0.46), and their friendship choices were less likely to be reciprocated (d=0.34). CONCLUSIONS: Children treated for brain tumors are at risk for social isolation and difficulties establishing friendships but may also exhibit less disruptive and more prosocial behavior than comparison peers. Final analyses will include significance tests as well as analyses of variations that occur as a function of demographic, medical, or treatment variables.

acteristics were assessed in 271 applicants for genetic testing of a known familial pathogenic mutation in BRCA1/2 or a HNPCC related gene before genetic test result disclosure. Hereditary cancer related distress and worry were assessed before, one week after, and six months after result disclosure. The prevalence and nature of changes in family relationships, familial difficulties and conflicts due to genetic testing were assessed six months after test result disclosure. Regression analysis procedure backward elimination was used to identify the predictive qualities of family characteristics. Predictor of cancer related distress over the study period was inhibited communication about hereditary cancer in the nuclear family and the family of origin. Cancer worry was predicted by inhibited communication in the nuclear family. A minority reported unwanted changes in family relationships (19%), problematic situations in the family (13%) or family conflicts (4%). Adverse effects comprised feelings of guilt towards children and carrier siblings, imposed secrecy and communication problems. Predictors of adverse consequences on family relationships were inhibited communication about hereditary cancer with relatives and maladaptive nuclear family functioning. Our data support the need to stimulate open communication between relatives in genetic counseling, because a lack of open communication is associated with genetic testing related distress and familial adverse effects.

1039 Open Family Communication and the Well-being of Individuals Opting for Genetic Cancer Susceptibility Testing Van Oostrom Ia,b, Meijers-Heijboer Ha, Duivenvoorden Hb, Brocker-Vriends AHJTc, Sijmons Rd, Tibben Aa a Department of Clinical Genetics, Erasmus MC, Rotterdam, The Netherlands; bMedical Psychology, Erasmus MC, Rotterdam, The Netherlands; c Human and Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands; dClinical Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands Objective of the study was to evaluate family communication, family functioning, differentiation to parents and support from relatives as predictors of psychological distress and adverse consequences for family relationships in individuals undergoing genetic testing for a cancer susceptibility. The predictive family system char-

Copyright # 2006 John Wiley & Sons, Ltd.

1040 The Effect of Personal Resources on Quality of Life Before and After Cancer Rehabilitation Van Weert Ea,b,c, van der Schans Ca,e, Otter Ra, Postema Kb,c, Hoekstra-Weebers Ja,c,d a Comprehensive Cancer Center, North Netherlands, Groningen, The Netherlands; bCentre for Rehabilitation, University Medical Center, Groningen, University of Groningen, Groningen, The Netherlands; cNorthern Centre for Healthcare Research, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; dPsychosocial Services, University Medical Center, Groningen, University of Groningen, Groningen, The Netherlands; eHanze University Groningen, Center for Research and Development in Healthcare and Nursing, Groningen, The Netherlands PURPOSE: The reasons why some cancer patients benefit more from rehabilitation than others do are unclear. This study examines the effect of

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cancer rehabilitation on social support and selfefficacy, and the effects of these personal resources on QoL. METHODS: 63 cancer patients who had completed cancer treatment, completed questionnaires before (T0) and after (T1) a 15-week multidimensional rehabilitation program. MEASURES: Positive and negative social support, selfefficacy and quality of life (physical, mental and social functioning (RAND-36). RESULTS: Negative support and self-efficacy were unchanged at T1, and positive support had decreased. Positive and negative support and self-efficacy explained between 17 and 47% of the variance in QoL at T0 and T1. Negative support had negative effects on social functioning at T0 and on all QoL domains at T1, along with a prospective effect on mental functioning. Self-efficacy had positive effects on mental functioning at T0 and on physical and mental functioning at T1. Positive support had a negative effect only on physical functioning at T1. The explained variance of change in QoL varied from 52 to 63%, with pre-existing QoL as the most powerful predictor. Decreased negative support and increased self-efficacy accounted for a significant increment in the explained variance of 12–15%. CONCLUSION: Cancer rehabilitation had little effect on the patients’ personal resources. Negative support and self-efficacy appeared to be more consistent predictors of QoL than positive support. Improvements in QoL were associated with increased self-efficacy and reduced negative social support.

effect of 12-week multidisciplinary rehabilitation (MDR) on cancer-related fatigue in comparison to 12-week physical training (PT) and to no intervention. METHODS: Subjects: in this ongoing study 183 cancer survivors, randomly assigned to MDR (N ¼ 75) or PT (N ¼ 65), completed questionnaires before and after rehabilitation. The nonintervention group (N ¼ 43) consisting of patients on the waiting list filled in questionnaires upon enrollment and twelve weeks later. Interventions: MDR consisted of psycho-education (2 hours a week) and physical training (2 hours individual, 2 hours group sports and games). PT consisted only of physical training. Five dimensions of fatigue were assessed with the Multidimensional Fatigue Inventory. RESULTS: ANOVAs revealed no significant differences in fatigue between the three groups at baseline. ANOVAs of post-intervention fatigue, corrected for baseline fatigue, revealed a significant group effect on four of the five fatigue domains (general fatigue F=4.35, p=0.014; physical fatigue F=13.62, p50.001; mental fatigue F=1.92, p=0.15; reduced motivation F=4.30, p=0.015; reduced activity F=4.04, p=0.019). Post-hoc analyses showed that both MDR and PT patients reported significantly less fatigue at twelve weeks than non-intervention patients. No differences were found between MDR and PT patients. CONCLUSIONS: This ongoing study revealed that cancer survivors receiving MDR and PT reported less fatigue than patients not receiving an intervention.

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Effect of an Oncological Rehabilitation Program on Fatigue in Cancer Survivors Van Weert Ea,b, May-de Groot Ac,d, Korstjens Ie, van der Schans Ca, Hoekstra-Weebers Ja a Comprehensive Cancer Centre, North Netherlands, Groningen, The Netherlands; bCentre for Rehabilitation University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands; c Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands; dDepartment of Medical Psychology and Psychotherapy, Erasmus Medical Centre, Rotterdam, Rotterdam, The Netherlands; eDepartment of Health Education and Promotion, Maastricht University, Maastricht, The Netherlands

Clinical Efficacy and Economic Benefits of Psychosocial Oncology Care Va´rady E, Lakos M, Molna´r Z, Risko´ A´, Rosta A Hematology, National Institute of Oncology, Budapest, Hungary

PURPOSE: Research indicates that rehabilitation reduces fatigue in cancer survivors. A randomized controlled trial was performed to examine the

Copyright # 2006 John Wiley & Sons, Ltd.

As health care costs continue to rise, decision makers must allocate their increasingly scare resources toward therapies which offer the most benefit per unit of cost. To be considered by these decision makers, efficacy of psychosocial interventions in cancer patients and their outcomes must be known. Psychosocial distress is a significant problem for one-third to one-half of all cancer patients. However, fewer than 10% of patients are actually identified and referred for psychosocial help. Distressed patients have trouble making decisions about treatment and adhering to treatment, and may extra visit to the physician’s office

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and the hospital emergency department. Unattended distress can contribute to poor treatment compliance, increased hospital stays, and possibly mortality. Psychological interventions offered as an adjunct to the medical care of recently diagnosed cancer patients aim to prevent distress and enhance coping styles. As some randomised studies have found that patients who have received psychosocial intervention show not only improved quality of life scores but tend to live longer. Psychosocial interventions saves money by reducing unnecessary office visits, medical procedures, and hospital admittance. For patients with cancer, integration of mental health service and medical service is critically important, and management of distress is part of their total medical care. The estimated benefit of psychosocial care is much greater than the cost of the psychological service. Authors want to convince decision makers that psychosocial interventions have proven efficacious for helping cancer patients and not only effective, but also economical.

1043 Assessment of the Psycho-social Well-being of an Oncological Home-care Team Varani Sa, Giardino Rb, Fierro Cc, Brighetti Gd, Pannuti Fe a Psychology, Service Fondazione ANT Italia, Bologna, Italy; b Experimental Surgery Laboratory, Codivilla Putti Research Centre, I.O.R., Bologna, Italy; cPsychology, Service Fondazione ANT Italia, Bologna, Italy; dPsychology Department, University of Bologna, Bologna, Italy; e General, Direction Fondaziona ANT Italia, Bologna, Italy PURPOSE: The purpose of this study was to assess the psycho-social and organizational determinants of well-being of an oncological home-care team. The study has been developed by the Fondazione ANT Italia, in several ANT oncological home hospices in Italy. METHODS: We studied the operators’ well-being from 3 dimensions: (A) personal (Maslach Burnout Inventory); (B) organizatonal (Team Climate Inventory); (C) environmental (Family Strain QuestionnaireShort Form). The sample consisted of 115 operators, 80 physicians and 35 nurses. The study has been developed in 11 home hospices. Group differences and similarities were analysed using ANOVA and Spearman’s correlation. RESULTS: Compared to controls, results showed a medium-

Copyright # 2006 John Wiley & Sons, Ltd.

low level of burnout in the ANT team. Emotional Exhaustion (15.76+10.27) and De-personalization (3.49+3.95) were significantly lower compared to normative data. The degree of Personal Accomplishment (39.38+7.02) was medium-low. Organizational climate was better than in the Italian normative sample to all levels. Scale of Vision (41.86+8.33) and Task Orientation (22.81+7.51) were significantly higher than the normative data. Also Participative Safety (24.26+6.12), Support of Innovation (33.23+ 8.71) and Interaction Frequency (10.77+2.67) were higher than in Italian normative data. CONCLUSIONS: These results should be considered an important starting-point to encourage a major knowledge of the organizational context. Moreover, our data could be useful to promote the consolidation of the positive aspects and to change the negative factors.

1044 Coping Style, Perceived Social Support, Sense of Coherence and PTSD Following Breast Cancer Varela MPa,b, Leal IPa a Instituto Superior de Psicologia Aplicada, Lisboa, Portugal; bInstituto Superior de Estudos Interculturais Instituto Piaget, Viseu, Portugal Breast cancer is the most prevalent cancer in women in Portugal. A diagnosis of breast cancer is difficult, and normally one believes that Posttraumatic Stress Disorder (PTSD) is experienced by individuals diagnosed for a life threatening illness, like cancer. Although the experience of traumatic event is unfortunately and surprisingly prevalent, a substantial majority of trauma victims do not ultimately develop PTSD. Accordingly, it is incumbent upon researchers to identify factors associated with vulnerability and resistance following exposure to a traumatic event. In the present study was investigated the presence of PTSD, as also the relation between PTSD, coping style, perceived social support and sense of coherence in a sample of 84 women with breast cancer. The measures completed were the following: perceived social support (Social Support Satisfaction Scale), coping style (Mini-Mental Adjustment to Cancer Scale), sense of coherence (Orientation to Life Questionnaire) and PTSD (PTSD Checklist Civilian Version). Results indicated that PTSD was associated with a lower degree of perceived social support and sense of coherence, and the use of avoidance coping,

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anxious preoccupation, fighting spirit, discourage/ weakness. Twenty-five percent of the women warranted a diagnosis of cancer related PTSD. It is necessary examine factors that protect women from PTSD following the diagnosis of breast cancer with the objective of designed specific interventions to improve the patient adjustment and functioning.

1045 Emotional Problems in Patients with Totally Implantable Venous Access System (PORT) Varetto A, Binaschi L, Torta D, Torta R Psycho-Oncology Unit, University of Turin, Turin, Italy PURPOSE: Totally implantable venous access system (PORT) is a common oncological practice. Patients frequently demonstrated depressive symptoms, undetectable before PORT implantation: this study evaluates emotional and coping responses to PORT implantation in advanced cancer patients. METHODS. Short term study (Jan/Apr 2000) 25 patients with PORT versus 25 patients without (colorectal, breast, lung ca; 22 F, 28 M) evaluated before implantation and three months later; long term study (Sept 2003/Mar 2004) 30 patients (colorectal, lung, breast ca;15 F, 17M, mean age 59.9), with more complete information, assessed before implantation and 6 months after, with: Hospital Anxiety Depression Scale, Mini-Mental Adjustment to Cancer Scale, Visual Analogue Scale, EORTC QoL C30, semistructured interview to evaluate physical, emotional and social problems. RESULTS: short term study: patients with PORT (group A) at T1 demonstrate higher levels of depression than patients without (group B). Long term study: HAD depression scores increase non significantly at T1; QoL and patient’ satisfaction were perceived quite good. Mini-MAC shows increase of cognitive avoidance, fatalistic and fighting coping styles, and a decrease of anxious and hopelessness/helplessness ones. Semistructured interview underlines that 98–95% of patients experienced PORT as an emotional recall of illness. CONCLUSIONS: Presence of PORT forces feeling of illness and prevent the onset of effective defensive mechanism, which increase depressive feelings. The long term study, with more information to patients, shows lower level of depression a T1 and a wide range of coping styles, with an improving of fighting spirit.

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1046 Emotional Evaluation and Patient Satisfaction in Patients with Endocrine Sequelae of Young Survivors of Childhood Cancer Varetto Aa, Brignardello Eb, Caldera Pa, Munari Ja, Torta Ra a Psycho-Oncology Unit, University of Turin, Turin, Italy; bOncological Endocrinology, University of Turin, Turin, Italy A turning point in childhood cancer young survivors life is the transition from a paediatric structure to an adult hospital. This elicits difficulties in coping strategies, mainly in disease acceptance, autonomy degree and responsibilities assumption. PURPOSE: Evaluation of disease impact and later side effects due to the oncological therapy in terms of emotional relevance and patient satisfaction. METHODS: 31 consecutive patients (mean age 25  4; 10 f, 11m) of the Oncologic Endocrinology ambulatory at the A.S.O. San Giovanni Battista of Turin, suffering from previous cerebellar neoblastoma, acute lynphoblastic laeukemia (LLA) and Hodgkin’s Lymphoma (LH), evaluated by MMSE; HAD, Cope Test Scale, semi-structured interview. RESULTS: Anxiety and depression levels are not relevant; both active coping (positive re-interpretation and growth; active coping and planning), and avoidance (behavioural disengagement, substance use) strategies are used; the semi-structured interview highlights the difficulty in relational growth (52% considered sufficient his extraparental relationships, 57% reported no relationship) and the acute awareness of the therapeutic implications, including the constant clinical support, perceived effectiveness of the therapy, evaluation of human background that has accompanied the patient so far: the judgment is ‘good’ in 30%, ‘sufficient’ in 60% and ‘poor’ in 46% of the cases. The patients opinion on the whole care unit is ‘good’ for 53% and ‘sufficient’ for 46%. CONCLUSIONS: Follow-up requires concerning both for these young patients personality considering the risks of avoidance or self-destructive behaviour, and for the staff which may represent their first adult relationship.

1047 Child Bereavement: Sharing the Pain of Loss Vasconcellos Ea, Perina Ea, Faria Fb, Aguiar Sc

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a

Mental Health Department, Boldrini’s Children Hospital, Campinas, Brazil; bLaboratory of Mental Health}Medical Science, State University of Campinas, Campinas, Brazil; cOncology Department, Boldrini’s Children Hospital, Campinas, Brazil INTRODUCTION: The psychosocial repercussion of childhood cancer upon the family dynamics is of extreme importance, mainly in cases when illness progresses to decease. At this moment, the integrity of families’ ties are threatened by arising conflict and disorganization. Children and adolescents going through the process of illness and treatment of close relatives suffer with all this disruption, having to give up their parent’s attention, witnessing the adults anguish as well as the suffering of the person who is ill. Confronting death and during the following period of bereavement, these children and adolescent have to elaborate the loss to invest again in life, a new family cycle. OBJECTIVE: Analyse the symbolic representation of death and understand the elaboration process of bereavement. METHOD: Qualitative study based on verbal and graphics content referring to intervention in a one session, through art therapy. Subjects: Ten bereaved children. RESULTS: The participants of the family group brought up themes referring to the suffering during the period of illness, taking experiences, fantasies and conflicts which were not related to the specific breaking up of relationship after death, but related to aspects of the previous relationship as a try of internalized image reconstruction of the deceased loved one, reminding of moments and important and positive facts as well as memories of intensive family anguish were sought during intervention, showing a wide range of feeling gone through. CONCLUSION: This study generated important reflections upon bereavement in childhood and adolescence, subsiding the perfection of the new interventions.

1048 You Cannot make an Omlet without Breaking Eggs: Personality/Stress/Coping and Cancer Ventura Ia, Santos Zb a Psychiatry/Clinic Psychology, Coimbra University Hospital, Coimbra, Portugal; bPsychiatry, Coimbra University Hospital, Coimbra, Portugal PURPOSE: To study, using the Comprehensive System from Exner of the Rorschach and a Stress

Copyright # 2006 John Wiley & Sons, Ltd.

Vulnerability Questionnaire, the psychological variables concerning Coping and Stress in women with breast cancer. METHOD: Twenty women with breast cancer currently doing chemotherapy/ radiotherapy in Coimbra University Hospital (Portugal referred to a Consultation Liaison} Psychiatry, were assessed with Psychodiagnostic from the Rorschach and the Stress Vulnerability Questionnaire (23 QVS). RESULTS AND CONCLUSIONS: Results are presented and discussed.

1049 Distress in Patients after Treatment for Head and Neck Cancer and Their Spouses Verdonck-de Leeuw IMa, Eerenstein SEJa, Van der Linden MHMb,c, de Bree Ra, Leemans RCRa a Otolayrngology}Head & Neck Surgery, VUmc University Hospital, Amsterdam, The Netherlands; b Medical Psychology, VUmc University Hospital, Amsterdam, The Netherlands; cMedical Oncology, VUmc University Hospital, Amsterdam, The Netherlands PURPOSE: To obtain more insight in distress in patients treated for head and neck cancer and in their spouses, in relation to age, gender, health status, coping style, cancer related factors (tumor site and stage, treatment modality; time since treatment), functional and social impairment after treatment, and caregiving burden. METHODS: 41 patient–spouse pairs completed the HADS. Possible determinants included age, gender, health status (ACE-27 comorbidity (patients) or SF36 (spouses)), coping strategy (UCL), time since cancer treatment, tumor stage (T1-2 vs T3-4) and site (larynx vs oral cavity/oropharynx), treatment modality (surgery or radiation, surgery and radiation, chemoradiation), functional and social impairment (EORTC H&N35 questionnaire), and care giving burden (CRA questionnaire). RESULTS: Mean total HADS score of the patients and spouses was 9.8 and 8.8, both higher compared to the age-matched Dutch normal population (mean 7.6). A clinical level of distress was noted in 27% of the patients and 20% of the spouses. Distress in patients was related to comorbidity, speech and swallowing problems, less social contacts, a passive style of coping, and nonexpression of emotions. Distress in spouses was related to the presence of a feeding tube in patients, a passive coping style, less vitality, and a disrupted schedule due to caregiving.

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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CONCLUSIONS: Distress is often present in head and neck cancer patients, and also in their spouses. Routine screening for psychological distress is recommended. A study on psychological group therapy has started to assess efficacy of intervention.

1050 Factors Predictive Decision to Continue Genetic Counselling: Psychosocial Variables and Risk Perception Vigna Ca, Caruso Aa, Savarese Ab, Cognetti Fb, Sega FMc a Department for Prevention and Formation in Psycho-Oncology, Regina Cancer Institute, Rome, Italy; bDepartment of Medical Oncology, Regina Cancer Institute, Rome, Italy; cDepartment of Surgery, Regina Cancer Institute, Rome, Italy PURPOSE: Survey influence of psychosocial variables as predictive of decision to continue genetic counselling for hereditary breast/ovarian cancer in order to: monitoring impact of first information counselling session; improving counselling organizational aspects; creating adequate informative campaign. METHODS: 120 subject received preliminary information and don’t ask for second step of counselling. A psychologist called subjects to explain the study and send by post following questionnaires: MMPI 2, FACESIII, HADs, Genetic and Cancer Risk Perception (GRP-CRP), motivations to interrupt counselling. RESULTS: Actually 26 female sent back questionnaires. Cancer affected 15/11; mean age 46. MMPI-2 profile shows normal values. HADs. Anxiety: Normal 50%, Borderline 27%, Disturb 23%. Depression: Normal 69%, Borderline 15%, Disturb 16%. FACES-III. Ideal Cohesion: affected=unaffected ¼ 44 vs 37; Ideal adaptability: affected=unaffected ¼ 37 vs 32. GRP: I don’t know ¼ 50%; Low ¼ 11:5%; Average 31%, High 7.5%. CRP: I don’t know ¼ 34:5%; Low ¼ 15:5%; Average 34.5%, High 15.5%. Frequent motivations to interrupt counselling: ‘It will be too difficult knowing that I will probably develop cancer’ (46%), ‘I’m afraid about consequences for me and my family’ (42%). CONCLUSIONS: Anxiety is higher than depression; cancer affected subjects perceived more distance between real family and ideal family. A high percentage of subjects answer ‘I don’t know’ about their own genetic risk. It seems that motivations to interrupt genetic counselling are bounded to the fear about

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knowing, and being unable to handle, the information about genetic risk.

1051 The Importance of Tele-Assistance in the Palliative Treatments of Terminal Phases. The Tele-medicine Raffaeli W, Vignali A Unit of Analgesic Therapy and Palliative Treatments, Infermi Hospital of Rimini}Local Health Unit of Rimini, Rimini, Italy PURPOSE: This study checked the applicability of telemedicine and its effectiveness in managing home palliative treatments through an integrated network connected with the hospice. METHODS: Tele-assistance has been experimented on a sample of 23 terminally ill patients affected by oncological pathologies. The clinical situation of each patient has been kept under control; they filled out questionnaires on their service satisfaction. A technical analysis has emphasized the importance of a double connecting system: a notebook provided with web-cam and a videophone. RESULTS: The set-up of the videophone took a long time (23.08 days), shortened by the anticipated use of notebooks and web-cams (only 3.43 days). There were two structural breakdowns, but no defaults due to technical reasons. Average of weekly contacts: 1.37. Average of the taking care days: 49.04, 95.83% of the patients were satisfied of the service. CONCLUSIONS: The computerized system has demonstrated to be an innovating and useful instrument in the organization of palliative treatments for terminally ill patients. It allows stronger patients to go home, and eases those patients having a difficult situation or a family that could not support them to stay at home. Even though technology is non-specific yet, the set-up of an assistance network is very important in managing the complexity of both patients and their families’ needs. ACKNOWLEDGEMENTS: This study has been developed thanks to the funds generously given by the Health Ministry and the Public Health Agency of the Emilia-Romagna region.

1052 Affective and Functional Status in Elderly Cancer Patients Vigorelli SM, Morgana F, D’Accordi S, Capovilla ED Oncologia Medica, Istituto Oncologia Veneto I.R.C.C.S Ospedale Busonera, Padua, Italy

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PURPOSE: Integrate acceptance: functional and psycho-affective status in a sample of 190 elderly cancer patients (125 female, 65 male), aged 70–92 in charge at Medical Oncology Department in the period from April 2004 to January 2006. METHODS: Frequency analysis on Activity of Daily Living (ADL) and Geriatric Depression Scale (GDS) scores as reported in Multidimensional Geriatric Assessment (MGA). RESULTS: Results indicated that 32.1% (61) of the sample had light or serious depression. Of these patients, 44.3% (27) had limitations for one or more ADL, while 55.7% (34) were self-sufficiency persons. CONCLUSIONS: Results show relation between the presence of light or serious depression and not self-sufficiency. It will be important, for the next steps of the study, to be able to verify the significance of such correlation.

1053 The Family Demoralization Trajectory (FDT): Caring for Families Facing a Cancer Recurrence Vivar CGa, McQueen Ab, Whyte DAb, Canga NAa a Community and Maternal & Child Nursing, School of Nursing, University of Navarre, Pamplona, Spain; bNursing Studies School of Health in Social Science, The University of Edinburgh, Edinburgh, Scotland PURPOSE: Cancer survival is increasing, and as people live longer, survivors can experience recurrent cancer. Suffering from recurrence has been described as one of the most stressful phases; even more distressful than the first experience of cancer. Despite this reality, the phenomenon of recurrence is poorly understood from a psychosocial perspective. Nurses, as part of the oncology team, need to develop an understanding of the way in which families perceive recurrence to assist them to cope with their experience of recurrence. This research aims to investigate the psychosocial impact of cancer recurrence from the views of patients, family members, and nurses. METHODS: This grounded theory study was based in Navarre in two Spanish hospitals. The sample consisted of 15 patients, 13 relatives, and 14 nurses. Data collection and analysis were based on the constant comparative method of Glaser and Strauss. NUDIST, a computer software for qualitative data, was used through the analysis. RESULTS: A substantive theory has been developed that articulates a nursing framework for the care of a family facing a recurrence

Copyright # 2006 John Wiley & Sons, Ltd.

of cancer. Demoralization, characterised by feelings of exhaustion, reawakening of thoughts of death, and fear of the unknown was found to be an emotional response of families to recurring cancer. CONCLUSIONS: This paper breaks new ground in the area of psycho-oncology by focusing on demoralization as an important issue in cancer care. An understanding of the feelings of demoralization in cancer can help nurses to comprehend better the family’s experience of cancer recurrence.

1054 Shared Decision Making in Women with Newly Diagnosed Breast Cancer. A Randomised Controlled Trial Vodermaier Aa,b, Caspari Ca, Ko¨hm Ja, Bauerfeind Ia, Kahlert Sa a Obstetrics and Gynecology}Grosshadern, University of Munich, Munich, Germany; bPsychiatry, University of Toronto, Toronto, Canada PURPOSE: Shared decision making interventions in the treatment of newly diagnosed breast cancer patients have demonstrated an increase in disease specific knowledge and influence medical decision making. Effects on psychological outcome have shown inconclusive results. Potential mechanisms have not been studied so far. METHODS: Three decision aids for the treatment of primary breast cancer were developed and we investigated the effect on medical decision making, decision related variables (decisional conflict, doctor–patient interaction, satisfaction), psychological variables (distress, body image, quality of life, health related locus of control, active/depressive coping) within a prospective randomised controlled trial. Of 152 patients randomised 111 were included in the analysis. Participants were followed up one year. Retention rate was 88%. RESULTS: Groups did not differ at baseline on any dependent variables. There were no group differences in rates of breast conserving therapy and chemotherapy in women with hormone responsive tumours. However, the intervention group was better informed, perceived higher clarification of values, quality of decision, and had overall less decisional conflict. There was no impact on doctor-patient-interaction and satisfaction. Women in the intervention group reported more favourable body image, but there were no effects on anxiety and depression symptoms or quality of life. Participants of the intervention group had higher internal health

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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related locus of control. No group differences on coping measures have been found. CONCLUSIONS: Shared decision making in the inpatient setting under study had a limited effect on patients’ decision quality. No impact on doctorpatient-interaction and small effects on psychological outcome were demonstrated.

1055 Communication and Decision Making in Breast Cancer Care: Essentials for Patient Satisfaction Vogel BA, Helmes AW, Bengel J Department of Rehabilitation Psychology, University of Freiburg, Freiburg, Germany PURPOSE: Involving patients in the decision making process is widely advocated because it enhances patient control over their health care. The purpose of the study was to explore the patients’ decision making experiences and to find predictors for patient satisfaction. METHODS: 106 breast cancer patients were recruited at all clinics of the two breast cancer centers in Freiburg, Germany. Study staff approached patients within a week of either surgery or the beginning of neo-adjuvant chemotherapy and invited women to complete a self explanatory questionnaire. RESULTS: The majority of patients was satisfied with the decision making process and the physician-patient communication. Patients who felt having available choices regarding different treatment options were more satisfied with the decision making process and the communication than patients with no choices (p ¼ 0:023 and p ¼ 0:012; respectively). The decision making experience (active, passive or collaborative) showed no difference in the level of satisfaction, quality of life, anxiety and depression. Patients who participated to a greater or lesser degree than preferred were more depressive and anxious and were less satisfied with the physician–patient-relation, -communication and the decision making process compared to patients who achieved their preferred role. Satisfaction with decision making was predicted by satisfaction with the physician–patient communication, achieved role preference and information uncertainty ðR2kor ¼ 0:55Þ: CONCLUSIONS: Physician–patient communication is essential in decision making. Physicians should reduce patient information uncertainty and match the role preferences of the patients to satisfy patients with the decision making process.

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1056 Noncompliance in the Patients with Hodgkin’s Disease Vybornykh DEa, Savchenko VGa, Moiseeva TNb, Gabeeva NGb a BMT National Research Center for Hematology, Moscow, Russian Federation; bDepartment of Hematology and Intensive Care, National Research Center for Hematology, Moscow, Russian Federation PURPOSE: Significant noncompliance brings a lot of problems to treatment process noted in the patients with Hodgkin’s disease. This study has been undertaken to set up a typology of states lead to noncompliance in these patients and to propose the way to resolve this problem. METHODS: Twenty four patients with Hodgkin’s disease and with signs of noncompliance were enrolled in our study and examined by clinical psychopathological method. RESULTS: All patients were divided into three groups according to detailed of states types: (1) psychoses ðn ¼ 6Þ; (2) self-management of treatment process ðn ¼ 4Þ and (3) refusal of treatment ðn ¼ 14Þ: There were two patients with hallucinate-paranoid psychoses, two}with depressive-paranoid psychoses, one}with oniroid and one patient with hyperactive delirium in the first group. One patient with schizotypal personality disorder and three}with paranoid personal disorder were found in the second group. In the last group we revealed five patients with hysterical personality disorder, six patients with schizoid personality disorder and three}with schizotypal personality disorder. Therapeutic approaches included psychopharmacological treatment of psychoses (first group) and combined psychopharmacological and psychotherapeutic treatment for patients of second and third groups with accent on psychopharmacological agents in the second group and on psychotherapy in the third group. CONCLUSIONS: Noncompliance in the patients with Hodgkin’s disease is a clinical problem. The solution of last one contributes to the improvement of clinical hematological outcome.

1057 Strong Opioid Usage for Patients with Malignancy Who Died at Home Wada TWa, Irahara MIb, Onozawa SOc, Yamanaka TYd, Hirahara SHe a Department of Visiting Medical Services, Aozora Clinic Shinmastudo, Matsuda, Japan; bDepartment

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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of Visiting Services, Irahara Clinic, Matsuda, Japan; cDepartment of Visiting Services, Kameda Clinic, Kamogawa, Japan; dDepartment of Visiting Services, Tokyo Women’s Medical University, Arakawa-ku, Japan; eDepartment of Visiting Services, Kajiwara Clinic, Kita-ku, Japan PURPOSE: In Japan, most of the terminally-ill patients with malignancy in hospitals are given strong opioids for their pain relief. On the other hand, patients with similar condition at home, sometimes do not experience severe pain, or often require no strong opioid analgesics. However, the frequency of strong opioid usage in cases who died at home is not well studied. Therefore, we investigated the ratio of those who required strong opiods in patients with terminal stage of malignancy at home. METHODS: We investigated medical records of five clinics providing visiting medical services for patients at home until their death. The number of patients who received opioid analgesics at the terminal stage of malignancy, and who died at home were assessed. RESULTS: The physicians in the five facilities were very sympathetic to pain and discomfort of patients, and willing to use analgesics, if needed. In 355 patients who died at home, 201 patients (56.6%) received strong opioid analgesics until their death. CONCLUSIONS: Approximately half of patients who died with malignancy at home required strong opioids. But this ratio was thought to be lower than that of those who died in hospital settings. Visiting services of physicians at home are much needed in Japan, because of its tremendous rapidity of increase of elderly people. Government of Japan is seeking the measures to spread this type of treatment throughout the country. Under these medical services, terminally-ill cancer patients can receive variety of treatments including pain control at home. However, the medical data in home-care settings have not been accumulated sufficiently.

1058 The 1960’s Revisited Wade K, Foley S, Nitzberg L Department of Social Wok, University of Michigan, Ann Arbor, USA People with a cancer diagnosis are often identified only by their disease. Treating the person from a holistic perspective with a focus on understanding their quality of life and impact on significant

Copyright # 2006 John Wiley & Sons, Ltd.

relationships, is key to successful treatment. Although psychosocial variables may be addressed, the assessment, and corresponding treatment plan can fall short. Psychiatric illnesses, such as depression and anxiety, whether newly diagnosed or a pre-exiting condition, require intervention. In either scenario, medical treatment must integrate the individual’s psychological well being, as it relates to quality of life, and intimate relationships. Psychopharmacologic interventions may be required, but are not mutually exclusive to psychotherapeutic intervention. Although relationships are frequently impacted by serious illness, evaluating the person within the couple requires significant time and professional expertise. Treating them within the context of their environment requires investment in significant relationships, as well the patient’s health crisis. Couple work around intimacy and sexuality is generally unavailable or self-selected by ability to pay or have insurance reimbursement. Given looming health care costs and future limitations, treatment focused on couples and support systems may be seen as even more peripheral to treatment. The presenters: an administrator, psychotherapist (with a cancer diagnosis) and certified sex therapist will illustrate a replicable model for health professionals that is comprehensive, holistic and affordable. In this model, treatment planning addresses quality of lie issues, including relationships, sexuality/intimacy and psychiatric diagnoses, as key factors in best practice care.

1059 The Influence of Morphine and Tramadol on the Cognitive Functions of Terminally Ill Cancer Patients}Conditioned by the Time Needed to the Analgesic Effect De Walden-Galuszko Ka, Majkowicz Ma, Buss Ta, Modlinka Aa, Osowicka Mb, Pyszkowska Ja,b a Palliative Medicine, Medical University, Gdansk, Poland; bPalliative Care, Medical University, Katowice, Poland Despite of common use of morphine and tramadol in medicine there is few information about the effect of these drugs on human cognitive functions. One year ago we started to determine the effect of the drugs motioned above on cognitive functions of terminally ill cancer patients. Now we continue this examination. The aim of our work was to answer the question if the dependence does exist between the influence of morphine and

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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tramadol on the cognitive functions of patients and the time needed to obtain good analgesia effect. 40 hospice patients (range age 20–85) were examined. Cognitive Drug Research Programme was used (short and long duration memory, attention, logical thinking and psychomotor functions). All these examinations were performed twice: (1) Before analgesic therapy and (2) After two days of good analgesic effect. The intensity of pain and other complaints were assessed every day by Edmonton Symptom Assessment Scale (ESAS). One group (24 pts.) was treated with Tramadol, the rest}with Morphine. The results analysed by statistic programme STATISTICA PL revealed that shorter time (1–2 days) needed to effective analgesia was connected with better improvement of some cognitive functions (working memory) comparing to the longer time (3 days and more). Comments: (1) Treatment with morphine or tramadol influences on some of cognitive functions of terminally ill cancer patients. (2) Time needed to obtain effective analgesia affects improvement of working memory in patients treated with morphine or tramadol.

1060 Quality of Life During Three-weekly Versus Weekly Neoadjuvant Docetaxel: A Randomised Trial Eremin JMa, Wiseman Ja, Eremin Oa, Walker MBb, Walker LGb a Breast Unit, Lincolnshire Hospitals NHS Trust, UK, United Lincolnshire Hospitals, NHS Trust, Lincoln, UK; bOncology Health Centres, Hull and East Yorkshire Hospitals NHS Trust/University of Hull, Kingston upon Hull, UK BACKGROUND: Neoadjuvant docetaxel following anthracycline-based chemotherapy improves clinical and pathological responses, and 3-year survival, in women with large or locally advanced breast cancer. The aim of this study was to compare the effects on quality of life of weekly versus three-weekly sequential neoadjuvant docetaxel. MATERIAL AND METHODS: 89 women with large or locally advanced breast carcinoma received four cycles of neoadjuvant doxorubicin (60 mg/m2) and cyclophosphamide (600 mg/m2) at intervals of three weeks. They were then randomised to four cycles of docetaxel at three-weekly intervals (100 mg/m2), or to twelve cycles at weekly intervals (33 mg/m2). Quality of life, mood and coping were assessed during chemotherapy and at follow up (FU) 3 weeks

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after the final cycle. RESULTS: At FU, the two treatments did not differ on the Trial Outcome Index of the Functional Assessment of Cancer Therapy (breast cancer version) (FACT-B. Also, no significant differences were found for scores on FACT-B scales, Rotterdam Symptom Checklist scales, or Hospital Anxiety and Depression scales. However, women on weekly docetaxel reported significantly less distress at all four time points, and less tiredness, unhappiness, vomiting, diarrhea, constipation, nail problems, pain and neuropathy during at least one of the four time points. DISCUSSION: At FU, the two regimens are similar in terms of generic measures of quality of life. However, during treatment, weekly docetaxel appears to have fewer/less distressing side effects. Where resources permit, women should be offered the choice of weekly docetaxel. COMMENTS: Additional Authors: El-Sheemy M, Vassanasiri W, Jibril J, Valerio D, Cowley G, Clarke D, Kamal M, Thorpe G, Beer J.

1061 Patient Personality Predicts Postoperative Stay After Colorectal Cancer Resection Sharma Aa, Sharp DMb, Monson JRTa, Walker LGb a Academic Surgical Unit, University of Hull, Hull, UK; bInstitute of Rehabilitation, University of Hull, Hull, UK PURPOSE: Post-operative length of stay (LOS) is an important outcome after colorectal cancer surgery. The aim of this study was to evaluate the putative effects of personality, mood, coping and quality of life on LOS. METHODS: A consecutive series of eligible patients undergoing elective resection for colorectal cancer were invited to participate in the study. A battery of psychometric questionnaires including the Hospital Anxiety and Depression Scale, the Functional Assessment of Colorectal Therapy (colorectal), the Courtauld Emotional Control Scale, the Positive and Negative Affectivity Scale and the Eysenck Personality Questionnaire were administered 5–12 days before surgery. Nonparametric correlations were computed for psychometric scores, demographic variables and the post-operative LOS. Factors found to be significantly correlated on this analysis were entered into a multiple regression model to determine independent predictors of LOS. RESULTS: One hundred and four patients with colorectal cancer participated. Seventy were male (67%) and the mean age was 68 years. The

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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median LOS was 10 days (range 4–108). LOS was negatively correlated with pre and post-operative albumin levels, PANAS +ve affect, FACT-C functional well-being score and EPQ extroversion score. LOS was strongly positively correlated with post-operative morbidity. LOS was positively correlated with CECS anger score, age and being male. Post-operative morbidity (b ¼ 0:387; p ¼ 0:001) and extroversion (b ¼ 0:244; p ¼ 0:05) were independent predictors of LOS. DISCUSSION: Personality as measured by EPQ predicts post-operative LOS in patients with colorectal cancer. Extroverts have a higher pain threshold and this may be part of the explanation.

scores in the female population, the proportion of patients scoring in the abnormal range is low at 6 weeks ad declines significantly over the following 18 weeks. Fully integrated service provision appears to have considerable mental health benefits.

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PURPOSE: It has been suggested that dealing with cancer is associated with increased stress and burnout in health care professionals. The aim of this study was to evaluate this by comparing colorectal and vascular surgeons. METHODS: A national cohort of consultant colorectal and vascular surgeons were sent a questionnaire to assess job satisfaction, burnout (Maslach Burnout Inventory), probable psychiatric caseness (General Health Questionnaire), coping, and perceived adequacy of training and sources of occupational stress. RESULTS: 501 questionnaire booklets were returned, (response rate of 58.7%). The mean age of respondents was 47 years and 92% were male. 49% of colorectal surgery was cancerrelated compared to 7.5% of vascular surgery ðp ¼ 0:001Þ: 33% of all respondents scored above threshold on the GHQ, and 32% had high burnout. There were no significant between-group differences in psychiatric morbidity, personal accomplishment or emotional exhaustion, although vascular surgeons had higher depersonalization ðp ¼ 0:04Þ: 77% surgeons intended to retire before the statutory retirement age; this was correlated with psychiatric morbidity and burnout. Job satisfaction and perceived adequacy of training in communication and management were significantly negatively correlated with GHQ and MBI scores. Multivariate analyses showed that job dissatisfaction independently predicted psychiatric morbidity and all aspects of burnout, whereas being married or cohabiting reduced the risk of psychiatric morbidity. High depersonalisation was more common in younger surgeons. DISCUSSION: High levels of stress and burnout are prevalent in vascular and colorectal surgeons in the NHS. However, stress and burnout are not affected by cancer workload.

What Happens to Anxiety and Depression in Women with Early Breast Cancer Accessing an Integrated Oncology Health Service? Walker MBa, Walker AAb, Walker LGb, Sharp DMb a Oncology Health Centres, Hull and East Yorkshire Hospitals NHS Trust, Kingston upon Hull, UK; bInstitute of Rehabilitation PGMI, University of Hull in Association with the Hull York Medical School, Kingston upon Hull, UK PURPOSE: High levels of anxiety and depression have been widely reported following surgery for early breast cancer. This study aimed to evaluate the impact of an integrated oncology health service on anxiety and depression. METHODS: Women participating in a clinical trial received support in the Oncology Health Centres in Kingston upon Hull, UK. These Centres are fully integrated physically, functionally and financially with local cancer services. Patients and relatives accessed the service on a drop-in basis or by prior arrangement. Staff were trained to elicit and respond to concerns, and to provide effective emotional support. 172 patients completed the Hospital Anxiety and Depression Scale 6, 18 and 24 weeks after surgery. Cut off scores were used to determine probable caseness: abnormal (11 or above), borderline (8–10) and normal (7 or less). RESULTS: The proportion of patients scoring in the abnormal range for anxiety was 14.2% at 6 weeks, 7.4% at 18 weeks and 9.7% at 24 weeks. For depression, the proportion scoring in the abnormal range was 3.8% at 6 weeks, 0.6% at 18 weeks and 1.1% at 24 weeks. The proportions did not differ significantly across the three arms of the trial. CONCLUSIONS: Compared with previous reports, and the incidence of abnormal HADS

Copyright # 2006 John Wiley & Sons, Ltd.

1063 Stress and Burnout Among NHS Surgeons in the United Kingdom Sharma Aa, Sharp DMb, Monson JRTa, Walker LGb a Academic Surgical Unit, University of Hull, Hull, UK; bInstitute of Rehabilitation, University of Hull, Hull, UK

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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1064 Psychological and Spiritual Growth Associated with the Experience of Breast Cancer Wall KE, Warner A Institute of Transpersonal Psychology, Palo Alto, CA, USA PURPOSE: Exploration of psychological and spiritual growth associated with the experience of breast cancer. METHOD: As part of a broader study of a psycho-social intervention, a sub-sample of 12 women, diagnosed with breast cancer within 5 years, participated in semistructured interviews. Transcripts were analyzed using thematic content analysis and grounded theory methods. RESULTS: The experience of breast cancer brought forth psychological and spiritual growth. All women reported experiences of benefit-finding relating to breast cancer such as receiving support from family and friends (91%), experiencing more gratitude and positive thinking (75%), strengthening of inter-personal relationships (58%), experiencing greater appreciation for life (50%), and experiencing more willingness to serve and reach out to the community (41%). Furthermore, all women reported psychological and spiritual growth related to distressing issues experienced prior to the cancer diagnosis, such as a greater ability to let go of fears, inner conflicts, and inhibitions (75%), enhanced self-care, and greater ability to slowdown (75%), and increased sense of empowerment and self-esteem (41%). Sixty-six percent reported that the breast cancer experience was associated with increased sense of spirituality and a wide variety of spiritual experiences, such as feeling taken care of by the divine throughout the experience (50%). CONCLUSIONS: These data suggest that breast cancer may be associated with psycho-spiritual growth. Further research is planned to explore and enhance growth processes for cancer patients. ACKNOWLEDGEMENTS: Robbins Family Fund of the Jewish Endowment Fund of the San Francisco Jewish Community.

1065 Anxiety in Predictive Oncology: Evaluation before Counselling and Testing, During the Process, and One Year After Waltz Pa, Gex-Fabry Mb, Murphy Aa, Sappino APa, Chappuis POa,c

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a

Department of Internal Medicine, Hoˆpitaux Universitaires de Gene`ve, Gene`ve, Switzerland; bDepartment of Psychiatry, Hoˆpitaux Universitaires de Gene`ve, Gene`ve, Switzerland; cDepartment of Gynaecology and Obstetrics, Hoˆpitaux Universitaires de Gene`ve, Gene`ve, Switzerland

PURPOSE: Prospective evaluation of anxiety during genetic counselling for familial breast/ colorectal cancer. METHODS: Hospital Anxiety and Depression Scale (HADS) questionnaire was mailed before (T1) and after (T2) the first genetic counselling, after the second consultation (T3), at 3 months (T4), and one year after the second consultation or testing results (T5). RESULTS: At T1, the median score of the HADS anxiety subscale ðn ¼ 97Þ was 7 and it decreased to 6 at T2 ðP ¼ 0:021Þ: No changes were noted for the subsequent evaluation time points. Among asymptomatic probands ðn ¼ 51Þ; a decrease in anxiety levels was noted at T2 and T5 ðP50:025Þ: At T1, low cancer predisposition risk probands ðn ¼ 67Þ were more anxious than high risk probands (n ¼ 30; P ¼ 0:019); similar results were observed at T2 and at T5. No difference in anxiety levels was noted between tested ðn ¼ 39Þ and non-tested probands ðn ¼ 58Þ: We observed no difference at all evaluation time points between carriers of BRCA1/BRCA2 mutations ðn ¼ 10Þ and probands with non informative genetic testing ðn ¼ 23Þ: A decrease in cancer risk perception was noted among asymptomatic low risk probands at T4 and T5 ðP50:04Þ; when compared with moderate/high risk individuals. CONCLUSIONS: Before counselling, being asymptomatic and at low risk was associated with higher anxiety levels that significantly decreased after 3 and 12 months. Genetic testing was not associated with higher anxiety levels, even after one year follow-up. ACKNOWLEDGEMENTS: Ligue Genevoise contre le Cancer.

1066 Psychological and Spiritual Benefits of Yoga-based Practices for Women with Breast Cancer Warner ASa, Wall KEb a Residential PhD in Transpersonal Psychology, Institute of Transpersonal Psychology, Palo Alto, CA, USA; bInstitute of Transpersonal Psychology, Palo Alto, CA, USA PURPOSE: To explore the psychological and spiritual well-being of women diagnosed with

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breast cancer who, participated in a yoga-based stress-reduction program entitled the Art of Living. METHOD: Twenty-six women diagnosed with breast cancer within the past 5 years participated in an 8-day course followed by 5week maintenance period that included breathing techniques known as Sudarshan Kriya Yoga and other yoga-based processes. The mixed-method design consisted of pre- and post-intervention, within-subject assessments of quality of life (FACT-B), spiritual well-being (FACIT-Sp-Ex), positive states of mind (POMS), and perceived stress (PSS). Semi-structured interviews were conducted post-intervention with a sub-sample of 12 women. RESULTS: Quantitative results demonstrated a significant ðp50:0001Þ improvement in scores on all measures with large effect sizes after the 8-day course: FACT-B ðd ¼ 1:2Þ; FACIT-Sp-Ex ðd ¼ 1:0Þ; PSOM ðd ¼ 1:1Þ; and PSS ðd ¼ 1:2Þ: Large effect sizes were sustained following 5-week maintenance period. Qualitative results showed strengthen spirituality (100%) such as deepened personal connection to the divine (75%), and positive experiences such as peace (100%), love (66%), joy (50%), gratitude and mental clarity (33%). CONCLUSION: These data represent a preliminary investigation of the relationship between yoga-based practices, and the psycho-spiritual well-being of women with breast cancer, highlighting the need for further controlled studies in this area. ACKNOWLEDGEMENTS: Robbins Family Fund of the Jewish Endowment Fund, San Francisco Jewish Community.

1067 Adolescent’s Stress Responses and Psychological Functioning when a Parent has Early Breast Cancer Edwards La, Watson Ma, St. James-Roberts Ib, Baldus Cc, Romer Gc a Department of Psychological Medicine, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK; bThomas Coram Research Unit, Institute of Education, University of London, London, UK; c Department of Child and Adolescent Psychiatry & Psychotherapy, University of Hamburg, Hamburg, Germany PURPOSE: To identify factors associated with stress responses and psychological functioning in adolescent children of early stage breast cancer patients. METHOD: Adolescent’s self-reported psychological problems using the Child Behaviour

Copyright # 2006 John Wiley & Sons, Ltd.

Checklist (YSR) and Mental Health subscale of the Child Health Questionnaire (CHQ-MH). The child Impact of Events (C-IES) scale measured stress responses in terms of intrusive and avoidant thoughts. The Family Assessment Device (FAD) and the Family Environment Scale (FES cohesion subscale) assessed family functioning. The Beck Depression Inventory (BDI) assessed maternal depression and maternal quality of life (SF8). Using a cross-sectional within groups design, assessments were obtained for 56 adolescents, 11–17 years. RESULTS: High rates of stress response scores were found (C-IES); 33% males and 45% females. 30% of the sample was identified as having psychological problems (YSR) (28% males and 32% females). Adolescents’ reports indicated that poor family functioning is linked with internalising and externalising problems; poor family cohesion was associated with higher externalising and total psychological problems. Maternal depression was linked with internalising problems. CONCLUSIONS: Where mothers have breast cancer, a substantial minority of their adolescent children have psychological, and stress related problems, which are linked with poor family functioning. Our data show that adolescent children of adult cancer patients have levels of problems which argue in favour of a familyoriented approach to breast cancer.

1068 Palliative Care for Patients with Hematological Malignances Yamada Ya,b, Kawai Ka, Oikawa Tb, Kubo Ca a Psychosomatic Medicine, Kyushu University, Fukuoka, Japan; bPalliative Care Unit, Oikawa Hospital, Fukuoka, Japan PURPOSE: The treatment of hematological malignancies mainly involves intensive chemotherapy using multiple anti-cancer agents. However, patients often die as a result of complications in an acute setting. Thus, it has been reported that patients with hematological malignancies are more difficult to transfer to a hospice than patients with other cancers. This study investigated whether patients with end stage hematological malignancies can spend the last phase of their life in a hospice rather than the Department of Hematology. METHODS: The ten cases of patients with hematological malignancies in the hospice were studied retrospectively from the perspective of physical and psychological factors. Once a week, a

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physician experienced in hematology and psychooncology was concerned by liaison consultation. Patients are accepted with the understanding that blood would be sampled was taken about once every 2 weeks and transfusion would be avoided as much as possible. In addition, we examined patients in the hospice with other form of cancer (i.e. Breast cancer) as a control group. RESULTS: Two of ten patients were male (20%); the median age was 76 years (range 62–97); the median time in the hospice was 51 days (range 9–322+); the median Eastern Cooperative Oncology Group (ECOG) performance status was 4 (range 2–4). Regarding the clinical data, there were no significant differences. All patients experienced relief in the hospice. CONCLUSIONS: It was suggested that patients with hematological malignancies can spend time significantly in our setting, the same as patients with other form of cancer.

are exploring: relatives’ reactions to learning about the genetic test results in their deceased relative, prior and current perceptions of risk, and risk management decisions, communication with other relatives, information and support needs, whether relatives perceive that they have experienced benefit or harm as a result. RESULTS: Participants, some of whom have and some have not elected to have genetic counselling, include partners, adult children and siblings of the deceased men. Findings will be discussed, including}importance of the role of the communicator who may not be the closest relative. CONCLUSIONS: Effective communication and subsequent handling of the information, whether or not this includes engagement, is dependent on a positive relationship. ACKNOWLEDGEMENTS: This Research was supported by Cancer Research UK.

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Disseminating BRCA2 Test Results Identified in the Research Context to Relatives of Deceased Prostate Cancer Patients: A Qualitative Study of Relatives’ Experiences Ormondroyd Ea, Watson Ma,b, Eeles Ra,c, Moynihan Ca,d, Davolls Sa a Department of Psyhcological Medicine, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK; bPsychological Medicine, The Institute of Cancer Research, Sutton, Surrey, UK; cClinical Genetics, The Institute of Cancer Research, Sutton, Surrey, UK; dAcademic Radiotherapy, The Institute of Cancer Research, Sutton, Surrey, UK

A Modafinil Therapeutic Trial for Adult Brain Tumor Patients: III. Depression Outcomes Wellisch DKa, Steh Ba, Kaleita TAa,c, Graham CAb,c, Cloughes TFb,c,d a Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, USA; bNeurology, David Geffen School of Medicine at UCLA, Los Angeles, USA; cUCLA Neuro-Oncology Program, David Geffen School of Medicine at UCLA, Los Angeles, USA; dHenry E. Singleton Brain Cancer Research Program, David Geffen School of Medicine at UCLA, Los Angeles, USA

PURPOSE: This study was established as an adjunct to an earlier, national study at the Royal Marsden Hospital and UK Institute of Cancer Research, which detected pathogenic BRCA2 mutations in men diagnosed with prostate cancer before the age of 55 (Edwards et al., 2003). The men had died before the results of that study were available, and the Clinical Genetics team at the ICR/RMH attempted to contact the next-of-kin offering an information/counselling session. This study is a psychosocial evaluation of the impact of being contacted about the existence of a genetic fault in a deceased relative. METHODS: A snowball sampling strategy has been used to recruit relatives with whom the next-of-kin has shared this information. Semi-structured, in-depth interviews with 12 relatives are currently being analysed using a grounded theory approach. We

PURPOSE: To test a psychopharmacologic agent, modafinil, in adult brain tumor patients with depressive symptomatology. METHODS: Patients: 30 adults, mean age ¼ 45:3 ðsd ¼ 11:7Þ years; 63% male; Primary malignant and non-malignant cerebral tumors: high 18 (60%) and low grade 10 (33%) gliomas. Tumor locations: frontal 14 (47%), temporal 9 (30%). All had mild to severe fatigue and/or attention/memory impairments. Measures: Hamilton Depression Scale-31 items. DESIGN: Double-blind, dose-controlled randomization: 3 weeks; Washout: 1 week; Open label extension (50–600 mg/day after 100 mg/day  3 days, 200 mg/ day  4 days): 8 weeks. Statistical Analysis: Percentages of change: totals of patient standard score mean changes at designated points divided by the total sample means at baseline. Probability estimates: paired t-tests or Wilcoxon Signed Rank

Copyright # 2006 John Wiley & Sons, Ltd.

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Tests. RESULTS: Maximal mood outcomes 8 and 12 weeks post modafinil treatment baseline include: Total sample: 43% score changes ðp50:0001Þ at 8 weeks; 31% ðp ¼ 0:004Þ at 12 weeks. Median age split (42 years) score changes for older patients were 35% ðp ¼ 0:01Þ at 8 weeks; younger patients changes were 49% ðp ¼ 0:0003Þ at 8 weeks; 37% ðp ¼ 0:02Þ at 12 weeks. Score changes for males ðn ¼ 19Þ were 40% ðp ¼ 0:0009Þ at 8 weeks. Female ðn ¼ 11Þ score changes were 46% ðp ¼ 0:003Þ at 8 weeks; 34% ðp ¼ 0:03Þ at 12 weeks. CONCLUSIONS: Modafinil was effective at reducing depressive symptoms in adult brain tumor patients. ACKNOWLEDGEMENT: Supported by Cephalon, Inc., USA.

1071 ‘In Sickness and in Health’: Implications of Hereditary Cancer for Young Women’s Family Development Werner-Lin A School of Social Work, New York University, New York, NY, USA PURPOSE: Women from families with hereditary cancer must achieve normative development tasks of young adulthood and family formation against the backdrop of serious and persistent illness. Most empirical work on genetic testing, however, fails to address family history, the meaning of cancer, or its impact on the life-course. The purpose of this study is to increase the health professions’ understanding of the interplay between hereditary disease and family development for young women with genetic mutations placing them at elevated risk of developing breast and ovarian cancer. METHOD: Twenty-five women aged 22–36 with a BRCA mutation completed comprehensive illness genograms and participated in in-depth interviews designed to elicit family stories and meanings about cancer and hopes and fears for the future. Interviews were guided by the Contextual Model of Multigenerational Family Development and Hereditary Disease (WernerLin, 2005). Transcripts were analyzed using the Listening Guide, a narrative data analysis tool that emphasizes the use of voice to highlight key themes, relationships, and meaning structures. FINDINGS: Results reveal myriad meanings of hereditary cancer risk, influenced by family experiences with cancer and stage of family development. Pervasive themes included the presence of ‘danger zones,’ and specific concerns

Copyright # 2006 John Wiley & Sons, Ltd.

about sexuality, partner selection, and having and raising children. CONCLUSIONS: This study adds a systemic perspective to current understandings of genetic mechanisms across the life span. This perspective, and knowledge gained from this study, will aid in identifying life-cycle specific psychoeducational interventions targeted a key points in the illness experience.

1072 Establishing Systems and Structures for Developing Psychosocial Oncology Services White CAa,b,c, Mulhern Sa a Psychosocial Oncology NHS Ayrshire and Arran, Irvine, Scotland; bSchool of Health, University of Paisley, Paisley, Scotland; cSection of Psychological Medicine, University of Glasgow, Glasgow, Scotland Much progress has been made in understanding how psychosocial factors influence the responses of patients, relatives and staff members to cancer. This has not always been matched with the same degree of progress in establishing services that are able to deliver services that are evidence based, responsive to need and provided by those with the requisite competencies in psychosocial oncology. This presentation will describe the work that has been undertaken within a geographical division of the National Health Service (NHS) in Scotland, UK. NHS Ayrshire and Arran serves a population of around 350 000 people and, since 2002 has been developing a psychosocial oncology service. This service provides clinical consultancy, supervision and training. Specific project related work has been undertaken to develop the skills of nurse specialists to provide cognitive behaviourally based assessments and interventions. Modular training in psychosocial oncology has been developed in partnership with a local University and specific work has been undertaken to introduce the routine assessment, monitoring and management of distress. Partnership arrangements have been established with the voluntary sector. The key elements of the NHS Ayrshire and Arran approach (consultancy model, infrastructure development and training opportunities) will be outlined. The challenges, enabling factors and potential obstacles in considering service development will be presented. Recommendations for the development of similar psychosocial oncology service elements within other healthcare systems and teams will be presented and discussed.

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Pilot Study of a Clinical Psychology Service via Videoconferencing for Rural Cancer Patients in Australia Shepherd La, Goldstein Da, Thewes Ba, Whitford Hb, Brummell Vc,d a Medical Oncology, Prince of Wales Hospital Randwick, New South Wales, Australia; bMedical Oncology, Royal Adelaide Hospital Cancer Centre, Adelaide, Australia; cGlen Innes Health Service, Glen Innes, New South Wales, Australia; d Tamworth Base Hospital, Tamworth, New South Wales, Australia

The Association between Patient Distress, Patient Satisfaction, and Doctor–Patient Communication Prior to Bone Marrow Transplantation (BMT) Peterson Ma, Whitford Hb, Skinner Dc a Clinical Psychology, Royal Adelaide Hospital Cancer Centre, Adelaide, Australia; bMedical Oncology, Royal Adelaide Hospital Cancer Centre, Adelaide, Australia; cSchool of Psychology, University of South Australia, Adelaide, Australia

PURPOSE: This project was initiated to trial access for rural cancer patients to a clinical psychologist via videoconferencing to help reduce the psychological burden of cancer. METHODS: Cancer patients living in the rural New England region of New South Wales Australia who were screened and considered highly distressed by the Distress Thermometer, or who were referred by clinicians, were offered cognitive behavioural therapy by a clinical psychologist specialising in psycho-oncology via videoconferencing facilities based in Sydney. Patients’ anxiety, depression and quality of life were assessed pre and post intervention and at one month follow-up. Patient satisfaction with the service was assessed post intervention. RESULTS: Fifty-four patients were referred over nine months, 34 patients commenced treatment and 25 completed follow-up. One-hour individual sessions were held weekly or fortnightly for between one and six sessions. Results indicated a significant decrease in anxiety ðp ¼ 0:01Þ; and significant increases in emotional wellbeing ðp ¼ 0:003Þ; functional wellbeing ðp ¼ 0:02Þ and overall quality of life ðp ¼ 0:04Þ: Overall, patients found the intervention to have a positive impact (92%) and would recommend the service to others (96%). CONCLUSIONS: Videoconferencing appears to provide an innovative mode of delivery for necessary psychological intervention for patients with cancer living in remote vicinities. Larger studies are needed to adequately assess videoconferencing such as randomised controlled trials comparing face-to-face and videoconferencing including assessment of confounding variables like demographic and treatment characteristics. ACKNOWLEDGEMENTS: Thanks to the NSW Telehealth Initiative for funding. Dedicated to Mary Hicks.

Copyright # 2006 John Wiley & Sons, Ltd.

PURPOSE: This project aimed to explore the nature of psychological distress experienced by patients at their initial medical consultation prior to bone marrow transplant (BMT) and its relationship to patient satisfaction and doctor perception of patient distress. METHODS: BMT patients at the Royal Adelaide Hospital of South Australia completed standardized measures of physical and emotional distress related to their illness, the impact the illness was having on their life, anxiety and depression. Patient satisfaction with the doctor was assessed as were doctor impressions of the patients’ distress and behavior during the consult. RESULTS: Twenty patients were recruited over a six month period. Results indicated that patient distress was best represented by the physical and emotional impact it was having on their lives. Patients reported high satisfaction with their doctor. Overall, doctors had difficulty accurately assessing distress in their patients. Interpretation of a multiple regression analysis revealed that doctor perception of patient behavior during a consult was predicted more highly by patient distress levels than patient satisfaction. CONCLUSIONS: Doctors are often required to ascertain a patient’s distress level based primarily on quick judgments during medical consultations. This study suggests that there is a relationship between doctor perception of patient behavior, the patients’ actual distress and to a lesser extent the patients’ reported satisfaction. However, the continual restriction in accurately assessing distress during medical consultations suggests that further studies are needed, in particular regarding the use of direct questioning or brief screening measures to assist doctors with the identification of distress.

1075 Spirituality as a Core Domain in the Assessment of Quality of Life in Oncology: An Australian Perspective

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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Whitford Ha, Olver Ia, Peterson Mb a Medical Oncology, Royal Adelaide Hospital Cancer Centre, Adelaide, Australia; bClinical Psychology, Royal Adelaide Hospital Cancer Centre, Adelaide, Australia

City, KS, USA; cKansas University School of Nursing, Kansas University Medical Center, Kansas City, KS, USA

PURPOSE: Corresponding with Brady et al. (1999), this research investigated the clinical significance of including spirituality as a core domain in the assessment of quality of life (QOL) in an Australian oncology population. METHODS: A total of 490 new, consecutive cancer patients with mixed diagnoses were asked to complete the Functional Assessment of Cancer Illness Therapy-Spirituality (FACIT-Sp), the Mental Adjustment to Cancer (MAC) Scale and provide demographic ad treatment information. Overall, 437 completed assessments. RESULTS: Results indicated that spirituality demonstrated a significant, positive association with QOL ðr ¼ 0:59Þ; fighting spirit ðr ¼ 0:49Þ and a significant, negative relationship with helpless/hopeless ðr ¼ 0:47Þ and anxious preoccupation ðr ¼ 0:26Þ: Hierarchical multiple regression results showed spirituality to be a significant, unique contributor to QOL beyond the core domains of physical, social/family and emotional wellbeing (R2 change ¼ 0:08; p ¼ 0:000). However, the percentage of patients with low spirituality who reported to enjoy life ‘very much’ despite pain was greater than the percentage of patients reporting high spirituality ðp ¼ 0:01Þ: This result was inconsistent with Brady et al.’s (1999) findings supporting the clinical utility of spirituality. CONCLUSIONS: Results lend further support to the biopsychosocial spiritual model as spirituality appears to be a prominent factor in the assessment of QOL for Australian cancer patient. By failing to assess this core domain, the ‘true’ burden of cancer is likely to be miscalculated. However, at this stage, the exact clinical utility of spirituality assessment in an Australian population is unclear.

PURPOSE: Study purposes were to: (1) the assess the ease of use of the Therapy Related Symptom Checklist (TRSC) in a rural hematology/oncology practice in which patients are served by both on-site consultations (280 miles from the university medical center) and telemedicine videoconferencing; (2) assess whether the TRSC produces information about patient conditions equivalent to the FACT-G. METHODS: 56 patients seen at the clinic completed both the FACT-G and TRSC before consultations. Patients completed 1–11 pairs of forms depending upon the number of clinic visits over 12 months, giving 132 pairs of forms or observations for assessment. All statistical analyses were corrected for clustering by patient. RESULTS: Patients found the TRSC easier to answer than the FACT-G. The physician found the TRSC provided valuable information about patient symptoms that could be tracked over time. The TRSC and FACT-G total scores correlated significantly and in the correct direction, 0.6032, p50:0001: A multiple regression indicated that the TRSC subscales accounted for 52% of the variance in FACT-G scores, Fð14; 55Þ ¼ 15:03; p50:0001: Mean scores on both the TRSC and FACT-G indicated a report of worse symptoms or condition when receiving telemedicine consultations compared to on-site consultations; TRC comparisons t ¼ 2:233; p ¼ 0:0273; and FACT-G comparison t ¼ 3:878; p ¼ 0:0002: CONCLUSION: This study and earlier ones suggest that the TRSC is a patient and clinic friendly tool for systematically collecting and tracking patient symptoms. Additionally, the TRSC provides valuable information for symptom management, teaching self-care, and research, which is continuing with larger samples.

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Use of a Therapy Related Symptom Checklist (TRSC) in a Rural Telemedicine Hematology/ Oncology Practice in the United States Williams ARa, Doolittle GCb, Williams PDc, Lackore KAa, Spaulding Ac a Health Care Policy & Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA; bCenter for Telemedicine and Telehealth, Kansas University Medical Center, Kansas

Moments Held: Documenting Legacy, Life and Courage Wintermeyer-Pingel SAa, Murphy DLb, Hochberg Tc a Patient Support Services-Grief and Loss/Psychoncology, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA; bPatient Support Services-Complementary Therapies/Psychoncology, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA; cTouching

Copyright # 2006 John Wiley & Sons, Ltd.

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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Souls}Healing with Bereavement Photography, Todd Hochberg Photography, Evanston, IL, USA PURPOSE: This National Cancer Institute designated Comprehensive Cancer Center at the University of Michigan Medical Center developed a pilot project called ‘Legacy and Life’. The pilots purpose was to assess the impact of Legacy activities and interventions in several areas. These include the effect on patient, family and professional coping; on peer patient or caregiver groups experiencing the work in presentation and gallery exhibition formats; and to evaluate the viability of this project on a larger scale. METHODS: The project offered two cancer patients and their families the opportunity to share their ‘stories’ (thoughts and feelings) through photography, journaling, and film providing a documentary form of legacy. The project team included the Coordinators of the Complementary Therapies and the Grief and Loss Programs, and a professional documentary photographer known for his work in healthcare and loss and bereavement. RESULTS: Data demonstrated that photographs, journals, and film made collaboratively with patients, family, friends and caregivers proved to produce a tangible record that served as touchstones for feelings and memories pertaining to significant relationships, experiences and spiritual connections. Data was obtained through patient/family testimonials, staff surveys, and gallery evaluations. Steps to programmatic implementation in a broader scope were identified. CONCLUSIONS: While pilot subjects benefited from participation in creation of materials, programmatic implementation proved challenging and resource driven. This presentation will describe the program design and implementation; share some of the work produced; discuss the successes and challenges realized; propose ideas for future programs, and potential avenues for research.

1078 Psychological Distress in Disease-free Breast Cancer Survivors Completing Tamoxifen Therapy Whitnall La, Mulhern Sb, Millar Ka, White CAb, Doughty JCc a Section of Psychological Medicine, University of Glasgow, Glasgow, UK; bPsychosocial Oncology, NHS Ayrshire and Arran, Irvine, UK; c Department of Surgery, University of Glasgow, Glasgow, UK

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PURPOSE: Patient beliefs and psychological responses surrounding the completion of tamoxifen therapy have not been formally examined. It is not clear whether factors known to contribute to distress at earlier stages of breast cancer diagnosis and intervention are relevant during this period. Responses to completing tamoxifen may also impact on future treatment choice particularly when being considered for extended adjuvant treatment (Femara). The current study therefore examined the variation of distress related to completing tamoxifen therapy in a cohort of disease-free breast cancer survivors. METHODS: Patients about to complete tamoxifen in 1–6 months were identified through case note review. Suitable patients were sent an information sheet one week prior to routine follow-up clinic attendance and asked to participate following non-eventful consultation. Consenting participants ðn ¼ 72Þ were interviewed and asked to complete six standardised questionnaires with the researcher. Other factors known to contribute to distress such as treatment history and demographic factors were recorded and considered in the analysis. RESULTS: The study examined relationships between treatment representations, illness perceptions, coping style, fear of recurrence, personality constructs, demographic characteristics, and breast cancer clinical history, to variations of psychological distress, using correlation and multiple regression analysis. CONCLUSIONS: The results are discussed in relation to the implications these have for multidisciplinary clinicians working with patients about to complete tamoxifen treatment, the impact this may have on future treatment decision making, and the psychological management of distressed patients.

1079 Cancer-Related Stressors and Coping in Westernborn Caucasians and Asian-born Chinese Mah Ka, Lebel Sa, Lee Rb, Irish Jc, Rodin Gd, Wong Aa a Behavioural Sciences and Health Division, Toronto General Hospital, University Health Network, Toronto, Canada; bMcMaster University Medical Centre, Hamilton Health Sciences, Hamilton, Canada; cSurgical Oncology, University Health Network, Toronto, Canada; dPsychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, Canada

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PURPOSE: Culturally-based values may lead people of diverse backgrounds to experience different facets of disease and treatment as stressful, invoking diverse coping responses. An emphasis on individualist values leads to direct actions to modify the stressful environment (i.e. assimilation); in contrast, collectivist values lead people to make adjustments to themselves (i.e. accommodation) and to cope indirectly. This study examined whether cancer-related stressors and coping differ between Western-born Caucasians and Asian-born Chinese with cancer. METHODS: 82 Western-born Caucasian (proxy for individualist values) and 52 Asian-born Chinese (proxy for collectivist values) cancer outpatients completed a self-administered questionnaire package, including the Coping with Cancer Questionnaire (CCQ) and Cancer-Related Stressors Checklist (CRCL). The CRCL addresses 8 stressor categories (disease and treatment; existential; interference with life; interpersonal; lack of information; stigma; subjective distress; and uncertainty). The CCQ generates 4 coping subscales (factorial crossing of direct vs indirect and assimilation vs accommodation coping). RESULTS: Correlations between stressor categories and coping subscales were compared using Fisher’s r-to-z transformation. Correlations between existential stressors and direct-accommodation (D-ACC) coping differed significantly between Western and Asian patients (z ¼ 2:346; p50:05). Western-born Caucasians were more likely to use D-ACC in response to existential stressors (r ¼ 0:237; p50:05). This was not true for Asian-born Chinese (r ¼ 0:183; p > 0:05). CONCLUSION: Despite differences in culturally based social values, few differences were evident in coping among Western-born Caucasians and Asian-born Chinese.

1080 Pain Management in Chinese Women with Breast Cancer Wong-Kim ECa, Sun Ab a Department of Social Work, California State University, East Bay, Hayward, USA; bDepartment of Health Education, San Francisco Chinese Hospital, San Francisco, USA PURPOSE: The purpose of this qualitative study is to understand cultural approaches to pain management in Chinese women diagnosed with breast cancer. METHODS: A qualitative study

Copyright # 2006 John Wiley & Sons, Ltd.

was conducted with 30 Chinese breast cancer survivors using semi-structured interviews. Two groups of women are included in this study, 15 women in this sample are American-born and another 15 are foreign-born. Foreign-born Chinese women in this sample lived in the United States for less than 10 years. Bilingual researchers conducted the interviews using Cantonese, Mandarin, or English. RESULTS: We found that all survivors in our study experienced some level of pain. Although not all women are against using pain medication, many of them are concerned with the side effects of the medication. Almost all Chinese women in our study used some form of complimentary and alternative medicine (CAM) regardless of birthplace. Most of them mentioned the use of CAM before their breast cancer diagnosis. CAM is viewed by most of the survivors as a good and safe method to control pain. These approaches include herbal medication, soup therapy and acupuncture. However, issues such as affordability and quality of treatment are among many factors that prevent survivors from using CAM on a regular basis. Many survivors also feel that the Western medical system is disconnected from CAM approach in controlling pain. CONCLUSION: The findings from this study indicated the value of using CAM for Chinese breast cancer survivors in controlling pain. However, affordability and quality assurance are important issue that need to be addressed.

1081 Rehabilitation After Cancer: Patient Archetypes at Rehabilitation Tofte J, Larsen S, Piester CB, Kristensen T The Dallund Centre for Rehabilitation of Cancer Patients, Danish Cancer Society, Søndersø, Denmark BACKGROUND: Rehabilitation Centre Dallund is the first and only institution in Denmark offering residential courses in rehabilitation to all cancer patients. The centre receives approximately 650 patients annually from all Denmark. PURPOSE: An exploration of the possibility of identifying patient archetypes at the time of rehabilitation and to describe their attributes. These descriptions may be used in planning dedicated rehabilitation activities directed towards specific patients. METHODS: Prior to their stay at Dallund all patients are monitored by the Dallund Scale, which is a highly structured one page questionnaire qualified to disclose the

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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patients’ need of rehabilitation. The scale contains the possibility of checking 64 different complications. These results were analysed by factor and cluster analysis. All 624 patients attending Dallund during 2005 received the Dallund Scale. The patients attended Dallund 1–107 months after treatment (mean 8.5; mode 2.0 months). RESULTS: Factor analysis revealed that the complications may be generalized to a description by six factors (practical, work- or family related, psychological, physical or spiritual factors). Subsequent cluster analysis of the patients disclosed that archetypical patients for each of these factors may be found. The archetypes of patients towards these factors exhibit significant associations to age, gender, diagnosis and treatment. CONCLUSIONS: The proposed analysis proved possible and the detailed results will be presented.

1082 Child Cancer and Resilience: Phenomenological Study of Protection Mechanisms in the Mother– Child Dyad Teles SSa, Valle ERMb a Faculty of Philosophy, Sciences and Letters of Ribeira˜o Preto, University of Sa˜o Paulo Ribeira˜o, Preto, Brazil; bSchool of Nursing, University of Sa˜o Paulo Ribeira˜o, Preto, Brazil This study aims to understand the perceptions of mothers and children, based on their experiences with cancer, which contributed to their coping with the disease, treatment and hospitalization situation. We used the phenomenological-existential method. The research was carried out at the ‘Outpatient Clinic of the Cured’ of the Pediatric Oncology Service at the University of Sa˜o Paulo at Ribeira˜o Preto Medical School Hospital das Clı´ nicas. Collaborators were nine children between 6 and 11 years old, with different diagnoses, and their respective mothers. We carried out an interview with each mother, using the guiding question ‘How was your child’s treatment?’; and with each child, using the question ‘What do your remember about your treatment?’. The interview analysis was constructed in accordance with the steps proposed by Martins and Bicudo (1989), revealing three large theme categories in the discourse of mothers and children: the trajectory of the disease and treatment; conditions that helped to cope with the disease process: faith in God, multidisciplinary team, family, friends, municipal bodies, other mothers, play; and the

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current time, beyond treatment. In view of a risk mechanism like the disease, mothers and children took hold of protection mechanisms that helped them to cope with the disease, such as faith and playing, besides external resources that acted as a social support network, including the team, volunteers, family, friends and other mothers who were going through the same situation. ACKNOWLEDGEMENTS: This research was supported by FAPESP.

1083 A Longitudinal Study on Quality of Life (QOL) in Advanced Gynaecologic Cancer Patients Treated with Radiation Therapy Alone or Concurrent Chemo-radiation Therapy Kobayashi Ma, Ono Tb, Noguchi Wa, Matsuda Ab, Matsushima Ea a Liaison Psychiatry & Palliative Medicine, Graduate School of Tokyo Medical & Dental University, Tokyo, Japan; bResearch Center Hospital for Charged Particle Therapy, National Institute of Radiological Sciences Hospital, Chiba, Japan PURPOSE: The aim of the study was to describe the course of QOL in advanced gynecologic cancer patients. METHODS: Fifty-four advanced gynecologic cancer patients were evaluated. Group 1 consisted of 28 patients (mean age 65.7) treated with radiation therapy alone, and Group 2 consisted of 6 patients (mean age 60.0) treated with concurrent radiation therapy and weekly cisplatin. Participants were requested to complete questionnaires before treatment, a week after treatment, and six month after treatment. The evaluation instruments were EORTC QOL-C30 (QLQ C30) and QOL questionnaire in Japan (Kurihara QOL). RESULTS AND CONCLUSION: Emotional and social items in functioning scales and appetite loss, constipation, and diarrhea in symptom scales in QLQ C30 showed significant changes over the course of the treatment. Psychological and social items and face scale of Kurihara QOL also showed significant changes across the time. Moreover, there were interactions between the time course and the treatment groups in items of nausea/vomiting and constipation in QLQ C30 and physical items in Kurihara QOL. Generally speaking, psychosocial aspects of QOL increased gradually across the treatment. Physical aspects of QOL decreased right after the treatment, and increased at six month after the treatment. From recent studies,

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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during treatment, it is clear that patients treated with concurrent radiation therapy and weekly cisplatin scored worth QOL than patients treated with radiation therapy alone. The present study explained that QOL after treatment increased along with health recovery regardless of treatment methods. Further consideration is necessary to support and improve QOL as patients need arises.

symptom and seeking medical attention. RESULTS: Logistic regressions will be modelled with ‘delay’ as a dichotomous outcome measure. Grounded theory methodology will be used to analyze the interviews. CONCLUSIONS: The findings of this study will inform clinical practice and will be utilized to develop targeted interventions to improve clinical and psychosocial outcomes for this patient group.

1084 Psychosocial Variables Associated with Delayed Presentation of Locally Advanced Breast Cancer Gould Ja, Fitzgerald Bb, Fergus Kc, Clemons Md, Kerr-Creswell Dc a Ontario Breast Cancer Community Research Initiative, Women’s College Hospital, Toronto, Canada; bDepartment of Nursing, Princess Margaret Hospital, Toronto, Canada; cToronto Sunnybrook Regional Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada; dDepartment of Medical Oncology and Hematology, Princess Margaret Hospital, Toronto, Canada PURPOSE: To compare women who delayed presenting a breast symptom (average of 12 weeks) to those who did not on psychosocial variables of interest. BACKGROUND: Although survival rates for women with early breast cancer have improved, a subsection of women with LocallyAdvanced Breast Cancer (LABC) (tumours > 5 cm or that extend into surrounding skin/muscle tissue) continue to do poorly with a 55% 5-year survival rate. LABC accounts for up to 30% of all new primary breast cancer diagnoses. Clinical data illustrates that a considerable proportion of women with LABC delay seeking medical attention for symptomatic breast cancer with almost half waiting an average of 12 weeks. Delayed attention could mean more advanced lesions and lower survival rates for these women. METHODS: Sixty participants (delayers and non-delayers) with LABC were asked to complete a multi-instrument survey to measure breast cancer knowledge, psychological and social variables (including Ways of Coping Scale, and the Multidimensional Health Locus of Control Scale). In-depth interviews were conducted with fifteen of the delayers. They were asked to explore their experience/meaning of discovering a breast symptom and of the time between discovery of that

Copyright # 2006 John Wiley & Sons, Ltd.

1085 Developing an Integral Model for a Cancer Support Programme James Ga, Venn Gb a Chief Executive of Helen Rollason Heal Cancer Charity, UK; bAnglia Ruskin University, UK This paper aims to introduce the Helen Rollason ‘Live Well Experience’ and to start to explore several key issues arising from the small scale study of participant perceptions. The Action Research cycle that we have implemented has actively enabled us to start to translate our knowledge and understanding of an integral therapeutic model into action. The programme and the research are current and on-going. Key research questions: How do aspects of the integral model translate into practice through the programme? What are participants’ perceptions of an integral approach? What do participants feel they have achieved, if anything, as a result of the programme? The underlying model for the programme is an integral therapeutic one, based on the work of Ken Wilber (2001), Leonard and Murphy (2005) and Kabat-Zinn (2000). The programme is attempting to tentatively develop a version of such a model. Participant feedback is explored and issues arising from the process and data gathered are presented. The Helen Rollason ‘Live Well’ Experience is a five day residential programme designed to provide therapeutic support and development through a group process. The experience gives people the opportunity to leave their ‘normal environment’ and attend a programme that has been specifically designed to encourage exploration of the emotional impact of a cancer diagnosis and to potentially reconnect with parts of their lives that they have withdrawn from. Key aspects regarding the evolving model are discussed within the paper.

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AUTHOR INDEX

Listed by Author and Abstract Number The following pages display the authors of the abstracts selected for the 8th World Congress of Psycho-Oncology together with their abstract numbers

A Aapro MS Aaronson N Aaronson NK

8 261, 546 538, 578, 614, 730, 731, 1036 Abbey J 870 Abbott JM 848 Abe PK 70 Abell EJ 349, 922 Abernthy A 1001 Abian L 350, 490, 491, 574, 800 Abraham K 285 Abrardi L 553, 554 Achille M 907, 915 Achille MA 336 Ackland S 588 Adams C 251 Adams CA 249, 503, 794 Adams H 263 Adamsen L 352, 777 Adduci A 869 Adejumo PO 321 Adens A 83 Aflalo C 216 Afonso AA 746 Aggero I 354, 797, 989 Agnese A 556 Agnesone M 832 Aguiar S 756, 857, 982, 1002, 1047 Ahlberg A 355 Ahles TA 191 Aimola Davies AM 659 Ait-Kaci F 83 Aitini E 62, 356–358 Akabayashi A 456, 567, 926 Akazawa T 360 Akechi T 360, 361, 437, 681, 747 Akkerman D 268, 474, 476 Al-Khalili A 945 Albano V 212 Albarello M 556 Alberro JA 550 Alberti L 514 Albuquerque E 362, 363 Alcan˜iz M 365, 635 Alducci E 366 Alegrance FC 985, 986

Aleotti P 356–359 Alexandraki K 365 Alexandropoulos A 101 Alici-Evcimen Y 368 Allard P 271 Allen K 1001 Almonacid Guinot V 402, 786 Alunni G 560 Alvarado MC 369 Ambus I 548 Amir Z 570 Ammerman DJ 487 Amodeo L 282, 448 Anaissie E 993 Anclair M 371 Ancona A 512 Andersen BL 872, 996 Anderson B 29 Anderson JO 372 Anderson VA 452, 453 Andrade C 216 Andrade JM 593 Andrade MdGG 899 Andrade MG 931 Andre´ F 995 Andre M 77 Andreu Vaillo Y 541–543 Andrieu J 487, 843, 844 Andritsch E 71, 167, 308, 312, 373, 976 Andruccioli J 265 Andrykowski M 151 Anfossi M 374 Angelini C 412 Angen MMJ 375 Anker N 817 Annunziata MA 518 Antoine P 998 Anton SM 376 Antoni G 215 Antoni M 27 Aprile G 377 Arai H 378, 628 Aragona M 295, 894 Aranda S 717, 941 Araullo R 497 Arcidiacono S 422, 423 Arcusa A 726 Arden-Close EJ 379

Copyright # 2006 John Wiley & Sons, Ltd.

Ardiles P Arigoni F Armanni G Arranz P Arraras JI Arving C Asakura T Athanasiadis L Atsuko K Auba E Auguste P Aviv C Azaiza F Azzouz F Ayzenberg A

732 273 104, 318 545 380 382, 296, 648, 386 995 718, 479 217 281

274

481 384, 385 964

719, 720

B Babian R Bacci S Back A Bacque´ MF Bacigalupo A Bagnulo A Baider L Baile WF Bailer H Baillon C Bair AH Bairati I Baken DM Bakos A Balck F Baldus C Balistreri L Ballestrin G Bara BG Barak N Barata PC Barberis F Barbero J Barbi F Barbieri R Barbosa A Barbosa F Barca A Bardwell W Ba´rez M Bargellini F Bargetzi M

847 316 65, 66, 616 75, 387 278 388, 575, 576 9, 144, 860 13, 389, 673, 674, 675, 846 317, 390, 602–604 398 331 270 391 616 392 1067 153 366 519 147 393 863 318, 394 582 357, 464 395, 396, 570, 571 395, 396, 571 540 397 549 181 690

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

S464 Barlogie B Barr Taylor C Barrera M Barrett L Barth J Barthe E Bartsch HH Basen-Engquist K Bassanese N Bates U Bauer L Bauer S Bauer-Wu S Bauerfeind I Bauernhofer T Baughcum AE Bauwens S Bauwens SMG Bavarelli C Baxter H Bayne L Bayon C Beadle GF Beccaro M Beckmann J Beckers J Bedolis R Beeden A Belbusti V Belin TR Bell C Bellanger AM Bellaveglia M Bellizzi K Bellotti L Belluco G Bellver-Pe´rez A Belt RJ Beltramello C Bendrihen N Benedetti F Bengel J Bennett M Bennett MI Berant E Berend M Berg P Bergelt C Berger D Berglo¨f B Berman H Bermejo I Bernard M BernardDuBenske LL Bernardo A Bernhard J Berra C

AUTHOR INDEX 993 134 945 292 292, 327 716 329 152 228 345 533, 534 196 140 1054 167, 169 600 532, 544 398 941 839 379 364 399 297 896 400 525 292 910–912, 1013 225 114 485 935 141 421, 916 241 401, 402 958 366, 953 714 136 621, 1055 692 438, 783 480 403–405 406 309, 407, 715 715 517 109 245 408 205, 409, 410, 459 599 128 282, 415, 448, 882

Berte´ R Berth H Bestmann B Betta PG Bettega BP Bettinardi O Beve C Bezjak A Bharacha S Biagini E Biancalani F Bianchi Micheli G Biancosino B Bier A Bidin L Bidoli E Bierge C Biffa G Bigenwald R Bijvank EM Binaschi L Bindewald J Biondi M Birmele M Bishop J Bjarnaso B Bjorda K Blanco AM Blck F Bleijenberg G Bleiker E Bleiker EMA Bliss JM Bloch S Blomberg B Blomberg K Bloom JL Bobnar A Boccia V Bodo M Boesen E Boesen EH Boesen S Boinon D Boixado´s M Bolis T Boman KK Bonacchi A Bonanno A Bongiorno L Bonsignori M Bonucci A Boole LC Boran F Borasio GD Bordin F Borges MRL Borges S

Copyright # 2006 John Wiley & Sons, Ltd.

446 392, 411 405, 689 412 413, 744, 857 445, 446 889 713 482 181 471 126 381 411 446 518 414 272 627 1036 415, 1026 971 10 895 885 1012 545 862 411 291, 584 261, 416 614, 730, 731 634, 769, 770 208 27, 288 1016 751 969 267, 417, 418 750 326, 665, 705 310, 326 310 917 550 353, 419 371, 420, 640 421 221 422–424, 462 910, 911, 912 863 669 799 901 425, 426, 935 413 362

Borreani C 427 Borschneck JA 1031 Bosco A 246 Bosisio M 427, 572 Bostock N 692 Botega EJ 898 Bottero G 354, 989 Bottomley A 319 Boucher B 694 Bovbjerg D 653 Bovero A 428 Box F 80 Boyes AW 235, 429, 588 Boyes S 292 Boyle DA 236 Boyle F 992 Bracco V 279 Bradley A 342 Bragard I 432 Brain K 260 Bramsen I 1036 Brandalise SR 413, 744 Brandberg Y 380 Brando MC 431 Braun M 206, 617 Breaden K 619 Breatnach F 765 Bre´dart A 80 Breitbart W 2, 368, 808, 870 Brennan JH 432 Bressi C 733 Brighetti G 1043 Brignardello E 1046 BrintzenhofeSzoc K 955 Brisson C 325 Brisson J 325 Brocai D 293 BrockerVriends AHJT 1039 Brode K 433 Bron D 758 Broom DH 434 Brown J 1026 Brown R 90, 91, 92 Brown S 1081 Bruce L 1026 BruchonSchweitzer M 502 Bruera E 5, 54, 389, 438 Bruera ED 711 Brugieres L 215 Bruggeling M 935 Bruggeman SK 226 Brummell V 1073 Brunelli C 231, 427, 572 Brunello N 67 Bruno R 283 Brusa M 412

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

AUTHOR INDEX Brusco S 461 Buch Villa E 787 Buda C 435 Buda F 435 Buda P 388, 436 Budziski W 930 Buernhofer T 308 Bulli F 373 Bulotiene G 439 Bultz B 123 Bultz BD 245, 336, 457, 1010 Bumeder I 440 Burfoot A 11 Burhansstipanov L 342 Burnett PC 671 Burns C 145 Burns CM 443 Burns D 112, 114 Burns P 788 Busa F 953 Buscemi V 442, 492 Busch R 440 Buss MK 409 Buss T 1059 Bussian C 972 Bussieres E 948 Butler K 627 Butler L 122 Butow P 85–87, 89, 91, 94, 183, 184, 238, 631, 658, 1009 Butow PN 232, 612, 613, 668, 887 Buttstaedt M 970 Byers K 849 Bylund C 90, 92 Bylund CL 443 Byrne DG 509, 659

C Cabanela RL Cabral AS Cai P Calandra G Caldarella A Caldera P Calvio LC Camara F Campanella C Campbell T Campos ERC Cankurtaran ES Canga NA Cano A Canova R Cantore M Capanna L Cappellaro KMC

226 444, 464, 535 278 445–447 221 282, 415, 448, 1046 449, 559 450 135 100 977 451 1053 386 126 836 447 744

Capovilla ED

506, 507, 789, 954, 1052 Capozzo M 937 Caprino D 164, 165 Carboon I 452, 453 Cardinali M 426 Carlson L 100, 375, 458 Carlson LE 123, 457, 1010 Carreca A 465 Casden D 397 Castelo B 364 Caraceni A 6 Care O 1032 Carey M 651, 941 Carlsen K 97 Carmack Taylor CL 459 Carloni I 212 Carlson L 100, 375, 458 Carlson LE 123, 457, 1010 Carlsson M 816 Carotenuto M 460 Carpenter P 888 Carr A 753 Carretier J 461 Carric¸o LM 891 Carter GL 249, 251 Carter KE 669 Caruso A 40, 422–424, 462, 463, 1050 Carvalho A 444, 464, 535 Carver C 27 Carver CS 211 Casale V 462 Casault L 465 Caspari C 1054 Cassileth B 870 Castle KL 783 Catanzaro P 103, 104, 106, 274, 801 Catt S 63 Cavallari G 586 Cavalli F 14 Cavazzini G 356 Ceccarelli F 468, 840 Cengarle R 357 Cento G 374 Cerver C 288 Cervera-Enguix S 386 Cestelli C 233 Chachkes E 581 Chagas M 793 Chan M 237, 244 Chan P 336, 907, 915 Chandwani K 28, 481 Chappel R 1035 Chappuis PO 1065 Chauhan D 250 Cheng T 284, 467

Copyright # 2006 John Wiley & Sons, Ltd.

S465 Cheung AM 486 Chiari S 580 Chikota O 469, 840, 841 Chochinov HM 7, 524 Christensen J 641 Christensen S 305, 469 Christophe V 888 Chvetzoff G 84 Ciani L 766 Ciaramella A 470 C¸ic¸ek L 240 Cilenti G 1029 Cina` G 466 Cini R 228, 471, 472 Ciuffardi G 471, 472 Ciurekgian R 766 Ciyao H 473 Clair AA 217 Clark K 955 Clark L 224 Clark MM 861 Clarke DM 287 Clarke S 250, 548, 992 Clavarino A 229 Cleary JF 205, 409, 410, 459 Clements AM 260, 332 Clemons M 1084 Clerici CA 353 Clifford S 123, 457 Clinton-McHarg TL 588 Cloughey TF 662, 663 Clover K 251 Clover KA 249, 503 Coca C 318 Cockburn J 94 Cocozza A 754 Coens C 319 Coffin JM 268, 474–478 Coggan C 772 Cognetti F 40 Cohen I 480 Cohen L 28, 481, 829, 846, 847 Cohen M 285, 479 Cohen SR 207 Coleman EA 993 Colleran MC 482 Collins K 646 Collins SM 315 Collova` E 580 Colombo A 340, 739 Colombo E 763 Condoleo MF 858, 877 Consoli S 311 Consoli SM 483, 700, 843, 844, 875, 876 Conte MA 937 Coombes L 484

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

S466 Coon SK Copel L Copel LM Coppa GV Corbelli A Cordier S Corgna E Cormier J Correa DD Corsini L Cortes-Funes F Cort"ı V Corvasce C Cosimelli M Costa A Costa G Costa P Costantini M Costello A Costello T Cotroneo A Cotroneo M Couper J Coups EJ Courtney U Cousson-Ge´lie F Cowan R Cowderoy S Cox A Cox K Coyle N Crater B Crawshaw MA Creed F Creus J Crews C Crispino S Crispo A Cross LJ Crowe H Csikai E Culos-Reed SN Curran MS Currie S Currow D Currow DC Curti R

AUTHOR INDEX 302, 992 780 485 212 586 311 104 809 486 487, 488 350, 490, 491, 574, 800 442 914 960 493–496, 596, 597, 792 252, 299 980 41, 297 966 622 497 513 208 498 275, 499–501 502 256 432 63 43 871 225 220 32, 34 918, 919 25 856 334 503 966 884 504 505 375 589, 619 1001 763

D D’Accordi S D’Aiuto G D’Amico A Da Re S Dahl AA Dal Sasso L Dallanegra L

506, 507, 789, 1052 334 799 518 98, 324 366, 953, 954 447

Dalton SO Danker H Dander B Daniells E Dantzer R Dany L Dardanelli L Dauchy S Davenport SC David N Davies G Davolls S Day J De Amicis V De Bree R De Feudis R De Feudis RL De Groot JM De Grout J De Haes H De Hullu NM De Jager Meezenbroek EC De la Calle Prieto MA De Louwere E De Marco IF De Moor C De Nittis G De Pangher Manzini V De Pauli F De Roten Y De WaldenGaluszko K DeAngelis LM Dearnaley D Debess JE DeGeest K Deges G Degner LF Del Ben G Del Bianco P Del Nord R Del Rincon C Delage M Delavigne V Delfont S Dell’Agostino K Dellson P Delvaux N Demyttenaere K Denieffe S Denver J Deodhar JK Derchain MSF Dergent T

Copyright # 2006 John Wiley & Sons, Ltd.

97, 333, 706 341 841 254 132 508 574 81, 215, 714, 831, 995 509 703 695, 790 1069 510 279 1049 513 512 515 247 230 818 298 516 818 517 152 521 565 377 408 44 486 795 511 29 262, 514 124 518 241 169 318 949 461 510 419 517 234 23 520 956 522 898 1035

Derosas L Derzelle M Desbiens JF Desille N Despland JN Destrooper P Devery K Devi N Devins G Devins GM Dhillon H Di Dio P Di Giuseppe S Di Leo S Di Nunzio C Di Palma M Di Polito R Diaz-Sayas L Diderichsen F Didier F Diegelmann C Dieguez M Dietmaier G Dietrich L Dilhuydy JM Dinapoli L Dinauer SK Dinkevich I Dinkel A Disavoia A Distante V Distelmans W Distelmans WKHM Ditz S Diz MDPE Decoene E Dodd MJ Doecke J Dolbeault S Dolcetti G Doll R Domingues V Donegani S Doni L Dooley BA Doolittle GC Dori N Dorval M Douma KFL Douma M Doughty JC Dowell JM Drakopoulu F Drew D DrobilUnterberger A Drolet M Drory M

735 76 523 852 408 532 619 842 242 515, 713 612 527, 915 212 41 445, 446 853 423 394 97 525, 526 528, 649 364 167, 312 128, 129 502 529 410 530 411 531 553 532 398 533, 534 746, 880 943 133 229 80 228 110 444, 464, 535 188, 536 421 345 1076 925 537, 873 538 342 1078 848 296, 384 269, 539 33 325 925

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

S467

AUTHOR INDEX Dubois C Dubois S Ducimetie`re P Dudley HC Dudoit E Dufour M Dugas M Duglio E Duivenvoorden H Dunkley M Dumont S Dunn S Dupont A Dupont SL Dura´ E Dura´ Ferrandis E Duran G Duric Vlatka M Durieux JF Du¨ring M Duvall K

949 701, 728 311 644 508 180 873 354, 797, 989 1039 315 270 992 889 979 608–610 541–543 406 335 450 333 202

Eremin O Erg P Eriksson K Ermuth T Ernst B Ersoy MA Eskens FJM Espasa R Esplen MJ Espie A Essmann I Estape´ J Estape´ T Etienne AM Ettorre GM Evans A Evans G Evron E Ewertz M Ewing JE

E

F

Eaton G Edelson M Edgar L Edler L Edwards L Eelen S Eeles R Eerenstein SEJ Efficace F

Fabi A Fainsinger RL Fairclough D Falcicchio C Fallowfield L Falzetta A Fang C-K Fanke A Fasola G Faria F Faria FP Farvacques C Faulds Wood L Fava S Favara-Scacco CC Favre N Favre R Fawzy IF Fawzy NW Federici A Fegg MJ Fei L Feinstein MB Fergus K Fergusson L Ferna´ndez V Ferna´ndez Liria A Ferrandes G Ferrari S Ferrer AL Ferrero M Ferretti G Ferri F Ferro AM Ferrucci RE

223 154 728 344 1067 544 633, 795, 1069 1049 135, 307, 319, 545, 546 Egholm Inger L 817 Eichenberger C 130 Eisen A 548 Ekeberg Ø 942 Elbert I 262, 514 Elbi-Mete H 289 Eliott JA 277, 547, 827 Elklit A 890 Ellis P 232 Elsass P 326 Elverdam B 887 Emanueli T 735 Emery CF 996 Endo C 826 Endo K 328, 481 Endrizzi G 951 Enk V 694 Enge JR 820, 822 Engholm G 683 Engst-Hastreiter U 406 Engstro¨m E 420 Engstrom T 355 Enovi S 376 Ercole G 412 Eremin JM 1060

Copyright # 2006 John Wiley & Sons, Ltd.

1060 277 1007 896 511 289 1036 549 284, 290, 548, 627, 732, 754 294 33 337, 550 337, 414, 549, 550 430, 764 858 1032 332, 633 259 511 320

877 711 1038 135, 877, 878 63, 93 856 551 684 377 1047 552 450 21 580 221 408 508 60 46 540, 867 901 303, 553–555 498 1084 625 608–610 909 278, 556 531 216, 556 428 388, 576 763 279 905

Feuerstein M Fielding R Fieramosca S Fierro C Figer A Filion L Fillion L Finney Rutten LJ Finzi E Fiore M Fioretto L Fischer M Fischer N Fillion L Fishniak L Fitch M Fitch MI Fitzgerald B Flahault C Fleer J Fleming L Fletcher I Fluri M Fobair P Focardi F Foley S Fonseca S Font A Fontani S Forbes J Ford JM Forghieri M Forjaz MJ Foshe KA Fossa SD Foster C Foubert J Fournier C Fraberger G Fraid AK Franc¸a BAL Franchi R Franco MHP Franssen SJ Frederiksen K Frick E Friedlander M Friedman T Friedsam J Frierson GM Frigo AL Friis-Andersen K Frommer J Frood J Fuentes S Fukuo W Furukawa T Fyles A

449, 559 237, 244 734 1043 150 625 270, 523, 625 142 171 745 472, 560 253 440 270, 523 383 467, 804 45, 670 1084 780 1028 294 32, 34 130 286 472, 560 561, 1058 493, 494, 792 442, 492 554, 555 658 662 562 386 330, 961–963 98, 324, 605, 629 343, 565 58 888 338 527 977 980 564 230 310 440, 901 778 773 213 996 565 872 684 694 414, 566 456, 567, 926 360 515

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

S468 Fyles G Fyodorov A

AUTHOR INDEX 207 530

G Gabeeva NG Gaff CL Gagliardi A Gagliese L Gagnon B Gagnon P Gaisser AE Galan Brotons A Galanos A Galbiati S Galdon Garrido MJ Galeazzi G Galeazzi GM Galica JP Galinsky D Gallagher P Gama G Gamito E Ganesh N Gangeri L Ganuza BM Ganz PA Garaventa A Garce´s Furio` R Garc"ıa-Llana H Garcia Valverde A Gardiner RA Garssen B Garufi C Gasparini I GastonJohansson F Gateau C Gatti M Gauthier H GazendamDonofrio SM Gazzola M Gebest HJ Gehring K Gedge RB Geinitz H Gelati P Gelie F Geoffroy-Perez B Gerbino SB Gerhardt CA Gerritsma M Gerritsma MA Gessler SF Geue K

1056 256 266, 393 306 271 270, 271 344, 568 787 927 850, 869 542, 543 910–912 562 569 617 637 570, 571 342 845 572 573 605 734 787 394 350, 490, 491, 574, 586, 800 598 253, 298 135 388, 575, 576 672 998 381, 785 888 222, 954 344 578 287 277, 580 947, 311 580 600, 920, 261 538 254 970

577

580 948

601, 768, 906, 1038

Gex-Fabry M Ghinelli C Ghio P Giacalone A Gianini J Giannakakis T Giannarelli D Giardino R Gibson F Gidron Y Gielissen MFM Giese-Davis J Giesecke A Giesler JM Gil F Gil K Gil Nuno P Gilbert E Gillespie G GimenezRoqueplo AP Giraldi T Giralt M Girgis A

1065 582 835 209 126 367 529, 960 1043 923 379, 583, 802 291, 584 134 586 587 252, 299, 825, 1021 654 363 182 510

700 937–939 566 94, 235, 429, 588, 589, 612 Giuffra E 180 Glaser A 220 Glendon G 290 Glimelius B 380 Godbout L 879 Godet A 84 Goetze H 970 Golant M 107, 110 Goldberg WG 591 Goldman S 203 Goldstein D 736, 1073 Gollins S 790 Gondon N 414, 549 Gondo`n Espinasa N 592 Gongora B 491 Gonzales L 669 Goodenough B 320, 539 Gooney M 520 Gorayeb R 593 Goswami SS 522 Gould J 594, 694, 804, 1084 Graci G 155, 158, 159 Gradi S 914 Graham CA 663, 1070 Granat A 1007 Grangeia R 493–496, 596, 597, 792 Grassi L 16, 381, 785, 924, 939, 1021 Grau JJ 337 Graves KD 762 Gray R 187 Graziano F 913

Copyright # 2006 John Wiley & Sons, Ltd.

Greco M Green A Green HJ Green V Greenman J Gridelli C Grisoglio C Grisorio C Gritti P Gritz ER Grivas D Groenendijk M Groenvold M Groff S Grollman JA Grnbæk M Grulke N GuarinoA Gudbergsson SB Guedea-Edo F Guedj G Guedj GS Gueguen JA Guens GP Guerin S Guill AB Guix-Melcior B Guma´ J Gunnarsdottir HK Gunnarsdottir S Gustafson DH GustavssonLilius M Gutie´rrez Mart"ınez O Guy HL

231 229 598 101 322, 957 283 1005 1006 51, 599 1028 183 416 524 123 600, 601 309 317, 390 214, 540, 729, 867 98, 324, 605 696 620 606 443 607 765 669 696–698 973 95 1012 205, 409, 459 210 837 611

H Haase JE Hack T Haerter M Hagen-Aukamp C Hagerty RG Hahn D Hahn DEE Haines S Hakanen J Hale J Hallowell N Hamazaki K Hammelef K Hammell N Hansen HP Hansen JA Harada K Hardie J Hardwick PJ Harnett PR

112–121 125 895, 986 715 231, 612, 613 416 614 284 99 220 264 681 615 752 328, 706, 868 449, 559 378 160 48 588

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

S469

AUTHOR INDEX Harper FWK Harris L Hartmann O Hasenbring M Hasenbring MI Hassard J Hasson-Ohayon I Hastrup K Hausmann C Haut PR Heckl U Hedayati H Hegarty M Hegarty MM Hegarty S Heim M Heitzmann CA Hellbom M Heller A Helmes AW Henderson BJ Hendricks K Henne-Bruns D Henriksson R Henselmans I Herdman J Herna´ndez S Herna´ndzNavarro F Herndon JEII Herrmann E Herschbach P Hession N Heyison M Heys SD Hietanen P Hildenbrand B Hill H Hill J Hill KA Hilliard F Hinds PS Hirahara SH Hirai K

762 616 215, 831 514 262 268 617 641 433 115 293 618 1001 619 477 341 759–762 517, 621 169 621, 1055 260, 332 622 689 628 623, 624 772 608–610

318, 394 844 971 277, 406 626 25 102 96, 210 433 343 224 627 123, 457 269 1057 378, 628, 686, 688, 1019 Hirayama S 650 Hiroki I 964 Hitoshi O 815 Hjermstad MJ 629, 630 Hjortebjerg U 708 Hobbs K 87 Hochberg T 1077 Hodgkinson K 238, 631 Hoeber M 375 Hoekstra HJ 222, 577, 1028 Hoekstra-Weebers J 1040, 1041 HoeksraWeebers JEHM 222, 577

Hoey L Holcombe C Hlge-Hazelton B Holland JC Holte H Holzha¨user J Holzner B Homewood J Hompson A Hopf C Hopkinson J Hopwood P Horn J Horn S Horne DJ Horne DjdeL Horneber M Hospital A Hou L Houshmand S Hove´n E Howard RA Howe D Howlett R Hybye MT Huber JC Hubert A Hughes MK Hulbert NJ Humpel N Hunt GE Hunter J Hurley K Hurny C Husain Lopa S Hutson SP Hvidt NC Hyatt Al Hyodo I Hzelton M

476, 477 224 632 1, 348 629 684 72, 545 258 290 130 343, 565 300, 633, 634, 769, 770 997 243, 1027 1020 484 546 365, 635 636, 638, 639 375 640 611 22 393 641 940 480 339, 642, 643 644 304, 645 238, 631 290 153 127, 128 646 647 706 752 686 315

I Iaderosa S Iaiza E Ibanez Guerra E Ilesanmi RE Iliadis I Imhof M Inagaki M Inbar M Ingham R Innominato PF Inoue S Inui H Invernizzi G Irahara MI Iren Akbiyik D

Copyright # 2006 John Wiley & Sons, Ltd.

561 377 542, 543 321 555 940 681, 747 147, 148 243, 1027 131 68, 655 648, 688 733 1057 175

Irish J Isermann M Ishiguro Y Italia S Ivers H Ivers ME Iverson DC Iwamitsu Y

713, 1079 528, 649 677 221 879 345 304, 631 650

J Jackman M Jacobsen AB Jacobson CM Jagsch R Jaienois MF Jalali MR Jamard A James G Jandolo B Jankovic M Jarvis S Jeffery D Jefford M Jenkins K Jenkins V Jensen AB Jessen J Jeunemaitre X Jhanwar S Jian R Johanse C Johansen C

Johansen MB Johansson B Johnson CE Johnson G Johnson L Johnson LG Johnson R Johnson S Johnson T Jokinen J Jokinen T Jones BA Jones J Jones JM Jones L Jones TJ Jonsdottir T Jonsson T Jost R Jovell E JRT Juan E Juel-Blicher U Jul Houmann L

284, 467 629 808 830 758 814 77 1085 529 166 778 143 372, 478, 651, 941 652 63, 93 305, 469, 489 757 700 153 483, 844 653 16, 97, 309, 310, 326, 333, 665, 683, 706 641 672, 1007 589 654 559 449 654 625 779 346 346 314 284, 306 754 254 399 95 672 257 716 957 414 656 524

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

S470 Julkunen J Jung C Jung S Juraskova I Jussila AL Jussila ALI Just A Jutand MA

AUTHOR INDEX 210 257 657 86, 91 346, 660 659 292, 661 502

K Kaasa S 38, 630 Ka¨chele H 317, 390 Kaechele H 602–604 Kahlert S 1054 Kaiser W 649 Kakade AC 522 Kaleita TA 662, 663, 1070 Kaluai RK 664 Kaneko F 1033 Ka’opua LSI 664 Karahalios E 651 Karamitrou V 296, 384 Ka˚resen R 942 Karlsen RV 665 Karvali M 660 Kash KM 666, 667 Kasl SV 314 Kasparian NA 668 Kataoka T 68 Kato M 826 Katz M 233, 743 Katz ML 848 Kaw C 263 Kawai K 1068 Kazanjian A 108, 110 Kealey CP 277 Kearney N 923 Keats MR 504 Keck J 572 Kegel D 327 Kei H 964 Keir ST 669 Kejs AMT 683 Keller M 44, 257, 514, 579 Keller-Olaman SJ 670, 804 Kelly A 711 Kelly BJ 671 Kelly HL 294 Kelly P 671 Kenne Sarenmalm E 672 Kennedy KJ 399 Kennedy R 302, 991 Kent LM 391 Kerr-Creswell D 1084 Kerrins ET 922 Keskivaara P 210 Kettler P 673–675 Khatib J 313, 676

Kiernan G Kikuchi H Kim JM Kim SW Kim Y Kim YC King MT Kinney A Kinsinger D Kintner E Kishimoto S Kiss A Kissane D Kissane DW Kirk J Kirs K Kirsh KL Kirsten L Kjellberg C Klikovac T Kline G Klopfenstein K Kluijt I Knutsen L Kobayakawa M Kobayashi M Koch SV Koch U Koehler M Koenigsmann M Koerting A Koh OH Kohli Neena UA Ko¨hm J Koldewijn E Komura K Konsta A Kooken W Kooken WC Koppen G Korobkova LI Korstjens I Kotz R Kova´cs MJ Kowalczyk JR Koyama A Kraemer H Krebs LU Kreitler MM Kreitler S Krenz S Krespi R Kreukels BPC Krikorian A Krishnan R Kristensen T

Copyright # 2006 John Wiley & Sons, Ltd.

753, 765 456, 567, 677, 926 678 678 146, 211, 263, 679 678 320 1015 30 113 682 128 17, 92, 208, 717 49 258 761 849 85–88 425 521, 680 504 600 261 352 681 682, 748, 1083 683 59, 172, 309, 327, 407, 715, 755, 936 684 684 741 784, 1014 685 1054 818 686, 1019 385 117, 119–121 118 197 607 687, 749, 1041 338 564 930 688 134 342 147–150 147–150 35, 36 224 192 52 842 707–710, 1017, 1018, 1081

Kristjanson L Kru¨ger S Kryspin-Exner I Kubo C Ku¨chler T Kuechler T Kuenzler A Kui-Beda V Kuljanic-Vlasic K Kumar M Kumar S Kumar TM Kung S Kunkel EJS Kunstmann E Kupst MJ Kuranami M Kurbel S Kurchaova MS Kuromaru T Kuzeyli Y Kvist TW

264, 524, 589 411 830 1068 405 689 690 691 545 1008 53 248, 692, 838 861 667 262 1038 650 376 607 1019 240 693

L Labbe E Labrecque M Lacerda A Lacey RT Lackore KA Lacorte-Pi TM Ladinek V Lagarde SM Lahlou-Laforet K Lai A Lai V Lakos M Lam WWT Lambert SD Lambertenghideliliers G Landi B Langridge C Lannamann J LansbergenDe Vette J Lapointe BJ Larbig W Laron A Larsen I Larsen LR Larsen S LaSala K Lau H Laurell G Laurence V

77 694 793 695 1076 696–698 308, 313, 373, 699, 976 230 700 663 913 1042 237, 244 701 733 875 63, 93 616 416, 1037 702 317, 390, 602–604, 703 704 326 706 707–710, 1017, 1018, 1081 806 504 355 780, 949

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

AUTHOR INDEX Lawlor PG Lazzarotto E Leal I Leal IP Lebel S Lecathelinais C Lechner S Lecomte T Lecourt E Lee R Leemans RCR Leger I Lehmann C Leibbrand B LeichtnamDugarin L Leiker EMA Leimer M Leis A Leite EL Lejeune S Leo´n C Leo´n-Pizarro C Leonardi L Leppert W Leszcz M Lethborg C Levi della Torre S Levine EG Levy LB Lewin G Lewis J Lewis P Leyvraz S Li P Li P-Y Libert Y

711 1005, 1006 712, 851 1044 242, 713, 1079 235, 429 27, 288 875 998 242, 1079 1049 714 407, 705, 755 327

461 538 734 207 822 546 716 697 853 272 290 717 189 718, 719 849 976 806 788 35, 36 721 551 82, 234, 400, 430, 722, 723, 758 Lienard A 82, 723 Lieutenant F 400 Ligabue MB 575 Lima C 881 Lima CSP 997 Lima MBBP 997 Limoncelli L 424 Lindahl Norberg A 724 Lindbohm ML 96, 99 Lindeman GJ 256 Lindeman R 320 Lisboa C 216, 557 Liscio M 353, 869 Lissandrello G 725, 894 Livingston T 475 Lloyd-Williams M 39 Lluch J 716, 726 Lluch Herna´ndez A 786 Lobb E 264 Lobb EA 232

Lockhart K 993 Loge JH 630 Loiselle CG 347, 701, 728 Lombardi D 586 Longo C 562 Longo V 267, 417, 418 Loos C 183, 229 Lopez AL 658 Lopez E 214, 729 Lo´pez P 973 Lo´pez-Fando T 394 Lo´pez-Soler C 608–610 Lord R 761 Loscalzo M 25, 955 Loureiro R 558 Love A 208 Lowe J 254 Lu YFY 117, 119–121 Lucas HM 891, 893 Lucas V 843, 844 Lucente F 470 Luciano C 781, 782 Luciano G 265, 417, 418, 599 Luciano-Soriano C 837 Luczak J 272 Luini A 525 Lukas P 33 Lurati C 904 Lutgendorf S 29 Luthi F 35, 36 Luxford K 1032 Luzzatto L 560 Luzzatto P 556 Lync JW 333 Lyon Howe D 22

M Macedo TL MacEwan L Machavoine JL Macias T Macvean M Madalinska JB Maggi G Magri V Maguire P Mah K Maheu C Mai V Maiello E Maislinger S Majkowicz M Malchow B Malabaila A Malagoli M Malingher A Malina J Malone K

Copyright # 2006 John Wiley & Sons, Ltd.

984 752 77, 461 803 208 730, 731 877, 878 924 32 242, 515, 1079 732 393 1029 33 1059 405 448 938, 939 445 940 320, 345

S471 Maluta S 799 Mambrini A 836 Manenti S 733, 763 Manfredini L 734–736 Mangini I 180 Mann B 737, 738 Mann G 668 Manne S 154 Mantani T 655, 834 Marchal S 723 Marchesoni M 950, 951 Marciai N 799 Marcus J 156, 161 Marinho ML 705 Marino C 739, 740 Mark K 1017 Marmai L 381, 785 Marme´ A 568, 741, 990 Maroco J 712, 851 Martikainen R 96 Martignetti A 856 Martin C 549 Mart"ın MD 973 Mart"ın Va´zquez MJ 742 Martinelli F 766 Martinez Sanchez MA 762 Martini MC 799 Martins C 1021, 1023, 1024 Martins VB 984 Maruelli A 454 Maruelli APA 743 Marx E 78 Masatoshi I 437 Maschio M 529 Maskarinec G 965 Mason C 885 Massaglia P 179 Maˆsse B 325 Massimino M 850 Massimo L 165 Massimo LM 164 Massone ML 735 Mastellaro MJ 552, 744, 982, 983, 1002 Mastrogiacomo Russo F 745 Mastroianni CM 246 Mathys R 544 Matsuda A 748, 1083 Matsuoka Y 437, 747 Matsushima E 682, 748, 1083 Matsushita T 748 Matthaeus C 971 Matthes HTZ 593 Mattioli S 801 Mattsson E 517 Maunsell E 325, 537, 873

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

S472 Mauro A May-de Groot A May-de Groot AM Mayer C Mazzaferro V Mazzon N McCorkle K McCurdy RK McGettigan P McGrath D Mc Kiernan A McKinnon S McLean LM McMahon E McNamee S McNatt P McQueen A McQuestion M McQuillan RJ McTavish FM Medley A Mehnert A

274 687, 1041 749 752 572 557 112–115 751 794 520 753 622, 966 754 809 616 303, 993 1053 467 482 409, 410, 459 484 172, 327, 755, 936, 946 Meighen P 664 Meira WVA 756 Meiser B 256, 258, 264, 335, 668, 757 Meijers-Heijboer H 1039 Mehlsen MY 489 Mencacci C 904 Mendonc¸a V 396 Menko F 261 Menoni E 856 Mensa` A 913 Merckaert I 82, 234, 400, 430, 722, 723, 758, 764 Me´rette C 271 Merino S 919 Merluzzi TV 759–762 Mermillod B 273 Mertens L 1035 Meseguer Hernandez C 516 Messina G 435, 763 Messner S 548 Mesters I 687 Metzger RL 788, 956 Meunier J 764 Meyer ET 1038 Meyer L 796 Meyler E 765 Miaskowski C 138 Michelidakis K 367 Midtgaard J 352, 767 Mikulincer M 206, 480 Miano M 734 Miccinesi G 41, 233, 316, 454, 766

AUTHOR INDEX Milan L Millar K Miller KS Milloni D Mills J Minami H Minciotti E Ming Y Mino JC Mirante N Mirapeix I Mireskandari S Mirsu-Paun A Mirsu-Paun C Mitchell AJ Mitchske D Mivtach R Miyaoka H Miyashita M Mizgireuv IV Mode` A Modlinka A Modolell E Moeller T Moiseeva TN Mok K Mollen E Mller S Molls M Molna´r Z Monahan C Monahan P Monahan PO Monfardini S Monfredo M Monson JRT Montanaro R Monte P Monteggia Martignoni C Monteiro L Monteiro Grilo I Montel SRE Montella M Montesi A Montesinos F Montesinos Mar"ın F Monti A Monti DA Montreuil E Montrone V Moores TS Morais MICR Morasso G Mordenti P Morelli AC Moreno Bas P

Copyright # 2006 John Wiley & Sons, Ltd.

978 1078 768 916 300, 634, 769, 770 361 801 112 485 766 364, 635 757, 778 771 771 772–774 664 150, 775 650 815 897 359 1059 776 777 1056 778 779 469 579 903, 1042 751 112, 115 217 56 447 1061, 1063 914 735 126 44 396 780 334 266 837 781, 782 905 667 888 599 783 982, 983 41, 297 447 785 786, 787

Morgan A Morgana F Morikawa S Morison EJP Morita M Morita T Moriyama M Morley LK Moroni CF Morrison D Morrison VL Morse S Mortensen PB Mosquera JA Moss-Morris RE Mota M Moucheux A Moura MJ Moxey AJ Moynihan C Muell S Mulders P Mulhern S Mulinacci E Mu¨ller B Mu¨ller MC Mulrooney TJ Mumm A Munari J Murphy A Murphy DL Musick B Musick BS Mussa A Musso M Muszbek K Muthny FA Muzzi M Myhill K Myriokefalitakis I Mystakidou K

788 506, 507, 789, 1052 877 527 382, 481 360 815 280 445 921 644, 790 991 333 791 379 493, 494, 792 450 793 794 769, 795, 1069 895 818 1072, 1078 228 533, 534 558 796 329 1046 1065 1077 115 112 415 354, 797, 989 55 245 553 798, 1000 367 927

N Naaman S Nadalini L Nair MK Nakane Y Nanda MV Narayanan D Narvaez A Nashan D Nataloni G Nausheen B Navarra K Navarra S Neamat M Neary D

625 799 255 826 255 1008 350, 490, 491, 574, 586, 800 896 104–106, 274, 801 802 130 130 676 370

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

S473

AUTHOR INDEX Neblock T Negro M Nekolaichuk CN Nel RD Nelson CJ Nelson JJ Nelson JP Nencini G Neu Jean C Neumann M Nghiemphu P Niakan M Nicholl K Nicoll IM Nielsen A Nielsen Mogens M Niitani M Nikolaidis P Nilsson I Ninkovic M Nirensztstein S Nirmal AR Nirmalkumar AR Nissim R Nitzberg L Nocchi M Nogossek JMJ Noguchi W Noll RB Norville L Novembre MR Novotny P Noyan A Nucci NAG Nugent P Numico G

961 832 611 644 807, 808 803, 804 805, 806 454 83 810–813 662, 663 814 497 670 710 707, 709 815 355 816 33 228 874 340 239 561, 1058 910–912 818 748, 1083 601, 906, 920 803 466 861 289 351, 819–824 432 374

O Oakes LL O’Brien SM O’Reilly A O’Shea N Obbens E Ochoa C Ogata A Ogston K O¨hle´n J Ohshima A Oikawa T Okamura H Okamura M Okamoto I Okuhra H Okumura M Okuyama T Okyayuz U Oldervoll LM

269 702 213 807 871 825 834 102 672 1019 1068 68, 655, 834, 1033 361 563 382, 481 628 826 176 629

Oliveira AG Oliviere D Olsen LZ Olson K Olver I Olver IN O¨nen Serto¨z O¨ Onnis L Ono T Onozawa SO OnwuteakaPhilipsen BD Ophir R Oppenauer C Oppenheim D Oprean C Or A Orgaz P Orlandi M Ormondroyd E Osowicka M Ostacoli L Ostapenko V Ostroff JS Otmarich G Otter R Oyebode JR Ozalp E

552 37 693 458 618, 828, 1075 277, 547, 827 240 50 1083 1057 902 829 830 215, 831 994 237, 244 635 836 1069 1059 323, 832, 835 439 498 1003, 1004 1040 611 177, 451

P Pacchiana Parravicini MV Pace E Pace P Pacetti P Packer MP Pacquement H Pa´ez M Pa´ez-Blarrina MB Pakenham KI Palao A´ Palat G Palazzo S Palladino A Palmer JL Palmer L Palmer S Paloste R Palumbo G Pandey M Pannuti F Papa M Paparella S Papini M Papsdorf M Paradis M Parashar D Parker P

Copyright # 2006 John Wiley & Sons, Ltd.

323, 835 221, 438 221, 438 836 557 780, 949 781, 782, 837 781, 782, 837 598 909 838 246 853 438 389 839, 1011 660 468, 840, 841 255, 842 1043 259 905 181 219 483, 843, 844 845 389

Parker PA Parkkonen T Parle M Paroli M Parpa E Parra G Paskett ED Passik SD Pastore V Patenaude A Patenaude AF Patra˜o I Patta J Patterson P Pattison PE Pava M Pavese I Pavlik EJ Peabody E Pearce A Pearce K Pedersen AF Pedersen CG Pedersen I Pederson LL Pedro SE Pedrosa AM Pedroso E Pelegr"ı A Pelicier N Pellacani G Peltenburg H Pendlebury S Penedo F Peng P Pentz RD Pepall E Perce J Perdicaris MAA Perez M Perez X Perez Rodriguez S Perfetto R Perina E Perina EM

Periti J Perkins G Perkovic M Perrone A Perrone M Perrucci E Perry S Persiani M Petersen LR Peterson C Peterson LJ

846, 847 660 32 470 927 726 848 162 850, 869 1038 265, 537, 873 712, 851 835 852 372 793 853 151 348 185 88 854 305 1007 806 821 819 793 918, 919 483, 843 562 855 232 29, 30 636–639 862 264 397 898 856 299 542, 543 916 1047 216, 552, 557, 744, 756, 857, 982, 983, 1002 553–555 28, 481 376 359 139, 858, 877, 960 106 259, 859, 860 460 861 667 996

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

S474 Peterson M Peterson SK Peterson SL Petit JY Pettaway C Peveler R Pfaff H Phillips C Phosena A Piamjariyakul Piattelli A Picci RL Pierani P Pierce T Piester CB Pietrangeli A Pietrzyk AS Pike J Pikunas JDKA Pillai S Pirker C Pisters L Pitceathly C Poggi G Poli P Pollard A Pond G Ponman LK Ponta M Poppelreuter M Poppito SR Porazzo S Porcelli P Porock D Porterfield P Postema K Poulain P Poulsen R Power T Power TE Pozzi NT Pramod DS Prescott E Prestifilippo C Prevel MC Price M Priebe S Prigerson H Primic A˚akelj M Pronobis J Prudlo U Pucciarelli S Pucheu S Puig Herna`ndez MA Pugliese P

AUTHOR INDEX 1074, 1075 862 330, 962, 963 525 847 802 811–813 114 664 226 246 323, 832 212 959 707–710, 1017, 1018, 1081 863, 960 864, 865 263 866 838 277 847 32, 34 353, 850, 861 470 452, 453, 651 569 503 745 329 870, 871 279 1029 47 207 1040 81 872 537 873 857 340, 874 309 466 77 183 649 198, 199 978 107 703 241 79, 875, 876 787 139, 858, 863, 877, 878, 960

Punzi S Pyshniak L Pyszkowska J

419 775 1059

Q Qaeem M Queipo Peirats S Quesnel C Quist M

814 541, 786 879 352

R Rabe M Racalbuto SS Raco G Radice D Raffaeli W Rafnsdottir GL Ramdas K Ranchor AV Randall H Rankin NM Rapetti Al Rappat S Rascle N Rasheed M Rashid A Rasmussen DM Ravenna AR Ravaioli A Ray A Razavi D

Reed M Rega R Regni S Reich M Reinholt N Reis J Reis JC Remedios M Remie M Resega R Resicato G Respini D Reuter K Revskoy S Reynaert C Rezende SN Rezende VL Riccardi F Richards K Rickard J Rigatelli M Rigobello F Rika Y Rinkes MJ Riba M

Copyright # 2006 John Wiley & Sons, Ltd.

779 882 268, 475, 476 525 266, 1051 95 841 623, 624, 944 883, 884 885 412 689 947 30 886 887 424 436 198, 199 64, 82, 234, 400, 430, 450, 722, 723, 750, 758, 764 646 267, 417, 418 274 83, 888, 889 890 1022 891–893 781 44 904 599 725, 894 895, 896 897 234, 764 899, 931 898 278, 556 302, 993 250 531 799 964 584 615, 799

Riba MB Ribeiro MJ Rich T Rich TA Ridder EL Riedner C Rietjens JAC Rios P Risko´ A´ Riva M Rivera E Rivieccio E Rizzi RL Robb S Robb SL Robert J Roberts K Robertson M Robinson E Robinson JW Robinson KE Robitaille R Rock C Rodin G Rodin GM Rodino` C Rodr"ıguez Vega B Roffe L Roholm HH Roll L Roma S Romeo M Romer G Romito F Ronquillo JG Rooij M Rorth M Ros Wynand JG Rosberger Z Roscoe J Rose CL Rosenblum N Rosenfeld B Roser T Ross L Rosselli M Rossetti G Rossi A Rossi E Rossi R Rosta A Roth A Roth AJ Roth JL Rothenmund H Rouby P Rowa-Dewar N Rubin L

61 793 900 134 227 901 902 111 903, 1042 904 28, 481 267, 417 905 113–116 217 879 1026 671 213 504 768, 906 336, 907, 915 397 206, 239, 306, 1079 754 446 364, 365, 909 343, 563 693 113, 115 41 911–913 1067 914 449, 559 944 352 749 336, 907, 915 761 1020 154 807, 808, 870 901 310, 665 421, 916 924 266, 421 381, 924 1005, 1006 903, 1042 107 807, 808 330, 962 732 917 923 153

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

S475

AUTHOR INDEX Rubin S Rubio B Ruggeri E Ruggiero G Russell IT Russell K Russell KM Rutherford CG Rutledge R Ryan KJ Ryan MF Rydahl S Rydall A Rytilahti M

154 301, 918, 919, 973 436 283 790 117 118–121 920 223 923 349, 922 524 205 660

S Sa´ M 891 Saban K 1031 Sabatino C 466 Sabato S 381, 924 Sadeh-Tassa D 925 Saeki T 68, 655 Safra T 149 Sakamoto N 456, 567, 926 Sakkas P 927 Sahin CE 833 Saini A 323 Salamero M 252, 299 Salamini R 209 Salander P 928 Salazar HC 929 Salerno VL 899, 931 Salgokar RN 340 Salhi R 676 Salmon P 224 Saman M 377 Samardakiewicz ME 930 Samonigg H 73, 167, 170 Sa`nchez N 299 Sanderman R 623, 624 Sandoval M 89, 184, 186 Sanguigno G 436 Sanne B 324 Santana MG 984 Santiago CEG 881 Santiago SM 899, 931 Santos N 395, 444, 535 Santos Z 444, 464, 535 Sanz-Ortiz J 776 Sappino AP 273, 1065 Satta F 853 Sattel R 257 Savard J 465, 879, 968 Savarese A 40 Savchenko VG 1056 Savignoni A 80 Sawabata N 628 Scaffidi E 173

Scanlon KA Schaal AD Schachter SR Schagen SB Schattenberg AVM Schembri G Scherwath A Schildt EB Schillani G Schimitzek C Schirmer L Schittulli F Schlenker P Schmid P Schmidskamp J Schmiegelow K Schneebaum S Schneider T Schofield P Schofield PE Schopenhauer R Schou Bredal I Schrauwen W Schro¨der M Schroeter C Schroevers MJ Schulmann E Schulte F Schulte T SchulzKindermann F Schumacher A Schwarz R Schwarzkamp U Sciacca E Sciacchitano T Scott A Scott MR Seccombe M Sedda AL Sedgwick C Sega FM Segat E Segatti A Segrestan C Sehlen S Seidenari S Seigneur E Seldon JL Seliger E Selmi S Selvaggi G Sempreboni A Senzi G Sephton S Sepulveda C Serantoni G Sereno M

Copyright # 2006 John Wiley & Sons, Ltd.

933, 934 796 107 192 584 425, 426, 935 936, 946 620 937–939 940 936, 946 334 703 568 227 683 925 903 94, 651 941, 372 855 942 943 716 257 944 262 945 755 936, 946 44 341 810 1005 739, 740 637 796 658 83 86 40 130 174 947, 948 277 562 949 201 338 950, 951 835 356–359 916 31, 137, 952 18 540, 867 365

Sereno SC Serpentini S Serra J Serravezza G Seto T Seymour JF Seynaeve C Sguazzotti E Shahrokni A Shapiro JL Sharma A Sharp DM Sharp L Sharpe D Sharpe L Shatalova NE Shaw KL Shen WZ Shenton A Shepherd L Sheridan MA Sherman ML Shi W Shin IS Shiozaki M Shook J Shumay DM Sica A Siddons H Siegel S Sigurdsson F Sigurdsson H Sigurdardo´ttir V Sijmons R Sikorskii A Simard J Simard S Simeone M Siminoff LA Simonic A Simpson E Simpson J Singer S Siqueira SHG Sirgo A Sirri L Sitskoorn MM Sivashinskiy M Six N Skelton JR Skinner D Skufca Smrdel AC Slachmuylder JL Slawitschka E

892 241, 366, 953, 954 362 334 826 452, 453 1037 323, 832 955 788, 956 957, 1061, 1063 43, 44, 322, 957, 1061–1063 250, 355 101 992 607 783 636, 638, 639 633 1073 330, 958, 959, 961–963 330, 958, 959, 961–963 486 678 688, 964 958, 961 965 745 622, 966 30 95, 1012 95 95 261, 1039 908 537 465, 968 554 441, 590, 595 969 102 668 341, 970, 971 972 252, 299, 301, 918, 919, 973 914 578 974 830 1020 1074 975 750 852

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

S476 Sleijfer DT Sloan JA Sloper P Slovin S Smari J Smets EMA Smink A Smith A Smith EML Smith K Snoj Z Sogno G Sohn C Solander KG Solari F Soler-Vila H Solomon M Sonoda N Sood A Srensen E Sousa V Souza CAM Souza CB Souza GCF Souza Festugato M Souza MS Soygur H Spanevello M Spatuzzi A Spaulding A Sperduti I Sperner Unterweger B Spetz A Spiegel D Spiehl S Spillers RL Spinelli N Spinetta JJ Spiota E Spira O Springer C St. JamesRoberts I Stagno D Stammer H Stanzer S Stargatt R Stefel F Stegenga K Steggles S Steh B Steiger J Stein R Steinberg A Steiner G Steingart RM

AUTHOR INDEX 1028 861 220 807 1012 230 623, 624 320, 1026 796 85, 732 978 279 990 326, 641 980 314, 981 757 677 29 942 493, 494, 792 987 985, 986 881 558, 984 982, 983 178 736 188 1076 863 74 928 3, 138 970 679 988 163 354, 797, 989 829 866 1067 35, 36 741, 991 308, 373 218, 991 408 112, 115 626, 753 662, 1070 615 992 859 940 498

Stelter R Stemmer S Steneby S Stewart B Stewart CB Stewart DE Stewart H Stewart SL Stiefel F Stigliano V Stockler M Stockton MR Storch Y Stovall E Strasser F Strassnick K Strauss GJ Stravoravdi P Strong LC Stuart-Harris R Sugawara Y Sugimoto T Suh S Sumalla EC Sumo G Sun A Sundquist K Sundus SA Surbone A Suresh U Surgenor LJ Surugue P Sutherland G Suzuki S Svenda G Svolos G Sweetman J Swetenham K Sylos MD Szer J

767 259 724 751, 991, 993 302 393 991 751 36 462 335 783 80 19 438 349 595 296, 384, 385 862 335, 509, 695, 1009 747 682 996 825 300, 634, 770 1080 88, 185, 213 676 15 838 997 998 475, 477, 478 361 435 999 795 798, 1000, 1001 1002 452, 453

T Taal B Tagliani M Tait C Tajzichi S Takahashi M Tamburini M Tammaro A Tanasini R Tang L Taniguchi K Tannck I Tannock IF Tansini G Taob E

Copyright # 2006 John Wiley & Sons, Ltd.

261 836 1003 814 69 231, 316, 427, 572, 1006 518 734 247 361 569 193 980 259

Taphoorn MJB Tarabrina NV Tardif F Tardin JM Taskila T Taskila-Abrandt T Tattersall MHN Taversa M Taylor C Taylor L Teles SS Teller AM Tempia Valenta P Teren K Terenzani L Ternestedt BM Terzani Staude A Terzoli E Thale´nLindstro¨m A Thaler HT Thamm R Thekkumpurath P Theuns P Thewes B

578 607 271 985 96 99 94 513 134, 459, 997 294, 459 1082 81 1005, 1006 405 736 1016 12 135

1007 486 579 692, 1008 398 250, 335, 757, 1009, 1073 Thiboldeaux K 20 Thomas BC 255, 842, 1010 Thomas D 839, 1011 Thomas IL 255 Thome´ B 606 Thompson K 839, 1011 Thomson C 397 Thornton B 28 Thorvaldsdottir GH 1012 Tibben A 1037, 1039 Tiernan E 57 Tilkeridis J 478 Tilki SS 933, 934 Tiller K 1013 Ting JH 784, 1014 Tinley ST 1015 Tirelli U 209 Tishelman C 1016 Todarello O 1029 Todoroki K 650 Tofte J 707–710, 1017, 1018, 1081 Tokoro A 378, 628, 686, 688, 1019 Tolosa I 484, 611 Tolosa IL 1020 Tomamichel M 126 Tomanovic K 376 Tomasso A 426 Tookman A 254 Torres A 301, 918 Torta D 1045

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

S477

AUTHOR INDEX Torta R

4, 67, 282, 415, 428, 448, 882, 1045, 1046 Traeger L 30 Tralongo P 725, 894 Tramontana A 423, 424 Trasatti F 425 Travado L 1021–1024 Travado LS 891 Tremblay I 270 Trevisan E 1025 Trijsburg RW 749, 1037 Tringali D 181 Trista˜o Casanova L 1004 Trouette R 947 Tsang K 458 Tsiara N 296, 384, 385 Tsilika E 927 Tsuchiya M 243, 1027 Tsunoda A 682 Tucker K 258 Tuinman MA 1028 Tulipani C 1029 Tummino V 1030 Turhan L 451, 833 Turner J 213, 1032 Turner LJ 1031 Tuveri G 938, 939 Tuytel G 298 Twisselmann W 130 Tyndel S 260, 332 Tyroller M 440

U Uchitomi Y Ueno K Upadhay A Uromaru T Ussher J Ussher JM Utram SC Uyar M

26, 437, 747 1033 685 686 85, 87, 89, 186 184 503 240

V Vachon DO Væth M Vaishali PS Valdagni R Valdirmarsdottir HB Valencia-Reyes A Valente SM Valle ERM Vallisa D Van Andel G Van Beurden M Van Daele H Van Dam F Van Dam FSAM

760 469 340, 874 188, 536 653, 730, 731 104 1034 351, 824, 1082 445, 447 253 730, 731 190 546 192

Van de Wiel HBM Van den Berg M Van der Graaf WTA Van der Heide A Van der Linden MHM Van der Maas PJ Van der Schans C Van der Wal G Van Dooren S Van Hauwaert A Van Oostrom I Van Weert E Van Werven JR Van Wielinger L Vandebroek A Vandecasteele H Vandelli M Vanderlinden L Vannatta K Vanni B Vannucci L Vanotti B Va´rady E Varani S Vardy J Varela MP Varese P Varetto A Varghese FT Vasconcellos E Vasen HFA Vasiliki H Vecchi R Veglia F Velicogna F Venkateswaran C Venn G Vennarecci G Ventura C Ventura I Verdonck-de Leeuw IM Verhagen C Verhagen S Verhoef S Verrengia A Verres R Verrill C Verzelen A Veseliunas J Vielh P Vigna C Vignali A Vigorelli SM

Copyright # 2006 John Wiley & Sons, Ltd.

222 298 222 902 855, 1036, 1049 902 1040, 1041 902 1037 943 416, 1039 687, 749, 1040, 1041 230 100 1035 750 582 544 601, 768, 906, 920, 1038 135 583 419 903, 1042 1043 194, 569 1044 797 1045, 1046 671 857, 1047 538 385 937 519 471, 472, 560 248, 692, 838 1085 858 1021–1024 1048 1049 584 291 614 283 741 802 544, 1035 439 995 40, 422, 462, 1050 1051 506, 507, 789, 1051

Vijlbrief S Viladrich MC Vila˜o O´ Viol R Virago MCE Visser A Vitalone C Vivar CG Vivat B Vivorio B Vlisides D Vodermaier A Voerman B Vogel BA Vollmer TC Voltolini S Vybornykh DE

416 442 362, 363 207 315 253, 298, 852 988 1053 307 358 367 1054 253 621, 1055 42, 196, 197, 200 359 1056

W Waadt S Wada TW Wade K Wade-Walsh M Wagner B Wain G Wakefield C Waller AE Walls M Walker AA Walker LG Walker M Walker MB Walker T Walker V Wall KE Walsh A Walsh L Waltz P Wang JJ Ward PA Warner A Warner AS Warner E Watanabe M Watson E Watson EK Watson M Webb P Webb PM Wedderburn W Wefel JS Weinstein K Weis J Weis JB Weissbecker I Weissler K Wellisch DK

406 1057 561, 1058 157 219 85, 87 258 589 292 101 43, 102 43 102 223 101 1064, 1066 206, 306 370 273, 1065 636, 638, 639 862 1064 1066 627 217, 751 332 260 633, 795, 1067–1069 183, 229 183 153 195 225 293, 587 329 31, 133, 952 149 204, 225, 679, 1070

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

S478 Welshman A Welter M Werner-Lin A White CA White V Whitford H Whitnall L Whyte DA Wilcke S Wiley FM Wiley TJ Wilkinson CE Williams A Williams AR Williams PD Wilson D Wilson S Winkel G WintermeyerPingel S Winton S Wiseman J Witjes JA Wittmann M Witol A Wo¨lfl H Wollbrueck D Wong A Wong-Kim EC WoodDauphinee S Woolley CC Wossmer B Wright D Wright MJ Wright P

AUTHOR INDEX 425, 426, 935 457 1071 294, 1072, 1078 475, 478 618, 828 1078 1053 344 225 164, 165 644 226 227 226, 227 498 594 154 615, 1077 515 1060 291 196, 200 219 830 341 242, 1079 1080 689 391 128 343, 563 399 1026

Wright S Wyatt GK Wyze R

637 908 631

383, 829 1068 1057 655 68, 681, 834 240 647 718–720 678 382, 481 648 437 456, 567, 926 474 652 307 600 622, 966

Zander AR Zanetti L Zanna I Zanon CCS Zaraba A Zarie G Zdrojewski C Zebrack B Zemel GS Zenasni F Zhang AY Zhang ZW Zheng Y Zimmermann C Zimmermann F Zindel A Ziner KM Ziner KW Zinovieff F Zins M Ziv M Zkowski S Zloklikovits S

455 25, 955 25 454 435 305, 469, 489, 653, 854 905 784, 1014 356 980

Znoj HJ Zoboli A Zoe´ga Soares MR Zoller P Zolton L Zong Q Zorbas H Zordan R Zotti P Zucca AC Zucker JM Zyrina G

Y Yagil Y Yamada Y Yamanaka TY Yamashita M Yamawaki S Yasemin M Yin P Yoo G Yoon JS Yoshida M Yoshida R Yoshikawa E Yoshiuchi K Young MA Young N Young T Young-Saleme T Yuen T

Z Zabalza MA Zabora J Zabora JR Zaccherini M Zaccuri L Zachariae R Zago S Zainal NZ Zamagni D Zanaletti F

Copyright # 2006 John Wiley & Sons, Ltd.

946 954 454 881, 977 529 994 35, 36 605 746, 880 995 441, 590, 24, 247 636, 638, 306, 754 579 690 117 119–121 790 311 829 653 307, 308, 676, 699, 690 388, 576 705, 979, 91 958, 963 647 1032 86 241 235, 429 485 727

595 639

373, 976

1004

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon