Psycho-Oncology Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) Published online in Wiley Online Library ( DOI: 10.1002/pon.3478

Paper Abstracts of the APOS 11th Annual Conference Session 1: Invited Symposium 2–1 Breast Cancer Disparities in Northern Florida Sarah Rausch Osian, Laila Samiian, Dale Kraemer, Ryan Butterfield, Carmen Smotherman, David Wood The University of Florida Jacksonville, Jacksonville, FL, USA PURPOSE: The breast cancer mortality rate for black women in Duval County, FL (greater Jacksonville, FL) is the highest in the state of Florida, and is 38% higher for black women (36.7 per 100,000), than for white women (24.0 per 100,000). We sought to evaluate county specific breast cancer disparity data, in an effort to begin designing effective targeted interventions to reduce the disparities. METHODS: Data on female breast cancer cases from 2004–2010 were extracted using the Florida Cancer Data System (FCDS). This data was analyzed using traditional descriptive statistics. Additional classification included residence, race, insurance, and age. The primary outcomes were Stage at diagnosis, and time from diagnosis to treatment. RESULTS: Using the FCDS, 6,579 new breast cancers were identified in Duval County from 2004 – 2010. Of these women, 73% were white, 24% black, 5% Hispanic, 2% Asian, and 2% unknown/ other. Health Zone 1, which represents the urban core, had the largest population of black women with breast cancer (76%). Health Zone 1 also had the highest volume of uninsured (10% vs. 4% average for other areas), and Medicaid breast cancer patients (8% vs. 4% average for other areas), and the lowest number of breast cancer patients with Private insurance (33% vs. 56%). Black women had a higher percentage of advanced Stage IV disease than any other race (p < .001). Women in Health Zone 1 were more likely to present with Stage IV breast cancer than any other Health Zone (p < 0.01). Medicaid patients followed by the uninsured had the highest rate of Stage IV disease at diagnosis (p < .001). Time from diagnosis to treatment was found to be longest in black women, Health Zone 1, and those who were uninsured or had Medicaid (p < 0.001). CONCLUSIONS: Living in the urban core, black race, and lack of insurance or Medicaid funding was significantly associated with advanced stage at diagnosis and longer time from diagnosis to treatment in Duval County, Florida. RESEARCH IMPLICATIONS: This research will help to inform tailored interventions to reduce disparities in breast cancer outcomes. CLINICAL IMPLICATIONS: This information may help clinicians to provide clinical care in a manner that reduces disparities in the populations identified at high risk for disparities in outcomes. FUNDING: None. © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

2–2 The Obesity-Hunger Paradox and Cancer: Food Insecurity, Weight Status and Quality of Life Amongst Low-Income Ethnic Minority Cancer Patients Errol Philip1, Rosario Costas1, Julia Ramirez2, Abraham Aragones2, Jennifer Leng2, Francesca Gany1 1 Psychiatry & Behavioral Sciences, Memorial SloanKettering Cancer Center, New York, NY, USA, 2Psychiatry & Behavioral Sciences, Immigrant Health & Cancer Disparities Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA PURPOSE: The relationship between obesity and food insecurity (FI: limited or uncertain access to sufficient nutritious food to lead a healthy life) is yet to be fully explicated; however both have been associated with poorer outcomes independently. Obesity has been implicated in 20% of cancers and adequate nutrition is paramount during treatment and follow-up. The current study examined the relationship between obesity, FI and QOL amongst low-income minority cancer patients. METHODS: Participants (N = 407) completed a demographic questionnaire, the USDA Household Food Security Survey, the FACT-G and PHQ-9 as part of a larger study. The majority of participants were female (70%), African American/ Black (50%) or Latino (38%) and diagnosed with breast (46%) or gastrointestinal (16%) cancer. The average age was of 56 years and 83% reported income below the national poverty level. RESULTS: Analysis revealed that the average BMI of the sample was 27.8, with 36% overweight and 31% obese. Nearly half reported FI without hunger, while 28% reported FI with moderate or severe hunger. Based on previous research, the sample was stratified by gender. Female participants with FI without hunger had a significantly higher BMI than those who were food secure (BMI = 29.4 vs. 25.9, p = .004); no differences were observed in males. Amongst this group (females who were FI without hunger), further analysis revealed however that obese weight status (BMI ≥ 30) was not associated with impairments in QOL outcomes and depression compared to non-obese women. CONCLUSIONS: This preliminary study revealed that 67% of low-income minority cancer patients were overweight or obese and critically, 78% endorsed some degree of FI. This is substantially higher than national averages of FI and particularly concerning given the importance of nutrition during cancer treatment and survivorship. Women who were FI without hunger possessed a BMI more than 3 points higher than those who were food secure, providing evidence


of the obesity-FI paradox; however obesity was not associated with poorer psychosocial outcomes in this group. These results reinforce the importance of providing comprehensive support to vulnerable individuals during cancer treatment. RESEARCH IMPLICATIONS: The current study provides unique insight into the obesity-hunger paradox among cancer patients. For researchers, it documents a critical area of need among low income and/or minority patients and a challenge to research promoting comprehensive care paradigms that seek to enhance long-term health outcomes. CLINICAL IMPLICATIONS: The current study provides clinicians with insight into an issue that many low-income minority cancer patients and survivors may face. It also provides preliminary evidence that an individual’s obese weightstatus can still be associated with food insecurity, thus exemplifying the complex ’obesity-hunger paradox’. FUNDING: NIH-NCI: T32CA009461, U54-13778804S2; New York Community Trust; New York State Health Foundation; Laurie Tisch Illumination Fund. 2–3 Using a Financial Assistance Program as a Gateway to Support and Education for Underserved Breast Cancer Survivors Catherine Creme Henry, Arin Ahlum Hanson Living Beyond Breast Cancer, Haverford, PA, USA PURPOSE: Living Beyond Breast Cancer’s Cis B. Golder Quality of Life Grant assists with the financial burden of breast cancer treatment. Since 2006, the grant has funded more than 1,100 women and helped pay bills such as rent/mortgage (53% of funds disbursed), utilities (34%), and childcare. More than $1 million has been distributed in the Philadelphia region. 90% of recipients earn less than 300% of the federal poverty line. 41% are African-American; 60% live in urban counties. A 2010 needs assessment indicated that recipients were not familiar with LBBC’s programs and had limited interactions with the organization. For many recipients, personal and financial crises made seeking information and support a low priority. METHODS: Interventions were developed to increase contact time with recipients and provide personalized invitations to other LBBC education and support programs. All applicants receive a peer support phone call from an LBBC Breast Cancer Helpline volunteer to share information about upcoming programs and refer to resources to meet their needs. Special invitations are sent to recipients offering registration fee waivers to LBBC conferences and inviting them to tailored programs for low-income families. RESULTS: 65% of applicants were previously unaware of Living Beyond Breast Cancer and its support and education programs. All applicants receive 10–20 minutes of phone peer support and invitations to two local programs. Applicants receive several breast cancer publications on topics related to their © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Paper Abstracts of the APOS 11th Annual Conference

concerns or experience. A nutrition-on-a-budget education series was piloted in 2013 to address recipients’ other wellness needs and provide meals. 14 women participated and reported that the program increased their knowledge of other nutrition resources available to them (70%), improved their confidence in cooking healthy meals (85%), and increased their likelihood of using other LBBC services (85%). CONCLUSIONS: A financial assistance program provides a unique opportunity to engage underserved breast cancer survivors who may not otherwise seek support and education from an organization. The addition of peer support interventions helps assess and alleviate other concerns and connects recipients to a support system that they can access throughout their experience. Although LBBC’s financial assistance is regionally restricted, its interventions can act as a model for other grant programs. RESEARCH IMPLICATIONS: Engaging underserved patients through a financial assistance program allows researchers to begin to assess other needs and develop interventions. These interventions alleviate other non-financial concerns and connect patients to a support system that they can access throughout their breast cancer experience. These interventions can act as a model for other grant programs. CLINICAL IMPLICATIONS: This project demonstrates that a financial assistance program provides a unique opportunity to engage underserved breast cancer survivors who may not otherwise have sought support and education from an organization. Clinicians can engage underserved patients through referrals to grant programs in the hope that ongoing contact will meet their education and support needs. FUNDING: None. 2–4 Quality of Psychosocial Cancer Care Delivered to Lesbian, Gay, Bisexual and Transgender versus Heterosexual Cancer Survivors Charles Kamen1, Anita Peoples1, Mohamedtaki Tejani1, Marie Flannery1, Michelle Janelsins1, Luke Peppone1, Oxana Palesh2, Michael Andrykowski3, Gary Morrow1, Karen Mustian1 1 University of Rochester Medical Center, Rochester, NY, USA, 2Stanford University, Stanford, CA, USA, 3 University of Kentucky, Lexington, KY, USA PURPOSE: Recent studies have suggested that disparities exist in reception and perception of cancer care between LGBT and heterosexual cancer survivors. Psychosocial concerns such as depression and social isolation are more prevalent among LGBT than heterosexual adults, but studies have not examined the need for and delivery of psychosocial care among LGBT survivors. In the current study, we compare quality of psychosocial cancer care received by LGBT versus heterosexual survivors using the structure-process-outcome model. METHODS: Data for Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Paper Abstracts of the APOS 11th Annual Conference

the current study were drawn from the LIVESTRONG dataset, a U.S. national survey that sampled 207 LGBT and 4,899 heterosexual cancer survivors (all cancer types, 63.5% women, mean age 49) in 2010. Prevalence of psychosocial concerns was assessed with dichotomous yes/no items in eight symptom clusters (depression, grief, spiritual, recurrence, relationship, stigma, family, and appearance concerns). Quality in structure was assessed with multiple choice items asking which type of doctor provides care for each cluster. Quality in process was assessed with a Likert-type item asking the patient’s perception of quality for each cluster. Quality in outcome was assessed with a Likert-type item asking degree of impairment caused by each cluster. RESULTS: Chi-square analyses indicated that LGBT cancer survivors were more likely than heterosexual survivors to report at least one depression (chisq = 4.54, p = .03) and relationship (chisq = 7.06, p = .01) concern, but were less likely to report family concerns (chisq = 4.74, p = .03). T-tests indicated they also reported a higher number of symptoms of depression (t = 2.93, p = .003) and relationship concern (t = 2.28, p = .02). LGBT survivors were less likely than heterosexual survivors to report that they received care for depression concerns from their oncologist (18.2% vs. 34.7%, chisq = 6.40, p = .01). LGBT cancer survivors were more likely to report that their relationship concerns limited their activities “a lot” (likelihood ratio = 9.63, p = .02). CONCLUSIONS: Significant disparities exist in prevalence of psychosocial concerns between LGBT and heterosexual cancer survivors, and these disparities may extend to reception and perception of quality of psychosocial care. Additional structural and process-related improvements in the quality of psychosocial care delivery to LGBT cancer survivors may address some of these disparities, and oncologists may consider assessing psychosocial needs specifically when treating LGBT cancer patients. RESEARCH IMPLICATIONS: The current study represents an extension of the field of health disparity research in cancer, which has typically focused on race/ethnicity and socioeconomic status, to include sexual orientation. This is a critical and understudied area, as highlighted by the recent Institute of Medicine report (2011) and NIH request for applications (2012) focusing on LGBT health disparities. In this study we use a large sample of LGBT cancer survivors and present descriptive, baseline data on perception of quality. We also discuss future research directions for the field of LGBT health disparities. CLINICAL IMPLICATIONS: The current study indicates the importance of attending to sexual orientation when providing psychosocial care to cancer survivors. LGBT cancer survivors may experience more psychosocial concerns in a number of areas than their heterosexual counterparts. They may also be less likely to ask their oncologist for help. Opening a dialogue about sexuality in the context of psychosocial oncology care may make LGBT patients © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.


and survivors feel more comfortable about disclosing their concerns. Ways that the findings of this study can be incorporated into practice in order to begin such a dialogue will be discussed. FUNDING: This study was supported by funding from NIH grant NCIR25CA10618.

3–1 Fear of Cancer Recurrence, Distress and Depressive Symptoms in Hematopoietic Stem Cell Transplantation Patients Richard McQuellon1, Cassie Campbell1, Katharine Duckworth1, Greg Russell1, Seema Naik2, Ann Williams1, Kenneth Zamkoff1, David Hurd1 1 Wake Forest University School of Medicine, Winston Salem, NC, USA, 2Texas Transplant Institute, San Antonio, TX, USA PURPOSE: The purpose of this study was to identify specific time points along the survivorship trajectory where patients reported significant symptoms of psychological distress. METHODS: HCT recipients were surveyed with the Fear of Recurrence Scale (FCR), Distress Thermometer (DT), and the Center for Epidemiologic Studies-Depression scale (CESD) at hospital admission (T1), discharge (T2), and at 3 (T3), 6 (T4), 12 (T5) and 24 months (T6). Actual and estimated mean scores (SD and SE) and frequencies were calculated. Demographic data and performance status (PS) also were collected. MANOVA was utilized to assess change in FCR, distress and depressive symptoms over time. A multivariate repeated measures regression model [adding education, marital status, race, gender, age, disease type, BMT type, depressive symptoms, distress and performance status (PS)] was constructed. RESULTS: 198 patients [mean age = 52.9(SD = 13.9); 35% F; 88% white; 67% married; n = 48 lymphoma, 62 Multiple Myeloma, 56 leukemia, 12 Hodgkins lymphoma, 20 other; 64% autologous] completed questionnaires at hospital admission. Both CESD (p = .006) and DT (p = .0019) scores changed significantly over time and were higher at T2. FCR did not change over time (p =0.28). At T2 - T6, a percentage of recipients responded as follows: 1)agree/uncertain that they will probably have a relapse in the next 5 years (46%, 49%, 55%, 58%); 2)disagree/strongly disagree that their fear of cancer recurrence gets in way of enjoying life (82%, 78%, 80%, 77%). A substantial percentage of patients (24%, 37%, 26%, 26%, 23%, 13%) reported significant (>16) depressive symptoms and distress (≥4) levels (41%, 51%, 31%, 25%, 23%, 21%) at each time point. In the regression model, recipients with better PS (p = 0.001) and fewer depressive symptoms (p = 0.04) endorsed lower FCR scores. CONCLUSIONS: Depressive symptoms and distress were highest at hospital discharge. A substantial minority of patients reported both distress and depressive symptoms along the entire 2 year trajectory of survivorship. While FCR was reported by many as unpleasant, it was not Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


reported as an obstacle to enjoying life. RESEARCH IMPLICATIONS: The relationship between FCR and symptoms needs further investigation as symptoms may act as harbingers of recurrence. The extent to which FCR impairs those who experience it intensely over time is unknown. CLINICAL IMPLICATIONS: Psychosocial support/intervention is needed prior to and at hospital discharge. A significant percentage of patients will experience high FCR during their survivorship trajectory. The extent to which FCR represents a rational response to a high probability event presents a challenge to the clinician balancing a vision of both hope and reality. FUNDING: The Claude Higginbotham Memorial Cancer Patient Support, the Brenner Fund for Cancer Patient Support and a Comprehensive Cancer Center Support grant # P30CA012197-38. 3–2 The Sword of Damocles: An Exploratory Study of Fear of Recurrence in Young Women With Early-Stage Breast Cancer Belinda Thewes1, Caroline Séguin2, Phyllis Butow1, Sophie Lebel2 1 University of Sydney, Sydney, Australia, 2University of Ottawa, Ottawa, Canada PURPOSE: Objective: Fear of cancer recurrence (FCR) affects many cancer survivors, particularly young women with breast cancer. These women are at greater risk for poor psychological adjustment, but little work has been conducted to discover the reasons underling this trend. The goal of the research is to conduct an in-depth exploration of fear of cancer recurrence in young women with breast cancer and analyze some factors that may increase their vulnerability to this fear. METHODS: Methods: Qualitative phone interviews have been conducted with 30 participants (10 Canadian participants and 20 Australian participants) who meet the following criteria; had early stage breast cancer (0, 1, or 2), have been diagnosed at least one year ago at the age of 45 or younger, and are fluent in English. The thirty minutes semi-structured interviews have allowed us to better understand the fear of cancer recurrence in young women by discussing how their fears impact on emotions, thoughts, relationships and preferred ways of coping with these fears. The interviews have been transcribed to perform analysis following the method proposed by Miles and Huberman (1984) to determine the frequency of specific ideas, identify themes, and establish patterns and trends within the answers of the participants. A double coding method has been conducted to assure the relevance of important themes. The content of the Canadian and Australian interviews will be compared to establish cultural differences. RESULTS: Results: The identified themes include the emotional and physical impact of FCR, its triggers, and what participants are most fearful of when they © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Paper Abstracts of the APOS 11th Annual Conference

think about cancer returning. Four modulators have also been established: perception of the medical process, illness representation, coping strategies, and support system. CONCLUSIONS: The results of this research have enhanced our knowledge of fear of cancer recurrence in young women. We hope that it will ultimately lead to development of appropriate psychological interventions for this population. RESEARCH IMPLICATIONS: Breast cancer is the most common form of cancer in women; 1 in 9 women will be expected to develop breast cancer in her life time, the five year survival rate following the diagnosis is 88% for patients diagnosed with early-stage breast cancer (Canadian Cancer Society, 2011). Therefore, the prevalence of breast cancer survivors continues to increase. Even though the cancer is treated, its undesirable effects prevail upon women. It is therefore important, to explore the FCR in young women with breast cancer, to better understand the impact of this phenomenon in this growing population of cancer survivors. CLINICAL IMPLICATIONS: Our findings help clinicians better understand the fear of cancer recurrence in cancer survivors. In knowing the different modulators, the triggers and the impact of fear of cancer recurrence in cancer patients, we can offer a better psychological therapy to enhance quality of life. FUNDING: None. 3–3 Sleep Quality Before and After Surveillance Mammograms in Breast Cancer Survivors: Fear of Cancer Recurrence Predicts Longitudinal Change in Sleep Quality Heather McGinty1,2, Christine Laronga2, Charissa Hicks1,2, Mallory Cases2, Melissa Rose1,2, Yvelise Rodriguez2, Paul Jacobsen2 1 University of South Florida, Tampa, FL, USA, 2Moffitt Cancer Center, Tampa, FL, USA PURPOSE: Sleep problems are common among cancer survivors and are related to poorer overall quality of life. This study evaluated sleep quality during the week before and the week after breast cancer survivors completed scheduled surveillance mammography, a typically stressful period in the survivorship phase. Several studies have demonstrated that fear of cancer recurrence (FCR) is related to poorer quality of life, but few have focused on sleep quality. We hypothesized that sleep quality and FCR would improve following receipt of negative mammogram results. We also hypothesized that sleep quality would be related to FCR both before and after the mammogram, and that greater FCR would predict lower sleep quality. METHODS: Participants were 136 stage 0-IIIA breast cancer survivors who had completed treatment between 6 and 36 months previously. Participants completed the Pittsburgh Sleep Quality Index (PSQI) and modified Cancer Worry Scale (CWS) in clinic immediately before Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Paper Abstracts of the APOS 11th Annual Conference

(T1) and 1 week after their surveillance mammogram (T2). RESULTS: As predicted, sleep quality as measured by the PSQI improved from T1 (M = 5.95, SD = 3.73) to T2 (M = 5.29, SD = 3.66), p < .001, and FCR as measured by the CWS decreased from T1 (M = 6.32, SD = 2.58) to T2 (M = 5.48, SD = 1.87), p < .001. Expected negative correlations between PSQI and CWS scores were also observed at T1, r = 0.37, p < .001, and T2, r = 0.35, p < .001. After controlling for T1 PSQI scores, T2 CWS scores significantly predicted worse sleep quality at T2, R-squared change = 0.01, p < .05. CONCLUSIONS: These findings demonstrate that routine cancer screening may temporarily disrupt sleep quality in breast cancer survivors. FCR and sleep quality were significantly related such that survivors who reported poorer sleep quality reported greater FCR both before and after receiving negative mammogram results. Even when controlling for previous sleep quality, reporting greater FCR following the mammogram predicted worse sleep quality. These findings demonstrate how FCR can impact overall sleep quality in breast cancer survivors. Additional research should evaluate to what extent reducing FCR improves overall sleep quality in cancer survivors. RESEARCH IMPLICATIONS: This research further evaluates the relationships between FCR and overall quality of life by focusing on sleep quality. Additional research is needed to determine if FCR alone or other underlying characteristics are related to sleep difficulties in cancer patients. CLINICAL IMPLICATIONS: Even after patients were provided with reassuring results from the mammogram, those who reported greater FCR 1 week later had poorer sleep quality than those with less FCR indicating that cancer-specific anxiety contributes to worse sleep in breast cancer survivors. Clinicians should evaluate FCR in patients who are reporting sleep impairment as these problems are associated. FUNDING: Thomas Tighe Research Fund for Psychology Graduate Students, Department of Psychology, University of South Florida. 3–4 Belief in Curability and Treatment Preferences Following a Team-Based Planned Prognosis Discussion During Advanced Breast Cancer Mary M. Step1, Ashley M. Sova1, Andrea Dracon2, Catherine Downs-Holmes2, Paula Silverman1,2 1 Case Western Reserve University, Cleveland, OH, USA, 2 UH Case Medical Center, Cleveland, OH, USA PURPOSE: People with advanced cancer who know their disease status as incurable show better function, less severe symptoms and better quality of life. However, discussing prognosis remains a distinctly difficult task for most clinicians. This study objective is to test the feasibility and impact of a team based prognosis and © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.


treatment goal discussion (TPAT) within a breast cancer practice. The TPAT intervention is a planned, patient education appointment shared by an oncologist, nurse, and social worker. Topics include curability, treatment preferences, and palliative care options. Clinicians deliver separate but interrelated information components that a) address disease progression, b) create a foundation for advanced care, and c) provide immediate support and goal setting for moving forward. Throughout the appointment women are directed to express preferences and if desired, explore individual concerns. METHODS: Study hypotheses were tested in a randomized control trial at an academic medical center. Women diagnosed with metastatic breast cancer in a single practice were invited to participate in this brief trial that compared beliefs in curability, treatment preferences, and uncertainty immediately before and a few days after either a TPAT (n = 9) or usual care (n = 16) appointment. Data were collected immediately before and two days after either appointment. RESULTS: Analysis of change scores from baseline to post test suggest that the TPAT intervention significantly influenced beliefs in curability, willingness to tolerate adverse states and preferred aggressiveness of care. However, illness uncertainty increased following the appointment. Open ended comments from participants showed that TPAT was challenging, but highly valued by patients. Clinicians report high satisfaction with the TPAT training and implementation. CONCLUSIONS: The TPAT discussion shares the clinical challenge of a prognosis discussion, preserves patient preferences for information, and creates realistic expectations for care. Prognosis discussions are challenging milestones in advanced cancer care but central to the transition from active treatment to palliative care. Strategies are needed to better equip clinicians to address this difficult point in cancer care. TPAT holds some promise as a patient-centered approach to delivering prognosis information in a supportive, planned appointment. RESEARCH IMPLICATIONS: This research is grounded squarely in communication approaches that recognize patient-centeredness to be the outcome of strategic, informed, and skilled clinician communication. This study provides evidence for patient participation as likely a mechanism for important distal effects such as quality of life, symptom management, and effective health decision making. CLINICAL IMPLICATIONS: Prognosis communication is a difficult task and heavy burden for any one clinician. Distributing the effort and emphasizing the skills of the oncology care team reduces this burden and maximizes the effectiveness of managing advanced cancer care. It is possible that such an approach will reduce the downstream burden of addressing patient concerns and uncertainties. FUNDING: Funding provided by American Cancer Society IRG-91-022-18 (PI: Step) and American Cancer Society: MRSG 10-009-01-CPPB (PI:Step). Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


3–5 Lessons Learned From Adapting a Cognitive-Existential Group Intervention for Fear of Cancer Recurrence to an Individual Format Christina Tomei1, Sophie Lebel1, Christine Maheu2 1 University of Ottawa, Ottawa, ON, Canada, 2McGill University, Montreal, QC, Canada PURPOSE: Health anxiety is a preoccupying belief that can negatively impact individuals with physical illness, including cancer. Fear of cancer recurrence (FCR) is a form of health anxiety often experienced by patients with cancer, and is associated with impaired functioning, lower quality of life, and increased health care use. A manualized cognitive-existential (CE) group intervention for women with FCR was recently developed and pilottested. The group intervention showed a moderate effect size in reducing FCR, cancer-specific distress, and maladaptive coping strategies. However, it appears that no individual psychotherapy intervention exists that targets FCR. METHODS: The CE group intervention was adapted to an individual format over 6 weekly sessions with a breast cancer survivor, who requested services for her elevated FCR. She completed measures of FCR, cancer specific distress, depression and anxiety. Her FCR and cancer specific distress scores were in the clinical range at baseline. The sessions were 60–90 minutes long, and session activities included cognitive restructuring, challenging faulty beliefs, structured exercises, and mindfulness techniques. The content of each adapted session will be presented. RESULTS: The client showed a decrease in all outcome measures from pre-to post-intervention, including a clinically significant reduction in cancer specific distress. While her FCR scores were still in the clinical range post-intervention, she reported that the intervention was very helpful, that she has conquered her negative thoughts about FCR, and that she is better equipped to tolerate uncertainty. CONCLUSIONS: The individual intervention will provide access to care for survivors in underrepresented cancer populations, where comprising a group may not be feasible, or for individuals less comfortable in group therapy settings. This intervention will respond to a clinical need of building evidence-based care for cancer survivors dealing with FCR. RESEARCH IMPLICATIONS: Results from this case study display the feasibility of successfully adapting a group intervention to an individual approach. This intervention will be further pilot-tested with male and female colorectal cancer patients in a two-part dissertation study. The intervention will be adapted and standardized first using a series of n = 1 cases, followed by a randomized controlled trial. Development of future research will be further discussed. CLINICAL IMPLICATIONS: The individual intervention showed promising results in improving the client’s emotional mastery, well-being, and levels of distress. The © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Paper Abstracts of the APOS 11th Annual Conference

client’s suggestions for improving the intervention will be presented. FUNDING: None. 4–1 Adolescent and Young Adult Sexual Health in Oncology: Current Practices and Quality Improvement Dava Szalda, Susan Pultman, Lisa Schwartz, Anne Reilly, Lamia Barakat The Children’s Hospital of Philadelphia, Philadelphia, PA, USA PURPOSE: Adolescents and young adults (AYAs) with cancer have unique challenges meeting developmental milestones. AYAs with cancer strive for a sense of “normality” and engage in age appropriate developmental behaviors such as exploring sexuality. The role of pediatric oncology providers in addressing and supporting the sexual health of patients is understudied. We aim to describe current practices of pediatric oncologists and oncology staff in managing sexual health of AYA with cancer. We also explored the extent to which providers felt comfortable discussing sexual health with patients. METHODS: A survey of pediatric oncologists, nursing and psychosocial staff was conducted at The Children’s Hospital of Philadelphia Cancer Center. Participants were asked to recall interactions with their last 20 AYA patients and whether they discussed sexual health. They were also asked to rate their perception of their comfort in sexual health management on a 5-point Likert scale. Questions concerning gaps in knowledge were explored to inform educational programming. RESULTS: One hundred and two people completed the survey (20 physicians, 9 advanced practice nurses, 48 registered nurses, 5 psychologists and 3 social workers). Of respondents, 82% were female, working in oncology for on average 8 years. Providers reported that they spoke to less than 20% of AYA patients about sexual health and did not meet alone to discuss sexual health. Responses varied by respondent with psychosocial team members more likely to discuss sexual health than physicians or nurses. Providers ranked their comfort at a low to moderate in STI screening, discussing contraception, and taking a sexual history. Providers were comfortable explaining treatment associated changes that may affect body image. An educational lecture will be given to providers to review taking a sexual history, contraception and guidelines on pregnancy and STI testing. Follow up questionnaires on clinical practices of participants who attended the conference will be obtained and reported. CONCLUSIONS: Oncology providers are not comfortable asking about sexual health or confident in their ability to order correct testing surrounding pregnancy and STI screening. Providers are interested in learning more about appropriate clinical practices. Educational in-services may be of use to disseminate information on routine adolescent care to oncology providers. RESEARCH IMPLICATIONS: Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Paper Abstracts of the APOS 11th Annual Conference

This study explores the role of oncology providers in caring for the sexual health of their patients and explains the gaps in both provider knowledge and care. Further research might focus on increased understanding of AYA patient needs for sexual health education and support and interventions to improve the care of sexual health in adolescents and young adults. Future research might also explore other aspects of routine adolescent care and how they are being addressed during oncologic treatment. CLINICAL IMPLICATIONS: As this study was designed as a quality improvement project, it lays the groundwork for educational programming that may be used to disseminate information to subspecialty providers on routine adolescent care and improvements in care following appropriate provider education. FUNDING: None. 4–2 Second Life: A Cervical Cancer Education Intervention for Adolescents and Young Adults Versie Johnson-Mallard, Elizabeth Kostas-Polston, Belinda Rose James-Young, Kevin Kip, Cecile Lengacher, Lissa Mangini, Denise Passmore, Rasheeta Chandler University of South Florida, Tampa, FL, USA PURPOSE: The purpose of this project was to assess the feasibility of Second Life (SL), a virtual environment as an educational intervention to increase knowledge of HPV a viral STI with cancer causing risk. SL is an internet based application and home to 20 million users who each have a unique “avatar”. Avatars are digital identities that the user can create and customize. This study investigated the efficacy of SL as an educational intervention in improving knowledge of HPV a virus linked to causing cervical cancer. METHODS: Lime Survey was used to provide the study participants (SP) with the Adult Consent Form. Moodle was used to house the SP’s avatar name and information such as e-mail. The exhibit restricted access to the public. The reasoning for this was to prevent skew of statistics from other none SP users. Our virtual environment was geared to create an impact on user knowledge around HPV and potential cancer sequelae after exposure. RESULTS: The intervention was effective as mean knowledge score increased for pretest to posttest after exposure to content in the SL exhibit. The majority (60%) of the research participants had no previous experience with Second Life. Almost half (40%) found the exhibit “very” useful. CONCLUSIONS: This explosive tactile experience has the potential to mentally captivate audience and draw them into a different educational virtual world platform. SL exceeds current barriers by increasing the scope of people who could be reached. RESEARCH IMPLICATIONS: This method of health care information dissemination has the potential to psychologically enthrall young © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.


adults and promote cancer prevention education using a virtual world platform. SL has the potential to reach young adults globally. CLINICAL IMPLICATIONS: The need for continued health information to promote better reach groups most vulnerable to contracting a cancer causing virus. Creative, innovative, cloistered methods of increasing HPV knowledge are logical and essential to prevention behavior. FUNDING: Funded by RWJF Nurse Faculty Scholars Program: 9301022–0001; IRB:108452 I. 4–3 Contributing Factors to Oncology Practitioners’ Recommendations of Fertility Preservation for Adolescent and Young Adult Cancer Patients Alexandra Nobel1, Joan Chrisler2 1 University of Rhode Island, Kingston, RI, USA, 2 Connecticut College, New London, CT, USA PURPOSE: Modern medical technology has increased survival rates from childhood cancer, leaving many adult survivors with biological and psychological late effects including infertility. Fertility preservation (FP) may be an option for many patients; however, barriers exist that could influence oncology practitioners’ recommendations of fertility preservation including a patient’s gender and age. FP may be more difficult for female patients due to the time and procedures necessary to partake. Also, patients under 18 would need parents’ consent to participate in FP which could create tension between patient, family, and medical team. In this study, I aimed to test whether a patient’s gender and age would influence how strongly oncology practitioners would recommend a patient partake in FP. METHODS: Participants were 129 oncology practitioners (i.e., nurses (90%), oncologists) recruited online from oncology nursing and oncology practitioner organizations. Participants were randomized to read one of four vignettes about a 14 or 19 year-old, male or female patient whose proposed treatment course could affect their fertility and then responded to questions about how strongly they would recommend fertility preservation before treatment. RESULTS: Results indicated that recommendations to speak with an endocrinologist before treatment or to partake in FP did not vary significantly by patient age or gender. Recommendations were very strong across conditions. Practitioners responses were inconsistent surrounding recommending FP, endorsing acceptance of delaying treatment for FP, and familiarity with recent research in the area; these findings could be indicative of a lack of education about processes necessary for FP to occur. Having an endocrinologist on a medical team affected how strongly practitioners recommended their patients explore FP options. CONCLUSIONS: Education about recent findings in FP research should be disseminated to all members of Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


the medical team and more research needs to be done on how different members of the oncology team interact with each other and with patients making medical decisions. The continuing advancement of FP methods could continue to increase hope for the future for cancer patients and their families. RESEARCH IMPLICATIONS: This research may be relevant to practitioners whose adolescent and young adult patients may be eligible to partake in fertility preservation prior to the initiation of cancer treatment. Researchers in the fields of medical oncology, behavioral medicine, and public health have shown that fertility (and the threat of infertility) can affect quality of life and hope for the future for cancer patients. More research is needed to understand how new research in the area of FP is shared within institutions and whether medical teams discuss who/how this information will be communicated with patients. More research with oncology nurses could be useful as this study replicated past research findings that nurses believed oncologists were primarily responsible for discussing this information with patients, though nurses may have more patient contact than oncologists. CLINICAL IMPLICATIONS: Understanding how practitioners communicate risk to fertility and FP options with their patients, as well as how these practitioners understand responsibility for these conversations within the medical team, could ensure that patients are receiving proper information and increase quality of care during treatment. Patient satisfaction following treatment could also be increased if individuals believe they received proper, timely information about FP options. FUNDING: None. 4–4 Patient-Provider Discussions About Fertility Preservation Among Young Adults Diagnosed With Cancer Betina Yanez1, Alexis Munoz2, Mallory Snyder1, Marla Clayman1, Kristin Smith1, David Victorson1, Khouri Barnes3, John Salsman1 1 Northwestern University, Chicago, IL, USA, 2University of Illinois at Chicago, Chicago, IL, USA, 3Illinois School of Professional Medicine, Schaumburg, IL, USA PURPOSE: Young adults (YAs; age 18–39) diagnosed with cancer face multiple challenges that affect their health-related quality of life, including the potential for their diagnosis and/or treatment to affect their fertility. Providing information about the risk of infertility and options to maintain fertility are critical for the YAs who are newly diagnosed. However, research suggests many medical oncologists fail to discuss fertility preservation and barriers to effective communication exist for both patients and providers. The purpose of this study was to interview both oncologists and YAs to examine © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Paper Abstracts of the APOS 11th Annual Conference

factors influencing the discussion about fertility preservation. METHODS: Semi-structured interviews were conducted with medical oncologists and with YAs within 2 years post-diagnosis who represented the most common cancers affecting YAs. Interviews were audiorecorded, transcribed, and then coded using qualitative methodologies with the analysis software NVivo 10. RESULTS: 12 oncologists (50% female, 67% .05). There was no difference in the mean number of supportive care services in which HPV + and HPV- survivors were interested (p > .05; mean = 4.2 (SD = 3.9), range = 1–12). However, HPV + survivors were more likely to want information specific to oral cancer risk factors, including HPV (p < .001). CONCLUSIONS: The current study is one of the first studies to identify the supportive care needs of HPV + oral cancer survivors and the first to contrast these needs with those of HPV- oral cancer survivors. Findings have implications for the development of supportive care interventions in oral cancer survivorship and suggest the need to tailor content accordingly. RESEARCH IMPLICATIONS: Study findings support future research into the distinct supportive care needs of survivors of HPV related oral cancers. CLINICAL IMPLICATIONS: Study findings highlight the importance of considering HPV status in the psychosocial care of patients and survivors. FUNDING: None. 7–2 An Investigation of the Effectiveness of Molecular Assays and Sampling Methods for the Detection of Oropharyngeal Human Papillomavirus Infection Elizabeth Kostas-Polston1,2, Mark Varvares2,3, Leonard Grosso2,3, Juan Gonzalez2,3, Ron Walker2,3, Kara Christopher2 1 University of South Florida College of Nursing, Tampa, FL, USA, 2Saint Louis University Cancer Center, St. Louis, MO, USA, 3Saint Louis University School of Medicine, St. Louis, MO, USA PURPOSE: Amid the epidemic of HPV-related oropharyngeal (OP) cancer, tests with clinical utility are needed for distinguishing favorable from unfavorable tumor types; counseling patients and their sexual partners regarding infection, disease and prognosis; choosing treatment regimens appropriate to a patient tumor’s biology; identifying the presence of HPV infection and genotype for genotype-specific treatments; and for the purpose of identifying epidemiological trends. METHODS: This cross-sectional, exploratory pilot study involved collection of biologic specimens (pretreatment tumor tissue, exfoliated cells, and saliva) from forty individuals with OP lesions. Informed consent was valid for collection of data from the Sexual History and Social Behavior Survey, exfoliated cells, saliva samples, and tumor tissue. Molecular interrogation, cytological and histologic evaluation, sampling methods, and collection kits were tested in various combinations and compared with biopsy data. RESULTS: When comparing various methods, the oral scraping collected in a Non-GYN ThinPrep® kit, analyzed using the Hologic Cervista® assay, demonstrated the best sensitivity (78.5%) and specificity (78.5%). This combination detected the correct result (positive and negative) 78% of the time. Further, methods used for Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Paper Abstracts of the APOS 11th Annual Conference

evaluation of Biopsy Tissue-p16 yielded an 87.5% sensitivity and 100% specificity. When biopsy tissue was available, it was a good method for HPV detection. Saliva-Oragene®-Cervista® yielded a 100% sensitivity and 20% specificity. This method was a poor clinical tool due to the high number of false positive results. Here, positive infection was detected in the majority of cases; including many of the cases where the sample was negative for infection. Saliva-Non-GYNThinPrep®-Cervista® yielded 56.2% sensitivity and 66.7% specificity, suggesting it only detected the correct result 56% of the time. The Oral Scraping-Non-GYNThinPrep®-Cytology yielded 31.2% sensitivity and 73.3% specificity, while Saliva-FalconTube-Cytology a sensitivity of 18.7% and 64.3% specificity. Both methods proved to be poor clinical tools as they detected a high number of false negatives. CONCLUSIONS: Hologic Cervista® using an oral scraping, collected in a Non-GYNThinPrep® kit was the best screening tool; 87% true positives and 100% true negatives were detected. RESEARCH IMPLICATIONS: This cross-sectional, exploratory pilot study was designed to explore analytic and sampling methods to screen for HPV infection of the oropharynx. Assays and sampling methods were tested in various combinations and compared with biopsy data regarding the presence or absence of HPV infection. This design was innovative in that analytic and sampling methods used to detect HPV infection in cervical specimens were tested in oropharyngeal specimens. CLINICAL IMPLICATIONS: Establishing the best laboratory assay and sampling method may lead to the identification of an accurate, non-invasive test to screen for early detection of HPV-related OP infection. The development of a translational research program utilizing individuals atrisk for HPV-related OP cancer and guide clinical treatments. FUNDING: This research was supported by the E.R. Murphy Charitable Lead Trust Research Award, Saint Louis University Cancer Center; Delta Lambda Chapter Research Award (Sigma Theta Tau); Sigma Theta Tau International Rosemary Berkel Crisp Research Award; and the Robert Wood Johnson Foundation Nurse Faculty Scholars grant #68040 to Elizabeth A. Kostas-Polston. 7–3 Facing Disfigurement: Understanding Body Image Adaptation Following Surgical Treatment for Head and Neck Cancer Michelle Fingeret1, Irene Teo1, Sarah Kagan2 1 MD Anderson Cancer Center, Houston, TX, USA, 2 University of Pennsylvania, Philadelphia, PA, USA PURPOSE: This study was designed to understand how patients with head and neck cancer adapt to body image © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.


changes following surgical treatment. Our primary foci were on emotional reactions and psychosocial ramifications of mirror viewing during postoperative recovery, and how these unfold into survivorship. METHODS: We conducted a Qualitative Grounded Theory study. We obtained individual interviews with patients using a semi-structured interview guide with open questions and structured probes. Data analysis involved constant comparative technique along with open, axial, and theoretical coding procedures. We used NVivo 9 to manage data and facilitate analyses. RESULTS: Participants were 20 patients with a range of cancers affecting the midface. Ten participants were interviewed within 6 weeks of initial tumor resection, and ten were interviewed within 1–3 years after such surgery. Major concepts emerging from the data include: a) “layers of shock” experienced across time, b) “It’s not me” or a sense of disconnect from oneself when mirror viewing, c) “I’m a work in progress” tied to hope for the future and d) “It could be worse”, related to frequent use of downward social comparison. Intersections between monster/horror imagery and initial mirror viewing were apparent. We also found strong intersections between religion and the treatment team. CONCLUSIONS: The use of grounded theory enables body image stories to emerge from each patient’s own narrative voice, and provides powerful imagery and descriptive language to better understand patient’s experiences. Our preliminary grounded theory suggests that adjusting to facial disfigurement from head and neck cancer is an internal psychological and cognitive process for patients as they make sense of seeing themselves and interacting with the outside world. God and the treatment team play a large role in this process. RESEARCH IMPLICATIONS: Further attention is warranted to evaluate body image difficulties of this patient population. Empirically-validated psychosocial interventions aimed at preparing patients for mirror viewing following surgery are lacking, and important to develop. CLINICAL IMPLICATIONS: These data can be used to facilitate provider education and training so that body image issues are routinely addressed as part of comprehensive care for head and neck cancer patients. FUNDING: This research was supported by funds from the University Cancer Foundation and the Duncan Family Institute for Cancer Prevention and Risk Assessment via the Cancer Survivorship Research Seed Money Grants at the University of Texas MD Anderson Cancer Center. 7–4 Distress, Quality of Life and Causal Attributions in Human Papillomavirus Positive Oropharyngeal Cancer Patients Lora Thompson, Kristine Donovan, Gwen Quinn, Julie Kish, Judith McCaffrey, Andy Trotti, Anna Giuliano Moffitt Cancer Center, Tampa, FL, USA Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


Paper Abstracts of the APOS 11th Annual Conference

PURPOSE: Previous research suggests high levels of distress at diagnosis of head and neck cancer, and distress is associated with more physical symptoms, tobacco use, and alcohol use. A subset of these patients have been identified as having human papilloma virus positive (HPV+) oropharyngeal squamous cell cancer (OPSCC), which has distinct clinical characteristics (e.g., better prognosis). Limited research has focused on psychosocial factors, such as whether HPV + OPSCC patients experience increased distress about having a cancer caused by sexually transmitted infection (STI). This pilot study examined distress, quality of life, and causal attributions in HPV + OPSCC cancer patients. METHODS: Men (N = 32, mean age = 61 years), newly diagnosed with HPV + OPSCC, completed self-report questionnaires assessing distress (Hospital Anxiety and Depression Scale; HADS) and quality of life (physical, role, emotional, cognitive, and social functioning subscales of the EORTC-QLQ 30). Causal attribution was assessed by asking participants to indicate the primary cause of their cancer. RESULTS: Mean HADS total score was 11.56; 41% of men scored above the clinical cutoff of 11. Correlational analyses indicated that distress was not associated with age, time since diagnosis, stage, or current smoking. Greater distress was associated with less alcohol use (p < .05). Greater distress was also associated with worse emotional, cognitive, and social functioning (all p < .02), but not physical or role functioning. Only 38% reported that they believed STI was the primary cause of their cancer. The remainder identified genetics (13%), tobacco (25%), unknown (9%), environmental exposure (6%), bad luck/fate (6%), and other (3%). No participants identified alcohol or oral hygiene as a primary cause. Men identifying HPV as the primary cause were significantly less distressed than men who identified another cause (p < .05). CONCLUSIONS: These findings suggest HPV positive cancer patients may experience high levels of distress. Men, who attribute their cancer to a factor other than STI, are more likely to be distressed than those who attribute their cancer to HPV. RESEARCH IMPLICATIONS: Future research should replicate these findings with a larger sample, including an HPV- comparison group. CLINICAL IMPLICATIONS: Distress screening should include an assessment of patients’ cancer attributions. FUNDING: This project was supported (in part) by the American Cancer Society’s Institutional Research Grant.

PURPOSE: The incidence of oral cancers in the United States is increasing. Understanding the supportive care needs of oral cancer survivors is a necessary first step toward the provision of effective psychosocial care. To date, studies of supportive care needs have been limited to newly diagnosed patients. The current study assessed supportive care needs in short-term (1–5 years postdiagnosis) and long-term (>5-15 years post-diagnosis) oral cancer survivors. METHODS: Participants were 193 short-term and 145 long-term oral cancer survivors (N = 338; mean age = 56.2 years; 53% male) recruited through announcements endorsed by the Oral Cancer Foundation. In an online survey, participants self-reported demographic and clinical characteristics and completed the Survivor Unmet Needs Survey (SUNS). The SUNS is an 89-item measure of supportive care needs that contains five subscales: emotional health, access and continuity of care, relationships, financial concerns, and information. RESULTS: Compared to long-term survivors, short-term survivors reported significantly greater emotional (p = .01), care (p = .05), relational (p = .02), and information (p < .001) needs; the two groups did not differ significantly in work needs (p = .13). Short- and long-term survivors reported different top unmet needs (determined by the percentage of each group rating an item as a “high” or “very high” unmet need). The most prevalent needs of short-term survivors included adapting to life changes after cancer (22.1%) and dealing with feeling they had lost control (22.9%) and could not form long-term goals or plans (24.3%). Alternatively, long-term survivors emphasized difficulties adjusting to changes in appearance (16.8%), coping with cognitive problems (18.2%), and meeting financial obligations (15.7%). Both groups reported salient concerns regarding fatigue, changes in physical ability, stress, anxiety, earning money, losing confidence in their abilities, and finding others who could relate to their experience. CONCLUSIONS: Oral cancer survivors report considerable long-term care needs, the nature of which may shift over time. Findings indicate the necessity of interventions to address these needs and offer useful targets for such interventions. RESEARCH IMPLICATIONS: The findings of this study demonstrate the need for further research on the supportive care needs of oral cancer survivors. CLINICAL IMPLICATIONS: The findings of this study highlight a need for clinicians to assist oral cancer survivors in coping with and addressing their supportive care needs. FUNDING: None.

7–5 Supportive Care Needs of Oral Cancer Survivors Morgan Lee1,2, Kristine Donovan2, Lora Thompson2, Christine Brader3, Brian Hill3 1 University of South Florida, Tampa, FL, USA, 2 Moffitt Cancer Center, Tampa, FL, USA, 3Oral Cancer Foundation, Newport Beach, CA, USA

8–1 Minimizing Bias in Transplant Decisions When Considering Psychosocial Risk Factors Linda McLellan1, Larry Foster2, Ronald Sobecks1 1 Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA, 2Cleveland State University School of Social Work, Cleveland, OH, USA

© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Paper Abstracts of the APOS 11th Annual Conference

PURPOSE: Presented is a paradigm case illustrating the need for an interdisciplinary team to utilize objective criteria in order to minimize bias in making decisions regarding whether to proceed with transplant when considering psychosocial risk factors. METHODS: Mr. L, a 28 year old single male with aplastic anemia, was transfusion dependent, and had an HLA matched related donor for allogeneic hematopoietic progenitor cell transplant (alloHPCT). He lived with his girlfriend, their young children, and his grandmother; his family was unable to provide 24 hour caregiving post-transplant. Mr. L had a history of non-compliance, but no history of mental health needs or treatment. He reported smoking tobacco and marijuana, but he denied alcohol or other illicit drug use. Chemical dependency evaluation was ordered, but the patient cancelled this appointment twice. He later went for the evaluation, after he was informed that he could not proceed with alloHPCT until this was accomplished. Upon evaluation, Mr. L tested positive for cocaine, but negative for marijuana; poly-substance dependence was diagnosed and treatment was recommended prior to alloHPCT. RESULTS: Mr. L declined substance abuse treatment. A family meeting was held with the oncologist, social worker, and patient/family. Focus was on patient/ family motivation (willingness), ability (capacity), and opportunity (favorability of circumstances) to take charge of psychosocial risk factors and comply with care demands before proceeding to transplant. Mr. L and his family decided not to pursue alloHPCT. Fortunately, he is being treated successfully with immunosuppressant therapy and outpatient supportive care. CONCLUSIONS: This case led to formation of an interdisciplinary transplant selection committee at our institution and utilization of the Psychosocial Assessment of Candidates for Transplantation (PACT) Scale, a rating instrument that promotes objective decision-making when considering psychosocial risk factors. RESEARCH IMPLICATIONS: Warranted is empirical research about the structure and process of patient selection in alloHPCT, with a focus on interdisciplinary roles, behaviors, and approaches that lead to reasoned and objective transplant decisions. CLINICAL IMPLICATIONS: Engaging patients/ families in systematic discussions about their motivation, ability, and opportunity to take charge of psychosocial risk factors is necessary but may not be sufficient. The PACT Scale is useful in minimizing fears of bias in transplant decisions due to social stigma associated with lifestyle choices. FUNDING: None. 8–2 How’d You Get That? The Impact of Stigma on a Cancer Patient’s Body Shame Erin Buck The University of Texas MD Anderson Cancer Center, Houston, TX, USA © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.


PURPOSE: Similar to some medical conditions, the stigma associated with various cancer diagnoses can be a powerful catalyst for shame and guilt. Patients often worry what others will assume if they disclose a diagnosis such as lung cancer or anal cancer. Along with the overwhelming diagnosis, often comes accompanying embarrassment of having a type of cancer that the patient may, or may not have had a role in bringing upon themselves. METHODS: This patient is a middle aged female with history of anal cancer. She underwent colostomy and radiation therapy. The patient was seen for 9 individual therapy appointments in the Body Image Therapy Service, a specialized psychosocial service at MD Anderson Cancer Center that is designed to address body image concerns that arise for patients throughout the treatment trajectory. Issues of social stigma and shame surrounding a diagnosis of anal cancer will be discussed from the context of an interpersonal process approach. Attendees will be presented with cognitive-behavioral therapeutic interventions and experiential mindfulness techniques used to address body esteem and guide a patient toward greater acceptance of a surgically-altered body. RESULTS: Therapeutic work focused largely on the functional changes to the patient’s body as a result of her cancer and its treatment. Assisting the patient in preparing for, and coping with, the stigma associated with anal cancer was vital in shifting the way she felt about herself and how she managed the reactions of others. The patient’s movement from shame to empowerment will be spotlighted with discussion of how therapeutic timing of interventions impacted the work. CONCLUSIONS: This case presentation demonstrates how one patient’s humiliation about her diagnosis turns to acceptance as she becomes comfortable in her body after treatment. RESEARCH IMPLICATIONS: This presentation will demonstrate how evidenced-based techniques are relevant and effective among this population. CLINICAL IMPLICATIONS: This case will provide attendees with a greater understanding of the contributing factors of body shame within the cancer patient population. FUNDING: None. 8–3 Euthanasia Request in Supportive Care: Guidelines for Best Practices Mélanie Vachon1,2 1 UQAM, Montreal, Canada, 2CRISE, Montreal, Canada PURPOSE: The purposes of this presentation are twofold: First, based on a systematic review of the literature, the clinical and ethical implications of euthanasia request in supportive care contexts will be exposed. Second, based on two clinical case presentations, clinical Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


guidelines for dealing with euthanasia requests will be suggested. METHODS: First objective: Systematic review of the literature on euthanasia request: 32 articles out of 982 were selected, based on a systematic search on Pubmed and psych info, between 2000 and 2013. Second objective: Two clinical case studies of palliative sedation are presented. For both cases, patient’s characteristic, medical and psychological history and patients request are presented. End-of-life discussion, multidisciplinary work and ethical issues for both cases will be raised and discussed. Both patients died following palliative sedation in the context where euthanasia and assisted suicide are both illegal. RESULTS: Based on clinical case discussions, we identified that fear of suffering and lack of information about patients’ rights was central in euthanasia requests. CONCLUSIONS: Euthanasia request in supportive care raise both emotional and ethical concerns among health care professional. End-of-life discussions, addressing fear of suffering and informing patients about the different medical alternatives to relieve suffering are suggested to be promising tools to address euthanasia requests. RESEARCH IMPLICATIONS: The impact on endof-life discussion on both health care professionals and patients’ trajectories should be further documented and assessed by complex case studies or larger scale research projects. CLINICAL IMPLICATIONS: Clinical guidelines for end-of-life discussions, based on education and advanced directives might be helpful for clinicians who face ethical and emotional dilemmas in addressing euthanasia requests. FUNDING: None. 8–4 Applying Meaning-Making Concepts in Clinical Practice With Families After the Death of a Child: Difficult Cases Revisited Regina Melchor-Beaupre, Regina Mendoza Baptist Hospital of Miami, Miami, FL, USA PURPOSE: The death of a child is possibly the most devastating event in any parent’s life. Meaning-making efforts from parents after the tragedy of enduring their child’s death are areas requiring further exploration in pediatric psycho-oncology clinical practice, although research in that area has gained support and increased attention. Applying meaning-making concepts (sense making and benefit finding) and having therapeutic dialogues in clinical practice settings may become important initial steps for clinicians trying to meet the needs of these parents requiring support and continuity of care. This presentation will draw upon two families attempting to make sense of the loss of their child. The purpose of these two qualitative case studies is to illustrate the application of meaning making (sense making and benefit finding) utilizing primarily the work by Neimeyer, © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Paper Abstracts of the APOS 11th Annual Conference

Lichtenthal, Currier, and Keesee who suggest that the most sense-making themes are spirituality and religious beliefs, and the most common benefit-finding themes entail a desire to help others’ suffering. The symposium will explore the myriad of psychosocial problems as reported by the families, as well as the difficult challenges faced by the mental health professional who must deal with these matters within the context of other complications. In this intended symposium, the speakers will explore and weave the key concepts of meaning-making and discuss lessons learned from such experiences in caring for the families. Dr. Lori Weiner, Director of Pediatric Psycho-oncology at the National Institute of Health, will serve as moderator for this symposium addressing this challenging area of psycho-oncology. Dr. Regina Melchor-Beaupré and Dr. Regina Mendoza, both of whom work in private practice settings, and at Baptist Children’s Hospital where they serve as C/L pediatric psychologists/Medical Faculty and are part of the Pediatric Oncology Support Team and Pediatric Advanced Care Team, will be the presenters. METHODS: Sense making during initial phases of treatment and benefit finding during later phases were part of the strategies utilized to foster meaning-making in an effort to help families integrate the loss of their child. Having therapeutic dialogues also included “retelling” as a meaningenhancing strategy. In conjunction, these therapeutic strategies throughout the course of treatment have enabled these families to begin engaging in meaningmaking, by finding outlets for their grief, such as the formation of organizations which help other parents and family members to deal with the loss of a child. RESULTS: The family members engaged in therapy were catalysts for the formation of building a positive legacy for their child, which was deemed as a clinically significant finding. Themes, such as sense making and benefit finding during psychotherapeutic interventions were found to reinforce the weight of meaning-making for these families suggesting clinical utility in these private practice settings, and were considered positive outcomes. The less positive, although not necessarily deemed as negative outcomes, were essentially the family members who did not wish to participate in the therapeutic process. However, they did engage in building a positive legacy for their child and helping other parents navigate complications. CONCLUSIONS: The meaning-making themes prompted during psychotherapy suggest clinical utility in that these themes propelled the families to engage in extremely challenging, yet clinically relevant discussions about their child’s death. The interventions demonstrated that specific psychosocial strategies must be tailored to meet the needs of these families. Further research must be conducted on the psychosocial needs of this group of bereaved parents. Additionally, translational research should provide clinicians in private Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Paper Abstracts of the APOS 11th Annual Conference

practice settings dealing with this population with more meaning-making strategies and specific guidelines. Applying meaning-making concepts in clinical practice with families after the death of a child has multiple clinical implications, including and most importantly the difficult integration of the loss of a child. Considerations for the continuity of care model should be standard care for parents and families. RESEARCH IMPLICATIONS: Further research must be conducted on the psychosocial needs of this group of bereaved parents. Additionally, translational research should provide clinicians in private practice settings dealing with this population with more meaning-making strategies and specific guidelines. CLINICAL IMPLICATIONS: Applying meaningmaking concepts (as described by Neimeyer and others), which are considered important components of supportive care for families, would be an invaluable tool for private practice clinicians. These clinicians would find meaning-making strategies a good launching point for driving evidence-based practice strategies, which in turn can imply and lead to specific therapeutic guidelines. It has many other clinical implications, including and most importantly the difficult challenge and integration of the loss of a child. Additionally, the continuity of care model, which should be considered standard care for parents and families losing a child, is also an important clinical implication. These and other clinical implications may also give rise to policy considerations. FUNDING: None. 8–5 Ethical Dilemmas Involved in Pediatric Bone Marrow Donor Evaluation: Demonstrating the Need for Standards of Care Sarah Ross1, Sarah Tarquini1, Nancy Frumer-Styron2,3 1 Dana Farber Cancer Institute, Boston, MA, USA, 2 Massachusetts School of Professional Psychology, Newton, MA, USA, 3The Children’s Room, Arlington, MA, USA PURPOSE: Stem cell transplantation has become standard treatment for a variety of diseases in children and adults. Children often serve as hematopoietic stem cell donors, most commonly for their siblings. Although a general outline of recommended criteria to be met in order for a child to serve as a donor was presented in a 2010 policy statement by the American Academy of Pediatrics, there is currently no established standard of care in regards to the psychological assessment of child donors. The purpose of this presentation is to discuss a variety of ethical dilemmas that may be present during the pediatric donor evaluation process in order to demonstrate the need for standards of care. METHODS: We have completed sibling donor evaluations for a large pediatric hospital in the Northeast. Evaluations include a variety of components centered on providing psychoeducation, © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.


ruling out contraindications to participation, and ultimately obtaining child assent. RESULTS: Based on extensive clinical experience, we have compiled a list of ethical dilemmas faced while completing these evaluations, each illustrated by a brief case summary. These dilemmas are rooted in areas of development, culture, language, psychological functioning, and family dynamics. CONCLUSIONS: Ultimately, we aim to demonstrate the need for standards of care for pediatric bone marrow donors in an effort to provide guidance to clinicians and ensure the psychological well-being of these children. Challenges associated with establishing such guidelines will also be discussed. RESEARCH IMPLICATIONS: A standard evaluation procedure for pediatric donors would also result in an improved ability to conduct psychosocial research across hospital sites, with each hospital following a specific protocol for their pediatric patients. This may ultimately lead to multi-site studies that examine outcomes for pediatric donors. CLINICAL IMPLICATIONS: It is our hope that a standard evaluation procedure for pediatric bone marrow donors would lead to an improvement in the quality of care provided to pediatric donors, in addition to increased collaboration and discussion among providers from pediatric hospitals across the United States and internationally. FUNDING: None. 9–1 KidsCan!: Facilitating Conversations About Cancer With Families Cheyenne Corbett, Jennifer Harsh, Jean Hartford-Todd, Patrick Plumeri Duke Cancer Institute, Durham, NC, USA PURPOSE: The purpose of this presentation is to assist attendees in learning more about the practical skills needed for facilitating conversations with children and families around parental cancer diagnosis, treatment, management, end of life, and survivorship issues. Additionally, we will discuss the current research on the topic as well as the perceived gaps in the extant literature on the effects of parental cancer on children and families. METHODS: Addressing the impact of cancer diagnosis and treatment, the presenters will describe a support program designed for families with children ages 4–18 who have a parent or caregiver with a cancer diagnosis. The attendees will be introduced to the history of the program as well as therapeutic tools utilized to create a supportive environment for families facing this challenging time in their lives. Presenters will utilize case vignettes to illustrate how concerns, fears, questions, and hopes are discussed openly and honestly during this group. RESULTS: Results from a study designed to examine if participation in the KidsCan! support program was associated with changes in family communication Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


and overall family satisfaction will be highlighted. Participants reported increases in satisfaction in aspects of both of the aforementioned areas. CONCLUSIONS: Learning practical skills needed for facilitating conversations with children and families around a parental cancer diagnosis and learning about a model, in the form of a support program, can help attendees to become more skillful in establishing and facilitating conversations with children facing a cancer diagnosis of their loved one. RESEARCH IMPLICATIONS: Results from a preliminary study on the KidsCan! support program, as well as feedback from participating families, indicates that participants in the program experience a number of benefits in their emotional and relational wellbeing. Further research is needed to discover, in greater detail, how KidsCan! may impact participants’ wellbeing. Research project development is currently in progress and will be discussed. CLINICAL IMPLICATIONS: There are a number of practical skills needed for facilitating conversations with children and families around parental cancer diagnosis, treatment, management, end of life, and survivorship issues. These skills, as well as the structure and therapeutic tools utilized in the KidsCan! support program, will be highlighted. FUNDING: A combination of internal funding and funding from The Holt Foundation sustain the KidsCan! support program. 9–2 The School Liaison Program’s Effect on Parental Satisfaction and Understanding of Special Education Services Lisa Northman1, Marybeth Morris1, Sarah Ross1, Nicole Ullrich1,2, Peter Manley1,2 1 Dana-Farber Cancer Institute, Boston, MA, USA, 2 Boston Children’s Hospital, Boston, MA, USA PURPOSE: The objective of this study was to evaluate the effectiveness of a model of psychoeducation, consultation, and advocacy provided by a School Liaison Program (SLP) for families and schools of children whose cancerrelated diagnosis or treatment involved the central nervous system compared to a control group of parents of children at risk for neurocognitive deficits based on a diagnosis of Neurofibromatosis type 1 (NF1) who did not receive school-based services. In addition, parental understanding of current learning and school supports and satisfaction with services was assessed. METHODS: After IRB approval, a mailed survey was completed by parents of school-aged children demonstrating academic difficulties associated with their medical diagnosis. Surveys were sent to 123 families of pediatric cancer survivors who received psychoeducation and consultation through the SLP and to the control group of 126 families whose children have NF1. The ordinal responses of intervention (SLP) and control (NF1) groups were compared using a Wilcoxon © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Paper Abstracts of the APOS 11th Annual Conference

rank-sum test. RESULTS: Ninety surveys were returned from the SLP group, together with 76 from the NF1 group. Results indicated a significant between-group difference in parents’ belief that their child is meeting academic potential, with parents who received SLP services reporting greater satisfaction with their child’s progress as well as better understanding of their child’s learning needs and an increased ability to access school supports. Children followed in the SLP were significantly more likely than children in the control group to be supported by an Individualized Education Program (IEP). Finally, SLPaffiliated parents reported feeling more confident in their ability to advocate for their child as compared to the control group. CONCLUSIONS: The consultation, psychoeducation, and parental advocacy training provided by the School Liaison Program has a strong, positive impact on parent-reported knowledge of special education supports, satisfaction with their child’s school services, and increased belief that their child is meeting his/her academic potential. RESEARCH IMPLICATIONS: There is a lack of research investigating the types of special education supports provided to pediatric cancer survivors. Prospective studies will help to clarify the impact of school liaison interventions on academic functioning in childhood cancer survivors and children with neurogenetic diseases such as NF1 that place them at greater risk for academic failure. CLINICAL IMPLICATIONS: The results of this study support the development and implementation of similar school liaison programs across hospitals as part of the standard of care for pediatric cancer survivors and other children with chronic medical conditions that affect their neurocognitive functioning. FUNDING: None. 9–3 Establishing a Psychosocial Program Within a Small Pediatric Cancer Center: Overcoming Challenges and Improving Care Heather Christiansen Blank Children’s Cancer and Blood Disorders Center, Des Moines, IA, USA PURPOSE: Discuss the challenges and successes of starting a pediatric psychosocial program within a small pediatric cancer center one year post-initiation. Psychologist joined an interdisciplinary team of oncologists, nurses, social workers, inpatient and outpatient child life specialists, hospital school teacher, chaplain and school liaison to establish the Cancer Center Psychosocial team. Established pediatric psychology consult service and billing through mental health codes; initiated administration of distress screening to families of children with newly diagnosed cancer; improved school process for patients; expanding services offered to siblings to include support group and mailings; and participating in institution-wide expansion of bereavement support service for families and staff. Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Paper Abstracts of the APOS 11th Annual Conference

METHODS: Descriptive statistics conducted regarding psychological contacts and billing reimbursement. Psychosocial team created and disseminated a Psychosocial Needs Assessment evaluating patient and parent current psychosocial needs. Department is utilizing the PAT 2.0, a screener for assessing psychosocial risk in families of children newly diagnosed with cancer. Interdisciplinary bereavement working group established at Blank and created a bereavement care survey for staff to complete regarding their perception of care provided to families. RESULTS: Psychologist connected with over 50 patients and siblings over the course of the first year out of approximately 450 patients currently being served by the center. Psychosocial needs assessment data collection preliminary analysis reveals that parents and patients do not have outstanding concerns or questions and feel the team is meeting their support needs. Distress screening by the PAT 2.0 reveals that the majority of families report universal or targeted needs. Bereavement survey of cancer center staff revealed that the majority do not feel comfortable caring for a dying patient (60%). Sixty-six percent of staff believes that the service we provide to families after the loss of a child is poor or fair, and 50% of staff feels that staff receive poor or fair support when caring for a deceased or dying patient. CONCLUSIONS: The psychosocial service is thriving and meeting the needs of current cancer patients and families due to collaboration across disciplines, motivation and ancillary support. Services are expanding to provide additional coverage to siblings and provide additional bereavement support to patients, families and staff members. RESEARCH IMPLICATIONS: Researchers interested in the psychosocial needs of cancer patients and families, bereavement support and/or psychosocial distress screening may find this information useful. CLINICAL IMPLICATIONS: This is applicable to clinical providers who aim to improve psychosocial care within a pediatric cancer center. Examples of surveys and tools useful for providing care will be available so that they can be replicated by clinicians at other institutions. The information presented will demonstrate the potential benefits of both a psychologist, as well as a unified psychosocial team within a pediatric cancer center. FUNDING: Hyundai Hope On Wheels Grant (2011–2013). 9–4 Development and Dissemination of the Cellie Cancer Coping Kit Meghan Marsac1,2, Lamia Barakat1,2, Melissa Alderfer1,2, Nancy Kassam-Adams1,2, Olivia Klingbeil2,3, Aimee Hildenbrand2,3 1 University of Pennsylvania, Philadelphia, PA, USA, 2The Children’s Hospital of Philadelphia, Philadelphia, PA, USA, 3Drexel University, Philadelphia, PA, USA PURPOSE: Pediatric cancer and its treatment clearly place physical and psychosocial strain on children and © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.


their families, underscoring the need for behavioral and emotional support throughout treatment. A number of barriers (e.g., limited resources, child treatment schedules, difficulty engaging families) interfere with providing evidence-based psychosocial interventions to support children during cancer treatment. To address this gap we developed the Cellie Cancer Coping Kit (Cellie Kit) by tailoring evidence-based cognitive behavioral techniques for a range of cancer-specific stressors and adding practical strategies suggested by psycho-oncology clinicians and families of children with cancer. The Cellie Kit is comprised of a Cellie toy, cancer coping cards, and a caregiver book. The purpose of this presentation is two-fold: 1) to describe acceptability and feasibility of implementing Cellie Kit, and 2) to describe dissemination strategies and results. METHODS: To assess acceptability and feasibility, we provided Kits to children with cancer (ages 6–12 years old) and their parents. We conducted semi-structured interviews and administered satisfaction questionnaires. RESULTS: All parents found the Cellie Kit relevant to their families’ cancer experience and reported they could understand the book and enact the coping tips without additional assistance. All families reported utilizing the Cellie Kit. A majority (86% of children, 100% of parents) indicated they would recommend the Cellie Kit to others, and most (64% of children, 93% of parents) reported learning new information and/or skills such as new ways to take medication, how to communicate about cancer, and new coping skills. Dissemination efforts for the Cellie Kits began in February 2013. Strategies have included creating a webpage, presenting at conferences, creating Cellie blogs, and reaching out to pediatric oncology organizations and hospitals. To date, we have distributed 110 Kits to our hospital’s patients and 30 outside of our hospital (across the nation and internationally). CONCLUSIONS: In summary, the Cellie Kit may be an effective way in which to provide families with evidence-based strategies for dealing with cancer. Dissemination of this evidence-based tool to children with cancer outside our hospital has been challenging, and we continue to seek ideas for how to best provide this tool to children with cancer. RESEARCH IMPLICATIONS: In developing the Cellie Kit, we implemented a systematic approach of reviewing literature, eliciting opinions from experts, and including feedback from families. This approach may have contributed to the positive acceptability and feasibility results. Future research might consider this approach in developing other intervention tools. Additionally, future research ought to examine whether use of the Cellie Kit results in behavior change. CLINICAL IMPLICATIONS: Clinicians may consider using the Cellie Cancer Coping Kit or similar tools to help support children and their families during treatment. Given limited time and resources of medical teams, The Cellie Kit is a mechanism which can be used to help deliver evidence-based coping strategies Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


directly to families. FUNDING: Fighting Cancer Children’s Foundation. 9–5 Comprehensive Cancer Wellness Program for Young Adults Mary Sharon Curran1,2, Elizabeth Saylor2,3, Sara Burt1 1 Towson University, Towson, MD, USA, 2The Ulman Cancer Fund for Young Adults, Baltimore, MD, USA, 3 University of Maryland Baltimore, Baltimore, MD, USA PURPOSE: The Comprehensive Cancer Wellness Program is an initiative of the Towson University (TU) Wellness Center, TU Department of Nursing and the Ulman Cancer Fund for Young Adults (UCF). This free, eightweek program aims to improve the quality of life for young adult (18–40 years) cancer survivors in the Baltimore, Maryland region. METHODS: Individually tailored exercise training and guidance is provided by TU Wellness Center staff, two to three times per week, in a fully equipped facility with state-of-the-art cardiovascular and strength training equipment. Emotional support is provided by TU Nursing faculty specializing in psychiatric nursing. Young adult survivors are referred from local cancer centers where UCF social work patient navigators are stationed. All participants must be cleared by their treating oncologist to enroll. RESULTS: Among program participants, the most commonly preferred feature was access to consultation with an exercise specialist who could take into account the individual’s previous exercise experience, cancer history, and physical and emotional recovery goals. Medical oncologists were in favor of their younger patients increasing their posttreatment physical activity under appropriate supervision and noted the value of a real world, collegiate setting. CONCLUSIONS: This program offers an example of how medical centers, academic institutions and non-profit organizations can effectively collaborate to develop and implement a wellness program for young adults in their 20s and 30s surviving cancer. Exercise is not only safe after cancer treatment, but it can also improve physical functioning and psychological adaptation. Medical oncologists’ advice to “get more exercise” can be best followed by young adult survivors when they have a safe, structured option that allows for professional guidance in a real-life setting. RESEARCH IMPLICATIONS: Further research is needed to determine if this model can be effectively utilized in other urban, academic settings. In addition, longer term outcomes such as frequency and intensity of weekly exercise, general psychological well-being, and remediation of treatment side effects one year post program completion should be explored. CLINICAL IMPLICATIONS: This program model demonstrates how oncologists can easily and effectively help young adult cancer patients’ transition into survivorship and how exercise can be integrated into survivorship planning. FUNDING: None. © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Paper Abstracts of the APOS 11th Annual Conference

Session 10: Invited Symposium 11–1 Establishment and Growth of a Psychosocial Council to Address Institutional Needs Within a Comprehensive Cancer Center Michelle Fingeret, Guadalupe Palos, Karen Stepan, Frank Tortorella, Alma Rodriguez MD Anderson Cancer Center, Houston, TX, USA PURPOSE: Even within a large comprehensive cancer center with robust psychosocial programs to address patient psychosocial needs, fragmentation of care can occur and gaps in services can exist. Our objective is to describe the establishment and growth of a Psychosocial Council within a comprehensive cancer center that is supported by senior leadership. This council provides a unifying forum for healthcare professionals engaged in psychosocial research and clinical care to work together toward the common goal of integrating and improving the delivery of psychosocial services. METHODS: The Psychosocial Council at MD Anderson Cancer Center was created by the president in August 2006, reporting to the Quality Council and led by executive leadership. The full Psychosocial Council consists of 30 members representing 20 departments. After building an infrastructure and creating an institution-wide governance body, a gap analysis was conducted to review current psychosocial resources available to patients from the point of contact throughout the continuum of care. A number of multidisciplinary teams and subcommittees have been established to address the top gaps identified. RESULTS: Current priority projects being undertaken by the Psychosocial Council include efforts to: 1) raise awareness of providers and patients about the psychosocial services available and how to access these services, 2) further streamline processes for conducting distress screening, and 3) document standardized metrics for all psychosocial and clinical support services being delivered. Among the outcomes achieved include creation and dissemination of a broad range of patient education materials and restructuring our distress screening process to facilitate integration into an electronic medical record. We will also report findings from a promising new research endeavor designed to change institutional culture surrounding patient perception and provider practices related to psychosocial care. CONCLUSIONS: The process we have used to implement psychosocial initiatives can be translated to other settings and institutions. The model for our Psychosocial Council was built upon a number of basic components which include: 1) using a horizontal leadership process, 2) integration of psychosocial care into the strategic plan of operations, 3) including comprehensive representation across disciplines involved in psychosocial research and clinical care, and 4) prioritizing initiatives based on evidence. RESEARCH IMPLICATIONS: This Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Paper Abstracts of the APOS 11th Annual Conference

model provides a large number of avenues and opportunities to conduct systematic research for improving access to psychosocial services, patient satisfaction with care, and adherence to national guidelines for distress screening and management. CLINICAL IMPLICATIONS: Delivering effective psychosocial care is influenced by a broad spectrum of complex factors. Nonetheless, all health care providers must ensure that cancer patients and their families obtain the highest standard of psychosocial care. A multidisciplinary council comprised of members with diverse areas of clinical, educational, administrative, and research expertise can be directly used to impact psychosocial care and provision of psychosocial services. FUNDING: None. 11–2 Testing Adherence and Feasibility of Distress Screening Protocols: Implementing Best Practices in Psychosocial Cancer Care Bradley Zebrack1, Karen Kayser2, Chiara Acquati2, Laura Sundstrom1, Sue Ann Savas1, Michelle McCoy1, Rebecca Tamas2 1 University of Michigan, Ann Arbor, MI, USA, 2University of Louisville, Louisville, KY, USA PURPOSE: Despite widespread implementation of distress screening procedures, we know little about actual adherence to and feasibility of distress screening protocols implemented in routine clinical care. The aims of this study were to examine: 1) fidelity to distress screening protocols; 2) system responsiveness to distress screening (psychosocial contact/referrals); and 3) providers’ acceptance of distress screening protocols. METHODS: Data collection occurred at two university-affiliated cancer centers in the Midwest and Southern United States. We evaluated fidelity and responsiveness over a 12-week period via retrospective analyses of electronic medical records (EMR). A weekly online survey was sent to the providers (physicians, nurses, social workers, and medical assistants) to obtain their feedback on their acceptance of the protocol. RESULTS: At the first site, 371 patients were seen across two clinics. The Distress Thermometer (DT) appeared in the EMR in 60% of cases. Of these, 46% of patients reported distress scores requiring psychosocial contact or referral, as per protocol. Overall responsiveness-–action taken when a patient’s DT score was ≥4 -- was documented in 44% of these cases. Thirty-six percent of physicians and 68% of other clinicians indicated that distress screening helps patients receive appropriate follow-up, in spite of results suggesting that a substantial proportion of patients did not receive psychosocial contact or followup. At site #2, 212 patients’ records across five clinics were analyzed. The DT appeared in the EMR in 69% of cases. Of these, 59% of patients reported distress scores ≥4 requiring psychosocial contact or referral, as per protocol. © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.


The overall responsiveness was documented in 64% of the cases with distress scores ≥4. Eighty-nine percent and 80% of healthcare providers, respectively, indicated that distress screening helped to elicit patients’ concerns and address them with appropriate follow-up. CONCLUSIONS: Distress scores, adherence, and responsiveness varied significantly across clinics and between institutions. We will discuss the institutional, patient, and clinician factors that may have influenced the fidelity of distress screening protocol. This study serves as a model for how psychosocial care providers can evaluate their own distress screening programs and use data analytic results to advocate for system responsiveness and quality improvement. RESEARCH IMPLICATIONS: The study provides a protocol for researchers to use in evaluating the fidelity and feasibility of distress screening programs. CLINICAL IMPLICATIONS: The presentation will provide clinicians with information about best practices for implementation of distress screening in routine clinical care. FUNDING: Association of Oncology Social Work and Millennium-Takeda Pharmaceuticals. 11–3 Triaging Support: A Pilot Supportive Care Referral Program Using Automated Triggers Within the Athena Breast Health Network Screening System at the University of California San Francisco Breast Care Center Dianne Shumay, Alexandra Solomon, Paige Kendall, Timothy Henderson, Debby Hamolsky, Alyse Wheelock, Michelle Melisko UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA PURPOSE: In addition to distress screening, best practices call for cancer centers to refer, follow-up and monitor efforts to address unmet psychosocial needs. The current study analyzes the first 3 months of screening and supportive care referrals in this pilot program at the UCSF Breast Care Center (BCC). METHODS: UCSF is part of the Athena Breast Health Network, a system of breast care across the 5 UC medical centers. The Athena Health Questionnaire System supports discrete data capture, branching and skip logic, versioning, and interfacing with EMR and web services. Prior to their appointment, patients complete an Athena web-based survey of health history, current symptoms and psychological functioning. The study team met with breast clinicians, Athena Network experts, and representatives of the various supportive care services at UCSF to adapt the intake questionnaire to add needs assessments and establish triaging criteria for referral to Psycho-oncology, Onco-fertility, Genetic Counseling, Smoking Cessation, Social Work and Peer Support programs. After a phased implementation period, patients meeting threshold criteria triggered orders in the Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


EMR for clinician referral to supportive care services. Patients were given the option to consent for their data to be used in research. RESULTS: A total of 607 patients completed the survey since December 2012, with approximately 90% giving consent for data to be used for research. After a phased implementation of the triage and referral process, 192 patients were screened and gave consent during the 3 months of the study period. Mean age was 52.6(±13.7) and nearly 25% were of non-white ethnicities. 67.3% triggered at least one referral to a support service, with 48.5% referred to genetic counseling, 30% to peer support, 12.4% to social work, 6.7% to psycho-oncology, 2.4% to onco-fertility and 2.4% to smoking cessation. CONCLUSIONS: A web-based screening system can be used to triage patients to supportive care services within the EMR, and for adjusting thresholds for highest sensitivity and specificity. As follow-up surveys are rolled out, patients who have met thresholds can be followed longitudinally and documented in the EMR, whereas symptoms, distress and needs can be monitored for outcomes. RESEARCH IMPLICATIONS: This study provides information of relevance to researchers in distress screening, health policy and service delivery areas. The system described here may be useful to study alternative models of triage and supportive care and for screening patients for entry into psycho-educational, psychosocial, behavioral and decision support intervention trials. CLINICAL IMPLICATIONS: The current study describes a model of clinical care for identifying and triaging patients to supportive care resources seamlessly within the EMR. Studies such as this highlight innovations that can improve clinical efficiency and address unmet clinical needs while enabling monitoring of compliance with distress management guidelines. FUNDING: Safeway Foundation. 11–4 Implementing the NCCN® Distress Management Guidelines in Ambulatory Oncology: A Quality Improvement Project Karen J. Hammelef1, Christopher R. Friese1,2, Tara M. Breslin3, Michelle Riba1, Susan Schneider4 1 University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA, 2University of Michigan School of Nursing, Ann Arbor, MI, USA, 3Northwestern University, Lake Forest, IL, USA, 4Duke University School of Nursing, Durham, NC, USA PURPOSE: Distress assessment and referral to psychosocial services is an essential component of evidence-based oncologic care. This cohort quality improvement project with historical control was conducted at the hematology and oncology offices and treatment area in a satellite clinic of an NCI®-designated comprehensive cancer center. The project aims were to evaluate the feasibility and utility of the National Comprehensive Cancer Network’s (NCCN®) distress management clinical practice guidelines in © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Paper Abstracts of the APOS 11th Annual Conference

ambulatory oncology. METHODS: 175 adults with cancer were administered the NCCN® distress screening tool at patient appointments over 4 weeks. A survey was distributed to the 38 staff participating in their care at project conclusion. The Diffusion of Innovations Model provided the theoretical framework for the process design. The project components included staff education, screening and algorithm-based referrals to psychosocial services via a psychosocial intake center. A historical control group of patients from the same setting were examined for rate of referral to, and receipt of psychosocial services. RESULTS: A distress screening rate of 61.5% was calculated in the implementation group with a mean distress level of 2.81 and a 26.2% rate of referral. Notably, the rate of service delivery in the population with distress scores of four or greater was found to be 58.9%. Odds of receiving a referral were 5.84 times greater for patients in the implementation group than for the control group. 31.4% indicated moderate distress (level 4–7) and 6.5% high distress (level 8–10). 29 (76%) of the staff completed the survey: 100% found the process clinically relevant, 68% were satisfied with the process, 88% described the tool as easy or very easy to use, 80% noted their workload stayed the same and 86% recommended the continued use of the process. CONCLUSIONS: With modification, the NCCN® distress management guidelines can be successfully implemented in ambulatory oncology. Suggested modifications to the screening tool include selection options for desire for referral to, and satisfaction with, current psychosocial service. Identified barriers and facilitators of the process provide guidance for future implementation of distress screening and management including the potential confounding effect of pain assessment scales on reported distress levels. RESEARCH IMPLICATIONS: Identified barriers and facilitators of the distress management process provide guidance for future implementation projects and distress management processes. The patient confusion with pain assessment warrants further investigation. CLINICAL IMPLICATIONS: Identified barriers and facilitators of the distress management process provide guidance for future implementation projects and distress management processes. Patient confusion with pain assessment will be discussed and may indicate a need for further patient education regarding distress. FUNDING: This research was supported by a 2013 Clinical Project Grant from the Oncology Nursing Society’s Foundation®. 11–5 Developmental Supervision in Psychosocial Oncology Nicole Taylor1,2, Emily Newman1,3 1 University of Denver, Denver, CO, USA, 2Exempla Healthcare, Denver, CO, USA, 3Presbyterian/St. Luke’s Medical Center, Denver, CO, USA PURPOSE: Supervision is said to be the “signature pedagogy of the mental health professions (Barnett et al., Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Paper Abstracts of the APOS 11th Annual Conference

2007),” and is a primary way that trainees learn in their graduate programs as well as outside field placements. While many mental health professionals do not receive specific training in supervision, it is a distinct professional practice requiring specific training and competence (Falender & Shafranske, 2007). These co-presenters will discuss their experiences as both supervisors and supervisees in oncology settings. METHODS: The Integrated Developmental Model (Stoltenberg & McNeill, 2010) serves as a framework for this presentation. In IDM, the developmental stage of both supervisors and supervisees is assessed so pairings can be especially beneficial for learning. This model takes into consideration self-other awareness, motivation, and autonomy; factors that have a unique significance in psychosocial oncology. RESULTS: Supervisors balance the roles of teacher, counselor, and consultant (Bernard and Goodyear, 2013). Within a psychosocial oncology setting, supervision takes on increased importance. Trainees working in an oncology setting have added personal and emotional reactions and may seek out that work due to personal or familial connections to cancer. In addition, supervisors can help trainees assess whether a career in psychosocial oncology is the right fit for them. CONCLUSIONS: A discussion of developmental supervision will be integrated with a discussion of specific factors for supervisors in psychosocial oncology. These may include: helping supervisees prepare for the emotional impact of the work, providing a nonjudgmental space for discussion of countertransference, developing a relational and interpersonally-sensitive style of supervision as a way of modeling the therapeutic relationship, and providing necessary scaffolding for supervisees to learn about the medical and treatment issues (including effects of chemotherapy and radiation, treatment side effects, physiological and psychological changes to expect in patients, etc. …). Supervisors also play an important role in buffering the emotional impact of difficult work with patients at the end of life or in dealing with the physical and existential suffering present in the work. RESEARCH IMPLICATIONS: Research on supervision in oncology settings is virtually nonexistent and possible themes for future research will be explored. CLINICAL IMPLICATIONS: Clinicians will benefit from understanding more about the developmental model of supervision as well as unique issues that arise while doing supervision in an oncology setting. FUNDING: None. 12–1 Expressive Helping Intervention to Improve Survivorship Problems After Hematopoietic Stem Cell Transplant: What Is the Evidence and How Is it Done? Christine Rini1, Jane Austin2, Lisa Wu3, Gary Winkel3, Heiddis Valdimarsdottir4, Annette Stanton5, William Redd3 1 University of North Carolina, Chapel Hill, NC, USA, 2 William Paterson University, Wayne, NJ, USA, 3 Mount Sinai School of Medicine, New York, NY, USA, © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.



Reykjavik University, Reykjavik, Iceland, 5University of California, Los Angeles, CA, USA

PURPOSE: Calls to increase implementation of quality care standards for supportive care highlight the need to increase availability of clinically effective, evidence-based psychosocial services that can be integrated into a treatment plan. This presentation describes findings from a randomized controlled trial that evaluated an innovative, theoretically-based intervention called expressive helping (EH) that combines benefits of emotionally expressive writing with benefits that people experience when they help people facing a similar cancer treatment (“peer helping”). METHODS: EH targets psychological distress, physical symptoms, and poor health-related quality of life (HRQOL) among cancer survivors treated with hematopoietic stem cell transplant, and it is a low burden, low cost intervention that survivors can complete at home. It includes 2 components: 1) emotionally expressive writing (EW; writing one’s deepest thoughts and feelings about one’s transplant in brief, structured writing sessions) followed by 2) peer helping (PH; helping others prepare for transplant by sharing one’s own experiences through a written narrative). The trial included 264 survivors with at least mild survivorship problems (including elevated distress, poor HRQOL, and enduring existential concerns). It compared EH (EW + PH) to 3 conditions: neutral writing (NW), EW (without PH), and PH (without EW). RESULTS: Findings showed that among survivors with moderate to severe survivorship problems, EH improved distress (compared to NW and PH; ps < .05), physical symptoms (compared to NW, PH, and EW; ps < .002), and HRQOL (compared to NW; p = .02). Neither PH alone nor EH alone produced benefits, suggesting unique benefits of combining EW and PH. CONCLUSIONS: We will present findings from the trial evaluating EH, followed by a discussion of procedures for implementing EH, resources needed, and the potential for this new intervention to be used in other cancer populations, based on evidence from research on EW and social support provision, peer helping, and volunteerism. We will also discuss future research directions to enhance the intervention’s implementation potential. RESEARCH IMPLICATIONS: We will report the first test of a psychosocial intervention that applied "the Helper Therapy Principle" -- the idea that people benefit more from providing help than from receiving it. To our knowledge, it is the first intervention that tested this theory as the basis for an intervention. Our findings have theoretical implications (i.e., stem cell transplant survivors who helped others only benefitted from helping if they first processed their treatment experience through expressive writing, suggesting that there may be boundaries to the benefits of helping others). In addition, our findings highlight the need for additional research on mediators as well as research to extend our findings to new populations. CLINICAL IMPLICATIONS: Our findings demonstrated Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


the efficacy of a new intervention for cancer survivors suffering from persistent survivorship problems after undergoing stem cell transplant. The intervention is low burden and low cost, highlighting its promise for implementation in clinical care. FUNDING: This research was funded by the American Cancer Society (Grant #RSGPB-07-28501-CPPB; PI: Rini). 12–2 Disease Comorbidity Predicts Length of Hospitalization Whereas Psychosocial Risk Predicts Patient Survival One Year Post Hematopoietic Stem Cell Transplantation Jessica Geller1, Krista Ranby1, Teri Simoneau2, Dawn Speckhart3 1 University of Colorado Denver, Denver, CO, USA, 2 Colorado Blood Cancer Institute at Presbyterian/St. Luke’s Medical Center, Denver, CO, USA, 3Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, USA PURPOSE: Hematopoietic stem cell transplantation (HSCT) for hematological diseases can be lifesaving but involves risk of serious complications including prolonged hospitalization, graft versus host disease (GVHD) and death. Previous work found that psychosocial risk predicted hospitalization length and both psychosocial and medical risk predicted two-year post-transplant survival. In a larger sample, this study sought to further investigate the ability of psychosocial and medical risk to predict hospitalization length, GVHD incidence, and one-year post-transplant survival. METHODS: Data were collected on allogeneic patients (N = 533) with common diagnoses including acute myelogenous leukemia (42.2%) and nonHodgkin lymphoma (18.6%). Patients were categorized as low/moderate (n = 466) or high (n = 58) psychosocial risk using the Transplant Evaluation Rating Scale (TERS); low/ intermediate (0–2, n = 306) or high (3 or greater, n = 141) comorbidity using the Hematopoietic Cell Transplant-Comorbidity Index (HCT-CI); and low (n = 164), moderate (n = 119) or high disease risk (n = 240) based on physician ratings of Center for International Blood and Marrow Transplant Research (CIBMTR) criteria. RESULTS: Hospitalization lengths ranged from 0 to 254 days (M = 26.7, SD = 24.8). A substantial number of patients experienced GVHD (56.7%) and survival rates one-year post-transplant were 74.1%. Only comorbidity scores predicted hospitalization length; those with high comorbidity scores (M = 3.12, SD = .84) had longer hospitalizations than those with low/ intermediate (M = 2.81, SD = .95) scores (t(443) = 3.32, p < .05). There was no difference in hospitalization length of low/moderate as compared to high TERS risk groups or across disease risk categories. Interestingly, only psychosocial factors were predictive of survival at one year (X2 = 4.38, df = 1, N = 533, p < .05). Those with low/ © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Paper Abstracts of the APOS 11th Annual Conference

moderate TERS scores were more likely (75.7%) to be alive one year post transplant than those with high scores (62.1%). Neither disease risk, comorbidity nor psychosocial risk predicted GVHD. CONCLUSIONS: In contrast to previous findings, patient comorbidities were found to be the only predictor of length of hospitalization during transplantation. Only psychosocial risk predicted survival rates at one year suggesting that psychosocial issues such as compliance, psychiatric symptoms and caregiver support should be considered when assessing risk for transplant. Future studies should investigate in more detail the specific types of psychosocial issues that may impact HSCT survival rates. RESEARCH IMPLICATIONS: This study highlights the importance of medical factors such as comorbidities and their impact on length of hospitalization during Hematopoietic Stem Cell Transplantation. In addition psychosocial risk was found to predict survival rates at one year suggesting directions for future research, which could investigate in more detail the specific types of psychosocial issues (Transplant Evaluation Rating Scale categories) that may impact HSCT survival rates. CLINICAL IMPLICATIONS: Because psychosocial risk and not medical risk factors predicted survival rates at one year, this suggests that psychosocial issues such as compliance, psychiatric symptoms and caregiver support should be considered when assessing risk for transplant to help improve outcomes of Hematopoietic Stem Cell Transplantation patients as this is currently a lifesaving procedure but one that can involve serious complications. FUNDING: None. 12–3 Pre-transplant Substance Use: A Retrospective Chart Review of Inpatient Psychiatric Consultations Within 100 Days of Hematopoietic Cell Transplantation Lina Mayorga1, Jonathan Espenschied1, Liz Cooke1, Jennifer Gotto1, Rachel Lynn2, Marcia Grant1, David Snyder1 1 City of Hope National Medical Center, Duarte, CA, USA, 2 MD Anderson Cancer Center, Houston, TX, USA PURPOSE: The Hematopoietic Cell transplant (HCT) experience can include multiple readmissions, complications, slow recovery and long-term issues. Furthermore, addictive behaviors can contribute or significantly impact a patient’s outcome during the HCT process (Stagno, 2008). Despite the literature discussing known characteristics which may place patients at risk for psychiatric morbidity before transplant; to date, there is no report of a complete risk assessment of transplant patients, including use of alcohol and drugs. The purpose of this study was to identify common characteristics of HCT patients who received psychiatric interventions within 100 days of transplant. METHODS: This retrospective chart review includes adult HCT patients from the year 2011 who were referred for psychiatric evaluation within 100 days of transplant, either pre-transplant for screening or during inpatient Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Paper Abstracts of the APOS 11th Annual Conference


hospitalization for transplant. Data on sociodemographic, disease, treatment, assessment and personal characteristics of transplant patients who receive psychiatric evaluations were collected in a retrospective tool. Psychiatric variables were collected from psychiatrist’s dictated consultation note and social worker’s pre-transplant evaluation prior to admission. Analysis included simple frequencies and descriptive statistics. RESULTS: 22 charts were reviewed that met eligibility criteria. Gender was equally distributed; average age of 40.3 (age range 23–64). Common reasons for referral were depression (40.9%) and other (40.9%);”other” included referrals for: substance abuse (7.7%), bipolar history (7.7%), and “pre-transplant evaluation” (30.8%). Half of the patients had previous psychiatric illness, with anxiety and depression contributing to majority. Higher incidence of substance and alcohol use was noted in study population: alcohol use within 6 months (22.7%), history marijuana use (22.7%), history of tobacco or smoking (18.2%) and street drug use (4.5%). Half of the patients experienced pretransplant distress. CONCLUSIONS: Although this was a small sample size, the rate of substance use in this HCT population was relatively high. Data provides a glance at the psychosocial and psychiatric issues that HCT patient’s experience. Further research is needed on the effects of substance use amongst this population before/after treatment and its predictors on compliance, medical management and complications. Including education of staff involved in pre-transplant screening and patient education regarding potential problems that can arise if substance abuse occurs during transplant process and postdischarge. RESEARCH IMPLICATIONS: Currently there is little to no research available on the effects of substance abuse amongst the HCT population. Most of the research has been focused on solid organ transplantation. CLINICAL IMPLICATIONS: At times patients with prior history of alcohol or substance abuse are overlooked prior to transplantation. Patients with preexisting alcohol or substance use are at a higher risk for morbidity and mortality while undergoing an HCT, including impacting medical management, physical and emotional-wellbeing. FUNDING: None.

studies to date have examined coping and psychological well-being among HCT recipients. The aim of the current abstract is to report on patients’ perceptions of coping and psychological well-being obtained from a larger qualitative study on patient education regarding post-HCT QOL. METHODS: Men and women who had received allogeneic HCT one to four years previously participated in one of four qualitative focus groups based on a semi-structured interview guide. Participants were asked to recall what they had been told about post-HCT QOL prior to transplantation, what their QOL has been like since HCT, and how their QOL differed from what they expected. Content analysis was used to code verbatim transcripts for both a priori and emergent themes. RESULTS: Participants included 24 patients (50% female, median age 53, range 23–73). Participants emphasized the emotional challenges of recovery including depression, discouragement, anxiety, but they also described positive emotions such as determination and gratitude. They frequently reported coping by taking one day at a time, relying on faith, staying busy, seeking social support, and avoiding negativity. They also emphasized the psychological importance of milestones such as tapering off medications as a sign of improvement. CONCLUSIONS: Study findings highlight the unaddressed psychological needs but also the resiliency of HCT recipients. Future interventions should help patients to build upon their resilience to reduce emotional distress. RESEARCH IMPLICATIONS: It will help researchers better understand the impact hematopoietic cell transplant has on psychological well-being, and how patients cope with this treatment. Additionally, it will help them design quantitative studies to further explore the impact HCT has on psychological well-being and strategies patients use to cope with HCT. CLINICAL IMPLICATIONS: It will help clinicians understand how hematopoietic cell transplant effects patient’s psychological well-being, and what coping strategies these patients commonly employ. This will increase clinicians’ ability to provide support and empathy to patients undergoing HCT. FUNDING: Miles for Moffitt Milestone Award, NIH K-07-CA138499 & ACS MRSG-11-149-01-LIB.

12–4 Coping and Psychological Well-Being Among Patients Undergoing Allogeneic Hematopoietic Cell Transplant Julie Cessna1,2, Gwendolyn Quinn1, Clement Gwede1, Ashley Nelson1,2, Mallory Cases1, Anna Barata1,3, Juliette Christie1, Luis Gonzalez1, Alexis Koskan1, Joseph Pidala1, Heather Jim1 1 Moffitt Cancer Center, Tampa, FL, USA, 2 University of South Florida, Psychology Department, Tampa, FL, USA, 3Hospital Sant Pau, Barcelona, Spain

12–5 Social Support Facilitates Psychological Adjustment Following Hematopoietic Stem Cell Transplantation Savitri Viozat1, Mark Juckett2,3, Christopher Coe4, Ashley Nelson1, Erin Costanzo1,3 1 Department of Psychiatry, University of WisconsinMadison, Madison, WI, USA, 2Department of Hematology and Medical Oncology, University of Wisconsin-Madison, Madison, WI, USA, 3Department of Psychology, University of Wisconsin-Madison, Madison, WI, USA, 4University of Wisconsin Carbone Cancer Center, Madison, WI, USA

PURPOSE: Hematopoietic cell transplantation (HCT) can have a profound impact on quality of life (QOL), particularly psychological health. However, very few qualitative © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

PURPOSE: Cancer patients who receive hematopoietic stem cell transplantation (HSCT) face severe cancer- and Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


treatment-related stressors that can cause psychological distress and undermine well-being. We examined the extent to which supportive social relationships may serve as a protective influence with regard to psychological adjustment during the year following HSCT. METHODS: Adults undergoing HSCT for hematologic cancers (N = 364) completed the Social Provisions Scale, which measures six support dimensions (reassurance of worth, attachment, social integration, reliable alliance, guidance, nurturance) prior to HSCT. Dimensions of positive adjustment (positive affect, psychological well-being, meaning/peace) and negative adjustment (negative affect, depression, anxiety) were assessed pre-HSCT and at 1, 3, 6 and 12 months postHSCT. Mixed-effects linear regression models covarying for time, age and transplant regimen were used to determine the extent to which pre-HSCT support indices predicted positive and negative psychological adjustment across the assessment points. We also examined interactions between sex and support to determine whether relationships between social support and adjustment indices differed between men and women. RESULTS: With regard to positive adjustment, individuals who reported more overall social support prior to HSCT experienced higher positive affect (z = 5.03, p < .001) and psychological wellbeing (z = 5.58, p < .001) and were more readily able to find a sense of meaning and peace (z = 7.89, p < .001) during the year following HSCT. With regard to negative adjustment, those with more supportive social relationships experienced lower negative affect (z = 3.89, p < .001), depression (z = 4.51, p < .001) and anxiety (z = 3.32, p < .001). The same pattern of results was seen for each dimension of social support examined, except for nurturance. While most interactions between sex and support dimensions were not significant, there was a significant interaction between sex and reliable alliance in the models predicting psychological well being (z = 2.02, p = .044) and meaning/ peace (z = 2.54, p = .011). Having reliable support at the time of transplant had a stronger effect on indices of well-being for men than for women. CONCLUSIONS: These findings suggest that having supportive social relationships at the time of transplant can facilitate optimal psychological adjustment following the physically and emotionally demanding experience of HSCT, and that these effects can endure for the first year following transplant. RESEARCH IMPLICATIONS: Findings highlight the importance of examining protective factors that can promote positive adjustment in addition to traditional risk factors and distress indices. Results further suggest the value of investigating potential sex differences in understanding the function of social support for cancer patients. CLINICAL IMPLICATIONS: Assessing social support at the time of HSCT can assist clinicians in identifying patients who are at risk for poorer psychological adjustment following HSCT. Interventions to enhance support may help to improve psychological well-being. © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Paper Abstracts of the APOS 11th Annual Conference

FUNDING: NCI K07 CA136966; NCI R21 CA133343; NCRR KL2 RR0205012; Forward Lymphoma Foundation. Session 13: Invited Symposium 14–1 The Complexities of Resilience: A Report From the Understanding Resilience in Parents of Children With Cancer Study Abby R. Rosenberg1,2, Helene Starks2, Barbara Jones3,4 1 Seattle Children’s Hospital, Seattle, WA, USA, 2 University of Washington, Seattle, WA, USA, 3Institute for Grief, Loss and Family Survival, Austin, TX, USA, 4 University of Texas at Austin, Austin, TX, USA PURPOSE: Parent psychosocial function can impact the well-being of the entire family. Promoting parent resilience may provide an opportunity to improve family-level survivorship after the experience of pediatric cancer. METHODS: The “Understanding Resilience in Parents of Children with Cancer” was a cross-sectional, mixedmethods study of 120 English-speaking parents of children who had either completed cancer therapy or died from their cancer at least 6 months prior. Surveys included multiple validated instruments including the ConnorDavidson Resilience (CD-RISC) scale, the Kessler-6 psychological distress scale (K6), and the Post-Traumatic Growth Inventory (PTGI), and two open-ended questions: (1) “How has this experience affected you?” and; (2) “Are there other events that affected your answers?” We conducted a content analysis of written parent responses and arrived at consensus impressions of those who were clinically “resilient” based on evidence of psychological growth, lack of distress, and parent-reported meaning or purpose after cancer. We then compared findings with scores from the three instruments to examine how the individual instrument scores aligned with qualitative expressions of “resilience.” Analyses were stratified by bereavement status; group mean scores were compared with t-tests with unequal variance. RESULTS: Eighty-four (88%) of 96 non-bereaved (NBR), and 22 (24%) of 24 bereaved (BR) parents provided written responses. Among NBR, 53 (63%) were considered resilient, whereas 7 (7%) were not. Among BR, 11 (46%) were deemed resilient and 5 (21%) were not. All others suggested a mixed or incomplete picture. In both groups, resilient parents tended to have higher personal resources, lower psychological distress, and greater post-traumatic growth (p = 50% of the variance. CONCLUSIONS: These findings suggest that children’s psychological functioning is predicted primarily by dispositional traits, and secondarily by history of stressful life events, with illness and treatment variables accounting for minimal and often non-significant variance in children’s functioning. RESEARCH IMPLICATIONS: Highlights the importance of including community controls without history of serious illness in order to better appreciate the magnitude of cancer-related symptoms. Highlights the need to avoid focusing effects in designing assessments. Points to the importance of non-cancer related factors as determinant of psychological outcomes in cancer population. CLINICAL IMPLICATIONS: Points to risk factors for adverse outcomes (e.g., dispositional factors, such as high neuroticism, low optimism) and history of stressful life events. Highlights to generally good adjustment of children with cancer, and benefits of focusing only on those patients at significant risk of adverse outcomes. FUNDING: R01 CA136782 (to SP) and the American Lebanese Syrian Associated Charities (ALSAC). 14–3 Reducing Psychosocial Difficulties Among Parents of Pediatric Cancer Patients: The Moderating Effects of Social Support Louis A. Penner1, Felicity W.K. Harper1, Amy M. Peterson1, Chris Trentacosta2, Jeffrey W. Taub3, Sean Phipps4, Terrance L. Albrecht1 1 Wayne State University Department of Oncology, Detroit, MI, USA, 2Wayne State University Psychology Department, Detroit, MI, USA, 3Children’s Hospital of Michigan, Hematology/Oncology Department, Detroit, MI, USA, 4 St. Jude Children’s Research Hospital, Memphis, TN, USA PURPOSE: Cancer is the leading cause of disease-related death in children (ACS, 2012) and many parents of pediatric cancer patients report high levels of psychosocial difficulties during their child’s treatment and after treatment has ended. However, some parents may be more vulnerable to psychosocial difficulties than others. This study examined whether high levels of social support moderate the impact of anxiety and/or depression on psychiatric symptoms among parents of pediatric cancer patients. Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


METHODS: Participants were 121 parents of pediatric cancer patients (ages 3–12), who were receiving outpatient cancer treatments at two large children’s hospitals. Parents completed measures of Anxiety, Depression, and Social Support at study entry, permitted the video-recording of three treatment-related medical procedures, and completed three measures of psychosocial adjustment three and nine months after the last procedure was recorded; these included: perceived stress, psychiatric symptoms (i.e., symptoms of anxiety, somatization, and depression) and post-traumatic stress symptoms. RESULTS: Regression analyses (Hayes’ “Process” SPSS utility) was used to determine if social support significantly moderated the relationships between anxiety, depression, and psychosocial adjustment at the two followup data points. There were significant zero order correlations between anxiety and depression measured at baseline and all measures of psychosocial adjustment measured at the three and nine month follow-ups. However, the number of sources of social support moderated the impact of anxiety and/or depression on self-reported psychiatric symptoms. Specifically, among parents low in social support, the more anxiety and/or depression at study entry, the more psychiatric symptoms reported at the three and nine month follow-ups. However, among parents high in social support, anxiety/depression at study entry was unrelated to psychiatric symptoms at the follow-ups. High social support parents reported lower levels of psychiatric symptoms. CONCLUSIONS: Although having a child with pediatric cancer is a powerful stressor for all parents, some parents are more at risk for psychosocial difficulties than others. There are, however, factors that can reduce this psychosocial risk. Having good social support appears to be one of them. Clinics serving families of pediatric cancer patients should consider preventative interventions designed to increase parents’ social support. RESEARCH IMPLICATIONS: Researchers examining social support in the pediatric cancer context can use these findings to further their own research questions. CLINICAL IMPLICATIONS: Clinics serving families of pediatric cancer patients should consider preventative interventions designed to increase parents’ social support. FUNDING: This study is funded by a National Cancer Institute grant "Resources, Parent– child Communication and Adjustment to Pediatric Cancer" (R01CA138981-05, Penner:PI). 14–4 Meeting the Needs of Their Children: Correlates of Distress for Lone Parents of Children With Cancer Sandra Sherman-Bien1, Andrea Farkas Patenaude2, Haven Battles3, David Elkin4, Sarah Friebert5, Julia Kearney6, Mary Jo Kupst7, Avi Madan-Swain8, Larry Mullins9, Maryland Pao3, Sean Phipps10, Sima Zadeh3, Lori Wiener3 1 Jonathan Jacques Children’s Cancer Center, Miller Children’s Hospital, Long Beach, CA, USA, 2 Dana-Farber Cancer Institute, Boston, MA, USA, 3 National Institutes of Health, National Cancer Institute, © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Paper Abstracts of the APOS 11th Annual Conference

Bethesda, MD, USA, 4University of Mississippi Medical Center, Jackson, MS, USA, 5Akron Children’s Hospital, Akron, OH, USA, 6Memorial Sloan Kettering Cancer Center, New York, NY, USA, 7Medical College of Wisconsin, Milwaukee, WI, USA, 8University of Alabama, Birmingham, AL, USA, 9Oklahoma State University, Stillwater, OK, USA, 10 St. Jude Children’s Research Hospital, Memphis, TN, USA PURPOSE: Some single and some partnered parents of children with cancer characterize themselves as feeling burdened and alone in caring for their child. Such “lone parents” (LPs) report more financial concerns and depressive symptoms than those “demographically” single (Wiener et al., 2013). Not known is how LPs perceive their parenting abilities. We investigated: 1) relationships between aspects of LPs (e.g., demographically single; caring for child alone; sharing decision-making responsibility; feeling like single parent) and ability to meet basic/emotional needs of ill child and siblings, pre-/post-cancer diagnosis; and 2) relationships between LPs and distress. METHODS: Parents of children with cancer (6 months-17 years; 6–18 months post-diagnosis) completed the Lone Parenting Questionnaire (64 items) and Brief Symptom Inventory (BSI-18). For this series of analyses, t-tests investigated differences in parenting ability related to LPs (IVs = 6 aspects of “loneness;” DVs = 8 items rating frequency of meeting basic/emotional needs of ill child/siblings, pre-/post-diagnosis; 5-point scale, 0: not at all– 4: all the time). Pearson correlations determined relationships between parenting and psychological distress (BSI-18). RESULTS: 256 parents participated (79% mothers, 70% Caucasian). For all 6 loneness IVs, LP’s reported lower ability to meet basic/emotional needs of siblings post-diagnosis (ps < .001-.05). Lower ability to meet ill child’s basic needs post-diagnosis was reported by those ‘Considering self single’/’Feeling single in child’s care’/’Caring for child alone’ (ps = .001-.015). Those ‘Caring for child alone’ were less able to meet basic/ emotional needs of siblings pre-diagnosis (ps = .017,.045). Parents ‘Not sharing decision-making’ had lower ability to meet siblings’ emotional needs pre-diagnosis (p = .001). Perceived meeting of basic/emotional needs of ill child/siblings post-diagnosis was significantly, negatively correlated with distress (rs = .19--.30, ps < .01). CONCLUSIONS: LPs perceive greater difficulty in meeting needs of both their ill child and siblings than non-LPs, and parenting difficulties are significantly associated with psychological distress. Siblings may be particularly at risk for unmet needs. Different ways of assessing loneness reveal distinctions in parenting patterns, and may distinguish those with problems since diagnosis from those with pre-existing concerns. RESEARCH IMPLICATIONS: Further research is needed on assessment of parental loneness in relationship to parenting cancer patients and their siblings. CLINICAL IMPLICATIONS: Clinical assessment/treatment should incorporate consideration of LPs’ special burdens and needs, and inquire Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Paper Abstracts of the APOS 11th Annual Conference

specifically regarding siblings’ needs. FUNDING: This study was supported (in part) by the Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, St. Baldrick’s Foundation (161194), and by the Andre Sobel River of Life Foundation. 15–1 Cost-Effectiveness of a Patient-Centered Intervention for Persistent Urinary Incontinence in Prostate Cancer Patients Alex Fu1, Amy Zhang2 1 Georgetown University Medical Center, Washington, DC, USA, 2Case Western Reserve University, Cleveland, OH, USA PURPOSE: “STAY DRY” is a new patient-centered intervention to urinary incontinence of prostate cancer patients. This study evaluated the cost-effectiveness of the intervention by comparing “participating” subjects receiving the intervention and “nonparticipating” subjects that were eligible but declined the intervention. METHODS: The study intervention entailed a biofeedback session to teach pelvic floor muscle exercise and the problem-solving therapy to teach symptom self-management skills through a support group or telephone. The participating subjects were randomized to the support or the telephone group. The nonparticipating subjects were observed. All subjects were assessed at baseline, month 3, and month 6 on urinary continence, quality of life and costs. The costs included direct health care cost from medical billing data; patient out-of-pocket expense, expense for caregiver, and loss-ofwork cost from self-reported survey; and intervention cost. Intervention effectiveness was assessed on EQ-5D index score and incontinence-specific quality-of-life measures. We employed mixed models with repeated measure to obtain incremental cost and incremental effectiveness controlling for baseline covariates. We calculated incremental cost-effectiveness ratios (ICERs) from societal, provider, and patients’ perspectives. RESULTS: 223 patients were recruited including 78, 76, and 69 in the support, telephone, and nonparticipating groups, respectively. Support and telephone groups had significantly higher EQ-5D index scores (0.054, P = 0.033 and 0.057, P = 0.027, respectively) than the nonparticipating group at month 6. Intervention cost per subject was $252 and $484 more for providers and $564 and $203 more for the support and phone group subjects within 6 months. Other cost outcomes were not significantly different due to small sample size, but the numerical differences were applied for ICER calculations. The final ICERs are $16,759 per quality-adjusted-life-year (QALY) and $12,561/QALY for support and telephone groups compared to the nonparticipating group. These ICERs are much smaller than the $50,000/QALY threshold used as the consensus to determine cost-effectiveness. © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.


CONCLUSIONS: Both support and telephone interventions are cost-effective than patients that declined the intervention. The intervention does not cost much for health care providers and patients, but can provide meaningful outcome improvement for this patient population. Such evidence provides critical information for future health policy decision-making for health care providers and payers. RESEARCH IMPLICATIONS: The findings provided important information to help translate research outcome to practice. CLINICAL IMPLICATIONS: Findings form economic evaluation help clinicians understand the value of the study intervention. FUNDING: Funded by NIH/NCI R01CA127493. 15–2 A Randomized Trial, Examining the Cost-Effectiveness of Mindfulness Based Stress Reduction for Breast Cancer Survivors Cecile Lengacher1,2, Richard Reich2,3 1 University of South Florida, Tampa, FL, USA, 2Moffitt Cancer Center, Tampa, FL, USA, 3University of South Florida, Sarasota-Manatee, Sarasota, FL, USA PURPOSE: The purpose of this study was to assess the cost-effectiveness of a Mindfulness Based Stress Reduction for Breast Cancer Survivors (MBSR(BC)) program societal perspective, costs to the provider for the intervention, and the opportunity costs to the patient. METHODS: Using a two-armed randomized design, patients were stratified by cancer stage, (0, I, II, and III) and treatment. Participants were randomly assigned to either: (1) 6-week MBSR(BC) program or (2) Usual care. The effectiveness of MBSR(BC) on improving health-related quality of life (HRQoL) was measured by the SF-36 and incremental cost-effectiveness ratios (ICER) calculated to estimate the cost associated of the incremental improvement; these were summarized on a quality-adjusted life year (QALY) scale. A sensitivity analysis was performed to analyze and incorporate this uncertainty into the decision aid process from both a health care system and patient perspective. RESULTS: Of the 104 participants, 96 completed the 6 and 12 week assessments. The mean age was 55 years; 79% Caucasian and 85.6% had some college education. Clinically, most patients were treated for either stage I (38.5%) or stage II (38.5%) disease and (41.3%) were treated with both radiation and chemotherapy. Results showed the incremental gain in QALY during the 12-week period of 0.03 while the marginal cost of the intervention was $666 for providers and $592 for patients out of pocket. The expected life expectancy was 15 years using the age of the study population, translating into an expected lifetime increase of 1.95 QALY. CONCLUSIONS: Subsequent to these gains, the resulting cost per QALY is relatively low compared to the cost-utility findings of other published breast cancer interventions. In post-treatment HRQoL, Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


BCS appear to benefit from an MBSR intervention in a reasonably cost-effective manner. RESEARCH IMPLICATIONS: Examination of costs offers a unique contribution to the advancement of science in determining the benefit of the intervention on QOL. Cost assessment of psycho-oncology intervention research can strengthen the scientific implications and may further explain the long term societal benefit of behavioral interventions and their positive effects. CLINICAL IMPLICATIONS: These effects have the potential to enhance long term quality of life among cancer survivors. Organizations that support BCS should adopt the MBSR(BC) program as it has been proven as both efficacious and cost-effective. FUNDING: This work was supported by the National Cancer Institute, Grant Number: 1R01CA131080-01A2.

Paper Abstracts of the APOS 11th Annual Conference

post-intervention and six months. Results will be presented from the economic analyses. CONCLUSIONS: A key value of this pilot study is an understanding of the feasibility of collecting economic data alongside an ongoing trial of women with breast cancer. This pilot study will result in improvement of knowledge pertaining to the costs and cost-effectiveness of delivering MBAT versus a BCSG, and will employ health utility as the effectiveness measure. RESEARCH IMPLICATIONS: This presentation will help academic researchers learn how to expand their knowledge of the effectiveness of interventions to include cost and utility aspects of their projects. CLINICAL IMPLICATIONS: This presentation will help clinicians understand not only who will benefit from cancer interventions but the cost of supportive interventions. FUNDING: Economic Supplement to NCI Grant R01-CA111832.

15–3 Evidence From an Economic Analysis of a Clinical Trial: Mindfulness-Based Art Therapy Program for Women With Breast Cancer Laura T. Pizzi1, Kathryn M. Kash2 1 Thomas Jefferson University, Philadelphia, PA, USA, 2 KM Behavioral Consulting LLC, Spring Hill, FL, USA

16–1 “Sole Fathers”: Examination of the Challenges Facing Fathers Widowed Due to Cancer Justin Yopp, Leeza Park, Teresa Edwards, Allison Deal, Donald Rosenstein University of North Carolina, Chapel Hill, NC, USA

PURPOSE: The parent study compared a standard psychoeducational support group (BCSG) with a mindfulness based art therapy (MBAT) group for women with breast cancer. The primary outcomes were to improve quality of life (QoL) and decrease psychosocial stress. During the course of the parent study there were unanswered questions, such as; 1) did MBAT cost more or less than BCSG, 2) did either intervention lead to a more productive life for women, and 3) were the women receiving MBAT less likely to seek medical attention, use medication, or visit ERs? METHODS: The economic evaluation supplement study was initiated while the parent study was in the last two years of the intervention. The overall goal of this pilot study was to evaluate the direct and indirect costs of the intervention and to examine the cost-effectiveness of the intervention using health utilities deduced from the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), since this QoL instrument was already a component of the parent trial. The specific aims of the pilot study were: 1) calculate the cost of delivering MBAT versus a BCSG; 2) capture the healthcare costs due to psychological stress; 3) determine if MBAT results in improved productivity among working participants; 4) report on the effectiveness of MBAT versus a BCSG as measured by health utility; and 5) using incremental costs and effectiveness, calculate the cost-effectiveness of MBAT from a societal perspective as cost per quality adjusted life year. RESULTS: A total of 191 women enrolled. Both arms showed significant improvement in QoL and significant decrease in psychosocial stress post-intervention. However those stratified as high stress in the MBAT arm significantly improved

PURPOSE: Cancer is likely the leading cause of widowed fatherhood in the United States. Fathers whose wives have died from cancer and who are raising dependent-age children face unique challenges in adjusting to single parenthood while simultaneously managing their grief and that of their children. The importance of fathers’ adjustment is underscored by data showing that children’s coping is correlated with the surviving parent’s adjustment and ability to exercise their parental responsibilities. For these reasons, it is surprising to find a lack of clinical or research efforts focused on these widowers. In this study, we surveyed single fathers due to cancer to characterize their experiences with their wives’ deaths and explore the challenges they face as “sole” parents. METHODS: Fathers with at least one child living at home whose mother died of cancer completed an online survey housed at http://singlefathersduetocancer. org. The following domains were assessed: father and family demographics, aspects of family-physician communication, illness and death experiences of the children’s mothers, fathers’ perceived parental competence (Kansas Parental Satisfaction Scale), fathers’ adaptation (Psychological Adaptation Scale), fathers’ grief (Texas Inventory of Grief – Revised), and fathers’ mood symptoms (Center of Epidemiologic Studies of Depression Scale). RESULTS: A total of 275 fathers completed the survey. Demographic data and results on pre-death variables such as family-physician communication will be presented. Preliminary results indicate that fathers report elevated symptoms of depression, but are generally satisfied with their parenting. Data also suggest that the age of father and time since wife’s death correlate with grief and depression symptoms. The

© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Paper Abstracts of the APOS 11th Annual Conference

relationships between pre-death variables and outcome measures will be presented and discussed. CONCLUSIONS: To our knowledge, this is the first study to examine the experiences of widowed fathers whose wives died from cancer. The results should be used to inform the development of targeted interventions for this population of widowers and their children. RESEARCH IMPLICATIONS: Additional research is needed to better understand widowed fathers due to cancer. Future studies should focus on the relationship between children’s coping and fathers’ functioning, and assess other relevant aspects of father’s functioning such as resiliency. CLINICAL IMPLICATIONS: There is a dearth of available clinical services available for widowed fathers. Results from this study should be used to inform our understanding of the experiences and needs of these fathers, especially as it relates to their ability to effectively parent their children. FUNDING: Funding was provided by the University Cancer Research Fund at the University of North Carolina at Chapel Hill. 16–2 Factors Associated With Partner-Related Adjustment in Parents Bereaved by Cancer Geoffrey Corner1, Corinne Sweeney1,2, Lori Wiener1,3, Kailey Roberts1,4, Rebecca Loeb1, Talia Zaider1, Malwina Tuman1, Caraline Craig1, Wendy Lichtenthal1 1 Memorial Sloan-Kettering Cancer Center, New York, NY, USA, 2Fairleigh Dickinson University, Teaneck, NJ, USA, 3National Cancer Institute, Bethesda, MD, USA, 4 The New School, New York, NY, USA PURPOSE: Caring for a child with cancer often takes a significant toll on a family’s well-being, and when that child dies, both the individual parent and the couple can be profoundly affected. Although relationship challenges have previously been documented for bereaved parents, factors associated with such challenges have received less empirical attention. This study examined the relationship between perceptions about the impact of caring for a child with cancer on family well-being (CFWB) and post-loss partner-related adjustment (PRA). Mental health outcomes associated with PRA were also examined. METHODS: As part of a larger study, 118 parents who lost a child to cancer were surveyed with a battery of measures. The Family Appraisal of Caregiving Questionnaire for Palliative Care (FACQ-PC) assessed perceptions about the caregiving experience, the Adult Self-Report (ASR) measured PRA and psychiatric symptoms, the Experiences in Close Relationships-Revised (ECR-R) assessed attachment style, and the PG-13 measured prolonged grief. RESULTS: Parents were on average 47.4 years old (SD = 7.9 years) and 2.4 years (SD = 1.6 years) from the loss of their child. Ninetysix parents (81.4%) were partnered and responded to items assessing their relationship. We conducted a series of generalized estimating equations to control for intraclass © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.


correlations among parent dyads when both the mother and the father of a child provided responses. PRA was significantly associated with the expression of clinically significant grief, depression, and/or anxiety (95% CI beta = .034 to .139, p = .001). Controlling for levels of such psychiatric symptoms, we found that low CFWB was related to poor PRA (95% CI beta = .836 to 5.111, p = .006). Interestingly, this relationship was largely explained by attachmentrelated anxiety, with some evidence of mediation. CONCLUSIONS: Above and beyond psychiatric symptoms, attachment-related anxiety seemed to underlie some of the relationship between parents’ perceptions that their family well-being was negatively impacted by the caregiving experience and current partner/spouse relationship dysfunction. This suggests the extent to which parents feel secure in their relationship is a risk factor for couple- and family-related outcomes during caregiving and after the death of a child. The potential influence of attachment-related anxiety on retrospective reporting and mental health outcomes will be explored, and implications for interventions will be discussed. RESEARCH IMPLICATIONS: This study addresses an under-explored topic in the grief literature by empirically examining factors associated with the quality of partner/spouse relationships in parents bereaved by cancer. CLINICAL IMPLICATIONS: Understanding the role of attachment-related anxiety in the relationship between family well-being as impacted by caregiving and partner-related adjustment can help identify parents at risk for post-loss partner/ spouse relationship dysfunction. Further, the association between partner-related adjustment and mental health outcomes may be able to inform intervention design for this population. FUNDING: This research was funded by National Cancer Institute grants R03 CA13994 (Lichtenthal) and K07 CA172216 (Lichtenthal). 16–3 The Role of Coping in the Adjustment of Bereaved Siblings Cynthia Gerhardt1,2, Brian Misiti2, Laura Schwartz2, Diane Fairclough3, Maru Barrera4, Mary Jo Gilmer5, Terrah Foster5, Bruce Compas5, Tammi Young-Saleme1,6, Kathryn Vannatta1,2 1 The Ohio State University, Columbus, OH, USA, 2 The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA, 3University of Colorado Denver, Denver, CO, USA, 4Hospital for Sick Children, Toronto, ON, Canada, 5Vanderbilt University, Nashville, TN, USA, 6 Nationwide Children’s Hospital, Columbus, OH, USA PURPOSE: The death of a child is one of the most difficult losses for a family, yet limited research has focused on bereaved siblings and how they cope with this stressor. Thus, we compared internalizing and externalizing problems among bereaved siblings and matched classmates on average at one year post-death. The role of age, gender, and time Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


since death, as well as primary control, secondary control, and disengagement coping were examined. METHODS: Bereaved families (n = 87) were recruited from cancer registries at three children’s hospitals in the United States and Canada 3–12 months after their child died of cancer (M = 12.45 months, SD = 3.73). Eligible siblings were: (a) 8–17 years old, (b) in school, (c) English speaking, and (d) living < 100 miles from the hospital. Families of a classmate who was the same gender, race, and age served as a comparison (n = 73). Children had a mean age of 12.34 years old (SD = 2.57), 54% were female, and 80% were White. Parents completed a demographic form and the Child Behavior Checklist (CBCL), while siblings completed the Youth Self Report (YSR) to assess adjustment in the home. Primary control (e.g., problem solving, emotional expression, emotional modulation), secondary control (e.g., acceptance, positive thinking, distraction), and disengagement coping (e.g., denial, avoidance, wishful thinking) were assessed via child report on the Responses to Stress Scale (RSQ). RESULTS: Relative to comparison classmates, bereaved siblings had more internalizing and externalizing problems according to mothers (t = 1.81, p < 0.07; t = 2.01, p < 0.05) and more self-reported externalizing problems (t = 2.05, p < 0.05). Group differences in internalizing and externalizing symptoms did not differ as a function of gender, age, or time since death. Different aspects of coping accounted for significant variance in internalizing and externalizing problems above and beyond group status. CONCLUSIONS: Difficulties among bereaved siblings varied by informant but not child age, gender, or time since death. Coping, particularly primary and secondary control strategies may be important targets for intervention. More research is needed to understand other factors associated with adjustment among bereaved siblings to inform evidence-based care. RESEARCH IMPLICATIONS: This study is one of the first controlled studies of outcomes among bereaved siblings, with a special focus on testing developmentally informed models of coping. CLINICAL IMPLICATIONS: The understanding of specific coping strategies associated with distress or more resilient outcomes in bereaved children can inform evidenced-based practice. FUNDING: This research was funded by a grant from the National Institutes of Health (R01 CA98217), the Research Institute at Nationwide Children’s Hospital, and Cincinnati Children’s Hospital Medical Center. 16–4 Mental Health Professional’s Experience of Patient Natural Death Meagan Dwyer1, Shannon Nanna2,3 1 University of Kansas Medical Center, Kansas City, KS, USA, 2American University of Antigua, Coolidge, Antigua and Barbuda, 3Washington University/Siteman Cancer Center, St. Louis, MO, USA © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Paper Abstracts of the APOS 11th Annual Conference

PURPOSE: In health settings and other areas, mental health professionals can be faced with patient natural, or non-suicidal, death. There is currently only anecdotal discussion on managing ethical, professional, and personal/ emotional consequences of a patient’s natural death in the literature. To our knowledge no data has been published examining the actual behaviors and beliefs of mental health professionals experiencing patient natural death. The purpose of this study is to examine such behaviors and beliefs of professionals who have experienced the natural death of a therapy patient, and from professionals in the field who have not yet had this experience. METHODS: Participants were a sample of 111 mental health professionals who completed an online survey regarding their experience of the natural death of a therapy patient, or their prospective responses regarding such an experience. The survey was IRB approved by two institutions, and recruitment of participants was sought through membership in state, local, and national mental health organizations. All participants completed 9 demographic and professional questions followed by a series of both open and closed-ended questions regarding their experiences. RESULTS: The majority of participants were Caucasian, female, psychologists, who had experienced the natural death of at least one patient. The average age of participants was 47 years, with an average of 18.16 years of clinical practice. A majority of professionals who have experienced the natural death of a therapy patient have completed some mourning task, and have had contact with a patient’s spouse/partner or family. These providers sought out peer support and self-care activities. Participants who have not experienced patient natural death had lower responses regarding these activities, particularly with regard to contact with the deceased patient’s family. This second group indicated a stronger desire for ethical guidelines. Exploratory analysis examining other response differences will be completed. CONCLUSIONS: The current survey indicates patient natural death to be a fairly common experience. Findings suggest that mental health professionals utilize conventional bereavement responses, seek out professional and peer support, and participate in self-care activities. Many professionals also indicated interest in ethical guidelines to address this practice area. RESEARCH IMPLICATIONS: Results provide initial baseline data regarding the frequency of the experience of the natural death of a therapy patient, as well as information regarding responses of mental health professionals faced with such experiences. It is our hope that additional research examining specific practice areas, such as health psychology, psycho-oncology, etc., where such experiences may be more common. We also plan to further analyze open-ended responses to better understand professionals’ responses to this experience in greater detail. CLINICAL IMPLICATIONS: It is our primary hope to use this information to encourage a deeper and more open dialogue on how Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Paper Abstracts of the APOS 11th Annual Conference

mental health professionals might maneuver through the experience of a patient’s natural death with competence and compassion. We also feel that such data has the potential to inform professional training and guidelines in this neglected area. FUNDING: None. 17–1 The Cancer Psychosocial Care Matrix: A Resource for Implementing a Process of Care Lynne Padgett National Cancer Institute, Rockville, MD, USA PURPOSE: With the increased focus on screening for distress, it is easy to lose sight of the forest of psychosocial care, in the trees of distress screening. This presentation illustrates that high quality psychosocial cancer care is an ongoing process, encompassing assessment, education, intervention and evaluation at patient, provider, and healthcare system levels. Implementation resources, specifically the use of the NCI Community Cancer Program (NCCCP) Cancer Psychosocial Matrix, will be discussed. METHODS: The Psychosocial Matrix has been in use by the NCCCP since its development in 2008 and was originally designed to assist NCCCP sites in evaluating their programmatic capacity. Descriptions of use by participating sites indicate that application of the matrix has grown beyond its original intent as a self-assessment of capacity. These uses have been reported by participants and described in quarterly progress reports by NCCCP sites. Descriptions were compiled to qualitatively examine themes suggesting methods and benefits of use. RESULTS: When examining reports, two additional uses emerged: 1) facilitating communication and 2) strategic planning. Each of these uses was cited in the contexts of both the psychosocial team and of the healthcare system leadership. These themes suggest that the psychosocial matrix has utility in both the self-assessment of program capacity, and as a tool to facilitate the process of growth in psychosocial programs. CONCLUSIONS: By examining capacity for psychosocial care at patient, provider and system levels, the Cancer Psychosocial Matrix provides a self-assessment tool focused on implementing the process of care delivery. In addition, the tool has also been used to facilitate strategic planning and communication. The matrix serves as an important resource for those involved in quality cancer care delivery. RESEARCH IMPLICATIONS: This presentation is targeted to research in the areas of dissemination and implementation, as well as health care services delivery and program evaluation. The Psychosocial Matrix is a useful resource for conceptualizing multi-level processes in cancer care. CLINICAL IMPLICATIONS: This presentation provides an instrument that is useful to clinicians for self-assessment, program development, and working with healthcare system leadership by providing © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.


a tool to implement psychosocial care standards and recommendations. FUNDING: Funded by NCI Contract No. HHSN261200800001E. 17–2 We Can Do Better: Implementing and Sustaining Better Practices in Screening and Providing Support Services to Oncology Patients Mary Helen Davis Norton Cancer Institute, Louisville, KY, USA PURPOSE: The importance of support services in oncology care has been highlighted in two Institute of Medicine reports. The first in 2008 "Cancer Care for the Whole Patient" outlines the importance of distress screening and attending to the psychosocial needs of oncology patients and their caregivers. In September of this year a consensus report entitled "Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis was released. This report highlights specific strategies for improving cancer care delivery. If we are to do better we must not only understand the support services spectrum but leverage both the knowledge and public policy issues to provide sustainable service provision. METHODS: This presentation overviews the support service spectrum utilizing the experience of NCCCP participants in developing best practices. We will discuss issues and problems with program initiation, barriers to implementation as well as highlighting areas of progress and success. Strategies for leveraging current healthcare reform to assist in designing, promoting and sustaining programs will be reviewed. We will explore bridging strategies to utilize resources within the community and processes needed to integrate clinical and community programs. RESULTS: We will share information on program assessment, program partnering and outcome on program expansion. CONCLUSIONS: There is a wide spectrum of support services available in community cancer centers, going from minimal to extensive. New quality standards are to be implemented within the next two years. Partnering with institutions both in the community as well as with those on the more active side of the support continuum can assist in programmatic expansion. RESEARCH IMPLICATIONS: New paradigms and delivery systems are needed to meet the economic constraints of increased health care costs. Further exploration of the utility of multiple institution partnering experiences, understanding their processes and outcomes is a viable area for ongoing research. CLINICAL IMPLICATIONS: Clinicians will learn how partnering with other institutions for sharing of best practices and program development provides both support and knowledge. Participants will learn how to leverage public policy and psychosocial standards in the service of stabilizing supportive care programs. FUNDING: NCCCP participation, otherwise none. Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


17–3 Implementation of Computerized Distress Screening: Challenges and Best Practices With Cancer Center and Community Organization Providers Victoria Kennedy Cancer Support Community, Washington, DC, USA PURPOSE: While a quality standard for distress screening is vital to identifying patients in distress, some community providers are struggling to implement solutions that are meaningful for the patient experience yet balance the demands on institutional workflow and resources. Screening is also occurring in select community organizations demonstrating that distress can be addressed across many settings. Challenges in any setting include limited staff to screen and manage referrals; uncertainty about how to mobilize or access resources; non-reimbursement for services; anxiety about workflow; patient and staff receptiveness; and lack of resources to invest in technology. Compound this with a fragmented system and chaotic transitions into new electronic health record systems and many providers are simply overwhelmed. In order to optimize health outcomes, providers and community organizations must be willing to embrace a paradigm shift and establish a culture embedded with technology around identifying and addressing psychosocial needs. METHODS: A web-based, comprehensive distress screening program that includes a 25 item validated measurement tool, automated feedback to the patient and referrals to institutional and community resources is being implemented in 20 community based advocacy organizations as well as 6 community cancer centers. Metrics track the number of patients screened, distress levels, and the nature of automated patient requests for information and/or to talk with a staff person. In addition, a qualitative analysis evaluates implementation strategies, provider/patient satisfaction and the impact on clinic/organization workflow. RESULTS: The implementation of a screening program requires careful assessment and understanding of system culture, workflow and readiness for change. This presentation will outline lessons learned through implementation of a computerized screening program in community cancer centers and support organizations. Best practices will be shared including experiences with EMR integration; script samples to engage patients and general staff; and resulting adaptation of the technology program. CONCLUSIONS: It is clear that tool selection is only part of a larger paradigm shift necessary for providers to truly integrate quality psychosocial care across the cancer trajectory. A successful program requires a team of champions can lead implementation and mobilize community partnerships so that patients can secure the information and resources they need in a timely, effective manner. RESEARCH IMPLICATIONS: As researchers continue to measure the impact of distress screening, it is important to understand the real-world © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Paper Abstracts of the APOS 11th Annual Conference

challenges and limitations around implementation as this could impact outcomes. More implementation science is needed to better delineate effective and efficient processes that demonstrate value in cancer care. CLINICAL IMPLICATIONS: Clinicians are seeking solutions in the delivery of distress screening. This presentation will provide clinicians will examples of best practices that can be implemented across a host of settings as well as lessons learned from strategies that were not successful. In addition, clinicians will be able to gain validation and reassurance that they are not alone in the trials and tribulations. FUNDING: None. 18–1 Prostate Cancer Patients Experiences of Participation in Recreational Soccer – A Qualitative Investigation of the ‘FC Prostate Trial’ Ditte Marie Bruun, Julie Midtgaard The University Hospitals Centre for Health Care Research, Copenhagen University Hospital, Copenhagen, Denmark PURPOSE: Evidence is accumulating that exercise-based rehabilitation improves physical capacity and quality of life in cancer survivors. However, recruitment and persistence of male cancer patients in rehabilitation and survivorship care are low. To meet the demand for novel health promotion strategies encompassing male cancer patients’ priority of action-orientated activities in rehabilitation, the ‘FC Prostate’ Trial was initiated with the aim to examine the effects of recreational soccer in prostate cancer patients undergoing androgen deprivation therapy. The purpose of this study was to conduct a qualitative investigation of the ‘FC Prostate’ Trial to gain an understanding of prostate cancer patients’ experiences with participation in recreational soccer. METHODS: Drawing on principles of ethnographic research, the study took advantage of method triangulation in collection of data. Data were collected through focus group interviews (6 x n = 4-6) and participant observations (a total of 20 hours) guided by the following topics: ‘motivation for participation’, ‘responses to the soccer training’, ‘interpersonal relations’, ‘safety and tests’, ‘practical implementation of the soccer training’. The two data sets were analyzed using framework analysis. RESULTS: The qualitative analysis produced 10 themes that were structured into three overarching categories: 1) motivation to act; 2) united in sport and 3) confirmation of own capacity. The findings indicates that soccer is perceived by participants as a unique opportunity to regain control and acquire a sense of responsibility for their own health, without having to take on the role of being a patient and legitimizes the exchange of concerns and mutual caring behaviors in a male-oriented setting, which allows and expects the participants to act like men. CONCLUSIONS: This qualitative investigation of the ’FC Prostate’ Trial suggests that recreational soccer due to its cultural representation Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Paper Abstracts of the APOS 11th Annual Conference

of masculine ideals may be a potent and unique strategy for increasing recruitment and adherence to physical activity in survivorship care in prostate cancer patients. RESEARCH IMPLICATIONS: Future cancer rehabilitation research should focus on provision of knowledge about the applicability and effectiveness of recreational soccer in real life settings to enable potential integration in cancer rehabilitation practice. Furthermore, studies which provide deeper understanding of long-term adherence to behavior change (i.e. physical activity) in male cancer patients and survivors are warranted. CLINICAL IMPLICATIONS: The present study indicates that recreational soccer can promote recruitment and adherence to physical activity in prostate cancer survivors. Furthermore, the findings reveal that prostate cancer survivors appreciate and benefit from interactions with peers through sport participation. It may therefore be imperative to incorporate gender sensitive initiatives and contexts that reflect male cancer survivor’s need for independency and self-determination on one hand and their need for patient care and support in the other in cancer rehabilitation strategies. FUNDING: The study is supported by grants from The Center for Integrated Rehabilitation of Cancer patients (CIRE), a center established and supported by The Danish Cancer Society and The Novo Nordisk Foundation, and from the Danish foundation TrygFonden. 18–2 A Pilot RCT to Test a Sexual Health Education Intervention for Male Rectal Cancer Patients: Impacts on Sexual Function and Psychosocial Adjustment Christian Nelson1, Tammy Schuler1, Errol Philip1, John Mulhall1, Lina Jandorf2, Anne Reiner1, Ray Baser1, Katherine DuHamel1 1 Memorial Sloan-Kettering Cancer Center, New York, NY, USA, 2Mount Sinai School of Medicine, New York, NY, USA PURPOSE: Post-treatment male rectal cancer patients show high sexual dysfunction rates. We pilot tested a sexual health education intervention for male rectal cancer patients. We hypothesized intervention arm (CSI-SH-M) men would improve more across sexual function/psychosocial adjustment than men receiving usual care (UC). METHODS: Post-treatment patients (N = 71) were stratified by stoma/ chemotherapy status and randomized to: 1) 4 1-hour sexual health education sessions and 3 follow-up calls aimed at bolstering sexual function and partner communication, and providing other resources (e.g., referrals); or 2) UC. Men completed sexual function [International Index of Erectile Function (IIEF)] and psychosocial adjustment [Self-Esteem and Relationship Questionnaire (SEAR), Sexual Bother Questionnaire (SB), and Impact of Events Scale (IES-R)] measures at enrollment (baseline), 4 months post-baseline, and 8 months post-baseline. Differences in mean score changes between assessments determined treatment effects, © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.


the magnitude of which were assessed by Cohen’s d effect sizes. RESULTS: The average man was middle-aged, Caucasian, and married. Most had Stage III cancer and received an operation, chemotherapy, and radiation. CSISH-M men improved more than UC men on IIEF from baseline to both 4 and 8 months with improvements most apparent from baseline to 4 months [e.g., Total (d = 1.22) and Sexual Desire subscale (d = 1.37)]. CSI-SH-M men improved more than UC men on SB Total from baseline to 4 (d = 1.44) and 8 months (d = 0.20). CSI-SH-M men also improved more on SEAR from baseline to 4 months and 4 to 8 months, with 4- to 8-month effects being larger [e.g., Total (d = 1.10) and Confidence (d = 1.14)]. Finally, CSI-SH-M men improved more than UC men on IES-R at both 4 and 8 months. CONCLUSIONS: Pilot data showed initial promise in a brief sexual health education intervention for this population. RESEARCH IMPLICATIONS: This pilot data suggests larger studies should be conducted testing this sexual health intervention. CLINICAL IMPLICATIONS: Rectal cancer patients may not be receiving important sexual health information which could help improve their sexual functioning and adjustment following cancer treatment. FUNDING: R21-CA137434-01. 18–3 Psychological Correlates of Perceived Cognition in Prostate Cancer Patients Two Years Post-Initiation of Androgen Deprivation Therapy Mallory G. Cases1,2, Kristine A. Donovan1, Julie M. Cessna1,3, Charissa A. Hicks1, Heather S. L. Jim1, Paul B. Jacobsen1 1 Moffitt Cancer Center, Tampa, FL, USA, 2University of Alabama at Birmingham, Birmingham, AL, USA, 3University South Florida, Tampa, FL, USA PURPOSE: Despite its long clinical success in men with prostate cancer (PC), androgen deprivation therapy (ADT) has a number of distressing side effects. Many men receiving ADT, which blocks testosterone production, report cognitive issues and experience decreases in quality of life (QOL). To date, however, there has been little research on the long-term effects of ADT on QOL and perceived cognition. It was hypothesized that depression, insomnia, and fatigue would be negatively associated with perceived cognition. METHODS: The sample comprised 28 men receiving ADT for PC who completed measures of perceived cognition (E-COG), depression (CES-D), sleep quality (ISI) and fatigue (FSI) 24 months following initiation of ADT. Univariate analyses were conducted to identify QOL variables significantly correlated with perceived cognition. A linear regression was conducted with perceived cognition as the outcome and depression, fatigue severity, and insomnia as predictors. RESULTS: Two years post-ADT initiation, these men were found to have a mean global perceived cognition score of 1.302 (SD = .429). Depression, insomnia and fatigue were significantly related Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


to perceived cognition in the predicted direction. In multivariate analyses, depression and fatigue emerged as significant predictors (p < .01), but insomnia did not (p = .16). Depression, fatigue, and insomnia accounted for 77% of the variance in perceived cognition (p < .0001). CONCLUSIONS: These findings support the hypothesis that higher levels of depression, fatigue and insomnia are associated with poorer perceived cognition. It was found that depression and fatigue predicted perceived cognition. Future research should determine if interventions to improve depression and fatigue lead to improvements in perceived cognition. RESEARCH IMPLICATIONS: Future research should determine if interventions to improve depression and fatigue lead to improvements in perceived cognition. CLINICAL IMPLICATIONS: Clinicians need to be aware of the association of depression and fatigue with the perception of poorer cognitive functioning. If patients are complaining of poorer cognitive functioning, depression and fatigue may be addressed first if relevant. FUNDING: FUNDING: NCI R01CA132803. 18–4 Relationship Functioning and Post-treatment Quality of Life Among African American Prostate Cancer Survivors and Their Intimate Partners Lisa Campbell1, Daphne McKee2, Francis Keefe2 1 East Carolina University, Greenville, NC, USA, 2 Duke University Medical Center, Durham, NC, USA PURPOSE: Surgery to treat prostate cancer is associated with well-known side-effects that have an impact not only physical functioning, but psychosocial functioning as well. The psychosocial effects may include symptom distress, negative mood, and other decrements to quality of life. These effects may also extend to intimate partners’ quality of life. Given the higher prostate cancer diagnosis and mortality rates among African American men there is growing interest in survivorship research with this population. Importantly, among African American men and their partners, perceived relationship functioning could have an impact on reported quality of life, however psychosocial research examining relationship factors in survivorship among African American men and their partners remains limited. To address this gap in the literature, we conducted correlational analyses to examine the hypothesis that stronger perceived relationship functioning would be associated with higher quality of life in both survivors and partners. We also examined the effect of partner perceptions of relationship functioning on survivor QOL and vice versa. METHODS: Survivors completed measures of relationship functioning (i.e., intimacy and dyadic adjustment), symptom distress, negative mood (depression and tension/tension), and disease-related quality of life (physical, functional, emotional, and social wellbeing). Partners completed the same measures of relationship functioning and mood, as well as a measure of caregiver strain. RESULTS: Survivors reporting higher © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Paper Abstracts of the APOS 11th Annual Conference

intimacy also reported less depression (r = 0.319, p = .029). For partners, relationship functioning was not significantly correlated with QOL (caregiver strain or mood). Analyses examining associations between partners’ perceptions of relationship functioning and survivor QOL indicated that when partners reported higher intimacy scores, survivors reported higher quality of life related to urinary symptom distress (r = 0.327, p = .025), functional wellbeing (r = 0.342, p = .019) and emotional wellbeing (r = 0.344, p = .001), and lower tension/anxiety scores (r = 0.460, p = .001) and depressive symptom scores (r = 0.454, p = .001). Relationship functioning in survivors was not correlated with QOL in their partners. CONCLUSIONS: The hypothesis that stronger perceived relationship functioning would be associated with better quality of life in both survivors and partners was only partially supported, with stronger perceived relationship functioning, specifically perceived intimacy, correlating with less depressed mood only among survivors. Analyses examining associations between partner relationship functioning scores and survivor QOL and vice versa showed some similarities to the previous finding: only survivor QOL was linked to relationship functioning. Taken together, these findings provide preliminary support for the idea that relationship functioning (particularly intimacy) may be important to QOL in African American prostate cancer survivors post-treatment, but may have less impact on the QOL of their partners. RESEARCH IMPLICATIONS: These findings suggest future research involving intimate partners of prostate cancer survivors may need to consider additional relational variables, beyond relationship functioning, to identify key correlates of partner adjustment. CLINICAL IMPLICATIONS: While the support of intimate partners appears to be important for survivor adjustment, partners may require additional supports, beyond the intimate relationship, to promote adjustment. FUNDING: Research supported by the National Cancer Institute grant #R01-CA-122704. 18–5 Defining Young in the Context of Prostate Cancer Suzanne K Chambers1,2, Anthony Lowe1,2, Melissa K Hyde1, Leah Zajdlewicz3, Robert A Gardiner4,5, David Sandoe OAM2, Jeff Dunn1,2 1 Griffith Health Institute, Griffith University, Brisbane, Queensland, Australia, 2Prostate Cancer Foundation of Australia, Sydney, Australia, 3Cancer Research Centre, Cancer Council Queensland, Brisbane, Australia, 4Centre for Clinical Research, University of Queensland, Brisbane, Australia, 5Royal Brisbane and Women’s Hospital, Brisbane, Australia, 6School of Social Science, University of Queensland, Brisbane, Australia PURPOSE: The experience of a diagnosis of prostate cancer is for most men a major life stress with the Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Paper Abstracts of the APOS 11th Annual Conference

psychological burden of this disease falling more heavily on those who are younger. Despite this, being young as it applies to prostate cancer is not yet clearly defined with chronological approaches most common. However, men’s responses to health crises are closely bound to their life course and masculinities from which their social roles emerge. METHODS: This paper applies an epistemological approach to defining what it means to be young and have prostate cancer. To investigate this question three focus groups with 26 key stakeholders (health professionals and men with prostate cancer) were undertaken in parallel with semi-structured interviews with 14 men with prostate cancer (M = 59.8 years, SD = 8.6 ranging from 43 to 66 years of age). RESULTS: There was a high convergence of results with life course and masculine self-identities emerging as most relevant. Chronological definitions were absent or inconsistent. CONCLUSIONS: We conclude that masculine constructions of what it means to be a young man and life course characteristics are more useful and salient in defining young as it applies to prostate cancer compared to chronological age. These findings have implications for describing and predicting morbidities associated with this illness; and in designing interventions to help young men reconstruct their identities after prostate cancer. RESEARCH IMPLICATIONS: Provides models for research for framing ways to describe and predict morbidities associated with having prostate cancer at a young age. CLINICAL IMPLICATIONS: Provide guidance for clinicians seeking to design interventions to help young men reconstruct their identities after prostate cancer. FUNDING: This project was funded by the Prostate Cancer Foundation of Australia. 19–1 Delirium: Risk Factors, Scales and the Actively Dying Patient Isabel Schuermeyer Cleveland Clinic, Cleveland, OH, USA PURPOSE: In this section of the Delirium symposium, the risk factors associated with this syndrome will be reviewed. Many of these are very common in the cancer setting, as cancer itself is a major risk factor. Delirium is associated with a higher morbidity and mortality when compared to patients with the same illness but without a delirium. Therefore, it is essential that this syndrome be quickly identified and treated. Delirium can be diagnosed using various tools and there are scales to measure improvement. In up to 90% actively dying patients, there can be a terminal delirium, which can also benefit from intervention to reduce suffering for both patients and their families. METHODS: Delirium has been widely studied. The guidelines and recent literature were reviewed, including the National Cancer Institute recommendations. RESULTS: Risk factors, including specific medicines and © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.


chemotherapies, along with other medical co-morbidities will be discussed. The specific scales that will be reviewed are the MMSE (mini mental status exam), CAM (confusion assessment method), DRS (delirium rating scale) and MDAS (memorial delirium assessment scale). Finally, the literature about terminal delirium will be examined. CONCLUSIONS: Identification of delirium is imperative as a misdiagnosis can result in significant distress for patients and their families. In addition, if a delirium is missed, this can result in a worse outcome for the patient. Understanding the risks and standardized tools to identify and measure delirium are essential for those working in psychosocial oncology, especially given the mandate that all cancer patients undergo psychosocial screening. RESEARCH IMPLICATIONS: Research that examines rates of delirium identification and screening tools used by psychosocial providers could be conducted and would be valuable as psychosocial programs implement the mandate to screen all patients. CLINICAL IMPLICATIONS: It is imperative that those doing psychosocial screening of cancer patients be aware of the risk for delirium and understand how to identify it. FUNDING: None. 19–2 Treatment of Delirium in Cancer and Terminally Ill Patients Elias Khawam Cleveland Clinic, Cleveland, OH, USA PURPOSE: Delirium is reversible in most cases, except in terminal delirium. Multidisciplinary team is essential to provide comprehensive management. Multiple therapeutic strategies have been proven to be effective. In this section of the delirium symposium, the treatment of delirium in both cancer and terminally ill patients will be discussed in details. METHODS: The first step in delirium management is to address any underlying etiology. We will review the pharmacological and non-pharmacological treatments approaches for all delirium types. Advanced and emerging treatment strategies especially for refractory and terminal delirium will be discussed. RESULTS: Multiple treatment approaches are important to decrease the severity and duration of delirium. Delirium symptoms and response to treatment need to be monitored closely. Medications are important to target specific delirium symptoms such as aggressive behavior, sleep disturbance and psychosis. Supportive care and non-pharmacological measures will reduce delirium severity and duration. CONCLUSIONS: Delirium is frequently under diagnosed and undertreated. Management of delirium is complex and often requires multiple treatment strategies. Early and effective treatment of delirium will result in reducing suffering for patients and their caregivers. In addition, it will improve morbidity and mortality in cancer patients. RESEARCH IMPLICATIONS: Treatment of delirium is essential in reducing Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


suffering and quality of life in cancer and terminally ill patients. This presentation will highlight the current research in this area and discuss future research goals and needs. CLINICAL IMPLICATIONS: Treatment of delirium is very important to reduce mortality and morbidity. We will present current guidelines and data on effective delirium treatment that clinicians can use in their practice. FUNDING: None. 19–3 Delirium: Overview, Identification and Updated Criteria Rachel Lynn UT MD Anderson Cancer Center, Houston TX, USA PURPOSE: As an introduction to the Delirium Symposium, an overview of the clinical presentation of delirium will be presented. We hope to provide a general introduction to the central diagnostic features of delirium, focusing on the presentation in the cancer patient. Focus will be placed on helping to clarify what features distinguish delirium from other common mental health conditions. We will identify updates resulting from the newest Diagnostic and Statistical Manual (DSM) V. This will serve as one section of an overall symposium approach to delirium looking not only to identify and define delirium but to shine like on patients at risk and treatment options and approaches. METHODS: Delirium is a well studied and well defined entity. Recent literature and changes with DSM V will be reviewed and presented. Clinical pearls used to uncover presentation of delirium will be shared. RESULTS: In defining and identifying delirium in a medical setting, a differential diagnosis for the multiple subtypes of delirium will be presented. Classical presentations and subtypes in different cancer treatment settings will be discussed – medical fragility, post surgical, post hematopoietic stem cell transplant. Focus placed on the how to tease out specific attentional symptoms and define the unique pattern and onset of delirium. We hope to present case presentations of commonly overlooked or misidentified delirious patient types. CONCLUSIONS: Delirium is frequently misidentified as a mood or anxiety disorder; it can be misinterpreted as poor coping or denial. Understanding the medical underpinnings of this disorder, is key characteristics, and clinical presentation can help mental health professionals working in a medical setting to help in the identification and triage of this common and under recognized condition. Assisting in appropriate triage to the correct medical provider can ensure more rapid evaluation and treatment of this condition. Necessary and critical psycho-education can be provided to the patient and the larger community of their families and friends for whom the distress of delirium is often quite significant. CLINICAL IMPLICATIONS: This presentation will provide a clear and comprehensive overview of the identification and presentation of the often misdiagnosed © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Paper Abstracts of the APOS 11th Annual Conference

delirium, using approachable clinical examples as illustrations. FUNDING: None. 20–1 Parental Dyadic Adjustment in the Face of Childhood Cancer Lori Wiener1, Caitlyn Loucas2, Wendy Pelletier3, Haven Battles1, Elaina Vasserman-Stokes1, Sima Zadeh1, Anna Muriel2 1 National Cancer Institute, NIH, Bethesda, MD, USA, 2 Dana Farber Cancer Institute, Boston, MA, USA, 3 Alberta Children’s Hospital, Calgary, Alberta, Canada PURPOSE: When a child is diagnosed with cancer, parents face numerous stressors that can place strain on the parental relationship, yet marital/partner relationships are often not addressed when providing care to children with cancer. This study explored parents’ relationships before and after the child’s cancer diagnosis, the time points and events when a parental relationship is most strengthened or most stressed, and specific behavioral markers of parents’ ability to manage stress together. METHODS: Married/partnered parents of children diagnosed with cancer (N = 107) at 3 hospital centers completed a selfadministered questionnaire that included the Revised Dyadic Adjustment Scale (RDAS) and items designed by the research team to assess communication and practical challenges at different points of the cancer trajectory. Demographic and clinical characteristics are summarized descriptively. Hierarchical linear regression was performed to analyze quantitative results. Qualitative analyses were performed to further enrich the quantitative findings. RESULTS: Parents whose relationship was either ‘poor’ or ‘very good’ prior to the child’s cancer diagnosis described worsening of the relationship after the diagnosis. Time of diagnosis was when participants felt most emotionally connected to their partner and when they recommended counseling should be offered. Barriers to receiving marriage/ couple interventions included time, financial cost, and exposing emotions. Parents reported a higher relationship rating after their child’s diagnosis if they perceived their dyadic stress management strategies as effective. Helping each other reduce and talk about daily stresses together were significant predictors of parents’ likelihood to rate their stress management ability as effective. CONCLUSIONS: Childhood cancer can have a significant impact on both healthy and discontented parental relationships. The findings suggest that diagnosis and relapse of disease are time points when mental health interventions should be offered. Interventions offered as part of the child’s treatment, while the family is at the medical center and apart from home/work external stresses can help reduce barriers to care. RESEARCH IMPLICATIONS: The data from this study will inform the design of a couple’s intervention to decrease stress and improve coping skills related to Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Paper Abstracts of the APOS 11th Annual Conference

managing the challenges posed by childhood cancer experience exists. Enrollment is ongoing. CLINICAL IMPLICATIONS: The data suggest that focus on working toward strengthening emotional bonds in couples coping with their child’s cancer diagnosis may improve or maintain the stability of dyads. FUNDING: This research was supported in part by the intramural program of the Pediatric Oncology Program, National Cancer Institute, Center for Cancer Research, National Institutes of Health. 20–2 Happily Ever After? A Prospective Longitudinal Study of Marital Adjustment, Stress and Coping When a Child is Diagnosed With Cancer Lynn Fainsilber Katz1, Iris Lavi2,3, Joy Kawamura1, Kyrill Gurtovenko1, David Breiger1,4, Debra Friedman5,6, Bruce Compas6 1 University of Washington, Seattle, WA, USA, 2University of California at Berkeley, San Francisco, CA, USA, 3 University of Haifa, Haifa, Israel, 4Seattle Children’s Hospital, Seattle, WA, USA, 5Vanderbilt-Ingram Cancer Center, Nashville, TN, USA, 6Vanderbilt University, Nashville, TN, USA PURPOSE: Research on the effects of childhood cancer on the parent’s marriage has yielded conflicting results, with some studies demonstrating adverse effects and others showing improvements in marital adjustment. Little is known about the nature and course of marital adjustment during the first year of cancer treatment, or the factors that predict improvements or declines. The current study examined the trajectories of marital adjustment over the first year of treatment in families with a child who had been recently diagnosed with cancer. Parental stress and coping were examined as risk factors predicting declines or improvement in marital adjustment. METHODS: Eighty-one families were followed on a monthly basis over a 12-month period following their child’s diagnosis of cancer. Children were ages 2–10 (Mean = 5.62; SD = 2.91). Primary caregivers (85.7% mothers) completed the Dyadic Adjustment Scale, and couple’s dyadic satisfaction, affectional expression, consensus and cohesion levels were obtained. Both primary and secondary caregivers reported on stress and coping using the Negative Life Events Scale, the Life Threat and Treatment Intensity Questionnaire and the Responses to Stress Questionnaire. RESULTS: Multilevel modeling was used to examine trajectories of marital adjustment. Marital consensus increased while dyadic satisfaction, affectional expression and cohesion levels remained stable over time. Moderation analyses revealed differences between families on trajectories of consensus, affectional expression and cohesion. When primary caregivers reported a high number of negative events at diagnosis or experienced these events as upsetting, or when the secondary caregiver reported high levels of stress related to the © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.


cancer itself, there was a decline in affectional expression over time. The spouse’s use of secondary control engagement (acceptance, distraction, cognitive restructuring and positive thinking) predicted an increase in affectional expression and consensus over time and their secondary control disengagement (denial, avoidance and wishful thinking) predicted decreases in cohesion over time. Surprisingly, the primary caregiver’s primary control engagement (problem solving, emotional regulation and emotional expression) were predictive of decreases in cohesion over time. CONCLUSIONS: For both primary and secondary caregivers, parent’s individual stress levels and coping strategies predict the course of their marital adjustment over the first year of their child’s cancer treatment. Implications for intervention will be discussed. RESEARCH IMPLICATIONS: Little is known about the nature and course of marital adjustment during the first year of cancer treatment, or the factors that predict improvements or declines. Understanding factors that predict declines or improvement in marital adjustment is important for treatment development. CLINICAL IMPLICATIONS: Implications for assessment and treatment of marital difficulties in the context of a child’s medical treatment will be discussed. FUNDING: We gratefully acknowledge funding for this research from the National Cancer Institute (PI: Lynn Fainsilber Katz, Ph.D. R01-CA134794). 20–3 CanThrive: A Couple-Based Intervention for Parents of Children With Cancer Laura Porter1, Donald Baucom2, Anne Kazak3, Corinne Linardic1, Melanie Bonner1 1 Duke University Medical Center, Durham, NC, USA, 2 University of North Carolina, Chapel Hill, NC, USA, 3 Nemours/A.I. du Pont Hospital for Children, Wilmington, DE, USA PURPOSE: Couples who have a child with cancer are faced with multiple and pervasive stressors from the time of diagnosis through survivorship. Couples play an essential role in families’ adjustment to childhood cancer, and their relationships are often adversely affected. However, to date there have been no studies of couple-based interventions for couples who have a child with cancer. This presentation will describe the development of a couplebased intervention for these parents and preliminary data on its feasibility and acceptability. METHODS: Participants will be 30 couples whose children are being treated for a first diagnosis of cancer. Couples are randomly assigned with a 2:1 allocation to the CanThrive intervention or an Education/Support control condition, both of which will consist of six telephone-based sessions. The CanThrive intervention provides couples with training in relationship skills to communicate effectively about issues related to caring for their child with cancer, strengthening Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


their own relationship, and supporting each other as individuals. All couples complete a treatment satisfaction survey after completing the intervention. Outcomes include selfreported measures of marital, individual, and child/family function as well as behavioral observations of couples’ cancer-related conversations. RESULTS: Approximately 50% of eligible families who have been approached have agreed to participate. To date, 15 couples have enrolled in the study. Nine couples (6 in CanThrive, 3 in Education/ Support) have completed post-test questionnaires. All couples in CanThrive reported high levels of satisfaction with the intervention. Comments indicated that they particularly valued the training in communication skills and the opportunity to focus on issues related to their child’s cancer together as a couple. They also appreciated the flexibility afforded by the telephone-based sessions. Updated data on feasibility and acceptability as well as preliminary outcome data will be presented. CONCLUSIONS: To our knowledge, this is the first couple-based intervention for parents of children with cancer. Preliminary data from this ongoing study suggest that the couple-based intervention is feasible, acceptable, and relevant to these parents. Challenges for recruitment and retention will be discussed as well as issues related to the choice of an appropriate control group. RESEARCH IMPLICATIONS: Information in this presentation can enhance researchers’ awareness of the importance of focusing on couples’ relationship functioning for optimizing adult, couple, child, and family well-being. In addition, the presentation will shed light on the importance of assessing couples’ relationship functioning, including the support partners receive from each other and the quality of their communication, as well as their overall relationship quality. CLINICAL IMPLICATIONS: The findings from this presentation can enhance clinicians’ awareness of the importance of focusing on couples’ relationship functioning for optimizing adult, couple, child, and family well-being. It can also provide clinicians with strategies to use to help strengthen couples’ relationships in the context of caring for a child with cancer. FUNDING: NCI R21 CA164817. 20–4 A Couple-Based Intervention for Patients With Head and Neck Cancer and Their Partners Tina Gremore1, Stephanie Horgan1, Bruce Brockstein1, Tiffany Benfield1, Laura Porter2, Donald Baucom3, Tamara Goldman Sher4 1 NorthShore University Health System, Evanston, IL, USA, 2 Duke University Medical Center, Durham, NC, USA, 3 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 4Northwestern University, Evanston, IL, USA PURPOSE: Approximately 48,000 patients per year are now diagnosed with head and neck squamous cell carcinoma (HNC) in the United States. There has been a shift in the HNC demographic: a smaller percentage of patients with © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Paper Abstracts of the APOS 11th Annual Conference

poorer prognosis cancers attributable to tobacco and/or alcohol and a higher percentage with better prognosis cancers attributable to human papilloma virus (HPV). HNC treatment can exhaust a couple and disrupt normal patterns of communication and support provision. Most patients with HNC require intensive multimodality care that consists of some combination of surgery, radiation and chemotherapy. The short-term side effects of treatment drastically alter life during and after therapy. A partner may want to protect the patient from negative aspects of the cancer experience and may encourage him/her to “focus on the positives” and avoid discussing cancer-related distress. Well-intentioned patients and partners often avoid addressing difficult emotional topics related to coping with cancer; however, protective buffering is associated with decreases in marital quality as well as increases in psychological distress. Findings from breast, prostate, and gastrointestinal cancer suggest that cancer-related self-disclosure of emotional experiences improves cancer-related relationship intimacy and patients’ perception of support. There has been little research on how to help couples dealing with HNC. METHODS: We are piloting a randomized control trial of a four session couple-based psychosocial intervention for couples coping with HNC. Our intervention addresses: 1) differentiating between problem focused and support conversations, 2) enhancing support communication, 3) discussing current support needs, and 4) transitioning to survivorship phase. RESULTS: Our goal sample size is 30 couples. All patients enrolled thus far have been male and partners female, average ages 55 and 52 respectively and average length of relationship 25 years. All patients were diagnosed with stage 4a and 67% were HPV positive. CONCLUSIONS: We will discuss the details of intervention as well as challenges to recruitment and implementation of the intervention. RESEARCH IMPLICATIONS: Couple-based intervention with HNC is challenging given the severity of treatment related side effects. We will discuss barriers as well as novel approach of providing couple-based psychosocial intervention during medical treatments. CLINICAL IMPLICATIONS: Couples coping with HNC are vulnerable to psychosocial distress. We will discuss initial impressions regarding the appropriateness of a support based intervention for this population. FUNDING: Anonymous donor. 21–1 Implementing Distress Screening: A Collaborative Approach Heather Kapp1, Jennifer Bires2, Monica Dreyer2, Mandi Pratt-Chapman1 1 The George Washington University Cancer Institute, Washington, DC, USA, 2The George Washington University Medical Faculty Associates, Washington, DC, USA PURPOSE: The American College of Surgeons’ Commission on Cancer (CoC) requires screening for psychosocial Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Paper Abstracts of the APOS 11th Annual Conference

distress be phased in for all accredited institutions by 2015. This abstract will describe a collaborative process of implementing Distress Screening (DS) to meet the standard. METHODS: Key stakeholders at GW, including nurses, social workers and patient navigators, drafted a policy for DS that was presented and voted on by cancer committee. The NCCN Distress Thermometer (DT) was selected as a simple, validated tool. The DT is provided upon patients’ initial visit in infusion, radiation and/or prior to breast surgery with a letter explaining the tool at intake. The completed DT is reviewed by a nurse, social worker or navigator depending on the clinic. Algorithms for standard assessment and intervention were agreed upon based on the level of distress and the NCCN distress management guidelines. The DT is scanned into the EMR along with documentation of referral or provision of care and follow up. RESULTS: The policy resulted in a standardized, approved process. Top problems for breast cancer patients at GW are worry (75.9%), nervousness (63%), sleep (55.6%), fears (53.7%), sadness (51.9%), and depression (29.6%). CONCLUSIONS: Working together across disciplines improved key stakeholder buy-in. Using lay navigators to administer the tool, resolve barriers to care and triage to clinical staff has worked well and resulted in resolution of barriers before they interfered with treatment. However, not every patient chooses to participate in DS. The policy will continue to be monitored and refined responsive to lessons learned going forward. RESEARCH IMPLICATIONS: Understanding patients’ distress provides information on which to build responsive interventions. CLINICAL IMPLICATIONS: This contributes to knowledge that aids in achieving a CoC standard. FUNDING: None.


oncology social worker. ET includes a 33 problem checklist in five categories: practical, family, emotional, spiritual, and physical. Patient diagnosis was categorized into twelve groups. The ET has known and acceptable validity and reliability. RESULTS: 1496 patients completed the ET (95% participation rate). Scores of 4+ were 34% anxiety, 22% distress, 21% depression, 14% need for help, and 13% anger; 42% of patients scored 4+ and 8% of patients scored 9+ on at least one domain. The most common problems were fatigue (48%) and worry (42%). ET domain scores were most highly correlated with emotional problems, and were associated significantly with patient diagnosis for all domains except anger. By diagnosis, distress scores 4+ were greatest for multiple myeloma (32%), anxiety 4+ greatest for gastrointestinal cancer (46%), depression 4+ greatest for melanoma (39%), anger 4+ greatest for melanoma (18%), and need for help 4+ greatest for brain tumor patients (24%). CONCLUSIONS: That ET domains correlate more highly with emotional than physical problems underscores distress as a psychosocial experience, though domains of emotion vary by diagnosis. Moreover, that response rate varied by distress, anxiety, anger, and depression indicates patients do not view these emotions as equivalent. RESEARCH IMPLICATIONS: Beyond exploring correlations between ET domains, patient diagnosis, and problem checklist, needed is research investigating why these correlations vary significantly. CLINICAL IMPLICATIONS: As a result of the levels of psychosocial distress identified, two additional social workers were hired and staffing was reorganized to focus on high risk patient populations. Distress screening is instituted as standard of care and an interdisciplinary committee formed to oversee distress screening. FUNDING: None.

21–2 Distress Screening Pilot Project: Clinical Findings and Implications Linda McLellan1, Larry Foster2, Lisa Rybicki3, Brad Pohlman1, Amelia McKenzie1, Brian Bolwell1 1 Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA, 2Cleveland State University School of Social Work, Cleveland, OH, USA, 3Cleveland Clinic Department of Quantitative Health Sciences, Cleveland, OH, USA

21–3 Meeting the Standard for Systematic Distress Screening Using the Knowledge Program Beth Gardini Dixon, Isabel N Schuermeyer, Linda McLellan, Rene Barrat-Gordon, Christa Poole, Barbara Savage Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA

PURPOSE: Significant clinical findings from a pilot project on distress screening in a tertiary cancer center and the impact on program development will be presented. METHODS: During two weeks in January 2012 all oncology patients completed the Emotions Thermometer (ET), a distress screening instrument with four predictor domains: distress, anxiety, depression, anger and one outcome domain of need for help, each rated on a 0 to 10 Likert type scale in thermometer format. A domain score of 4+ resulted in referral for psychosocial services. Patients with scores of 9+ were seen immediately by an

PURPOSE: New standards in oncology prioritize emotional health as a key aspect of treatment. Beginning in 2015, systematic screening for psychosocial distress will be a requisite for accreditation by the Commission on Cancer. This presentation will review an innovative clinical and research tool, the Knowledge Program, which utilizes an Electronic Medical Record (EMR)-integrated system for distress screening. The Knowledge Program enables efficient assessment of and intervention with patients, as well as compilation of screening results into a database for analysis. Implementation challenges and resolutions will be highlighted, in addition to data-driven

© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


modifications to the screening process. METHODS: During the first half of 2013, 3811 patients from a comprehensive cancer center were screened for psychosocial distress using the Knowledge Program. Patients completed a distress measure on a tablet computer at check-in and the results were immediately imported into the EMR. Results were automatically entered into a database and sorted according to multiple patient variables, such as demographics, disease type, and test results. Systems issues (e.g., completion rates) also were analyzed. Future enhancements will include an EMR-integrated graphing feature for multi-disciplinary reference, and built-in alerts for elevated distress scores. RESULTS: Analysis showed under-identification of individuals with moderate to severe distress (9% compared to the expected rate of approximately 35%). In addition, low completion rates using a tablet computer (18%) represented an implementation challenge. These figures guided screening program revisions involving process of administration, staff education, and selection of a different distress instrument. Categorical data will be presented, including distress scores, disease type, and demographic information. CONCLUSIONS: Using an EMR-integrated system for routine psychosocial distress screening helps uphold quality care standards and facilitates optimal patient outcomes. Implementation and instrument selection require careful consideration. RESEARCH IMPLICATIONS: The Knowledge Program database offers a rich source of information for program development. CLINICAL IMPLICATIONS: Incorporating distress screening into the EMR enables the provider to evaluate the results prior to seeing the patient, to proactively intervene and plan referrals for specific services, and to track changes over time. FUNDING: None. 21–4 One Size Does Not Fit All: Tailoring Supportive Care Services to Meet Distress Screening Needs Sharla Wells-Di Gregorio Wexner Medical Center at The Ohio State University, Columbus, OH, USA PURPOSE: To be most effective, cancer screening must be coordinated with service delivery. This study examines the most common and most distressing needs of 580 cancer patients with 11 different major types of cancer to highlight the need for a core set of supportive care services in addition to services to meet the unique needs of patients with specific types of cancer. METHODS: Five-hundred and eighty consecutive patients referred for palliative care services between 2010 and 2012 completed the James Supportive Care Screening, a 45-item validated distress screening measure. Cancer types included head and neck (n = 151), hematologic (67), breast (52), lung (51), GI (71), brain (28), gynecologic (52), neuroendocrine (26), genitourinary (36), sarcoma (26), and melanoma (20). © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Paper Abstracts of the APOS 11th Annual Conference

Descriptive analyses were used to determine the top 10 most common (yes/no) and the top ten most distressing (0 = none to 3 = severe distress) problems and symptoms for each group. RESULTS: The most common problems/ symptoms endorsed by at least half of the cancer groups were pain, fatigue, worry and anxiety, sleep difficulties, memory concerns, weakness, tingling and numbness. The most distressing problems/symptoms endorsed were pain, financial and insurance issues, housing, sleep difficulties, worry and anxiety, and fatigue. Several issues were uniquely distressing to specific groups of cancer patients (dyspnea – lung cancer, diarrhea – melanoma, vomiting – brain cancer). Although most patients were referred primarily for pain management, patients reported these additional symptoms as moderate to severely distressing. Spiritual concerns were not identified as most common or most distressing to any cancer group. CONCLUSIONS: In order to meet the broad needs of cancer patients, a core group of supportive care services would include symptom management (pain, fatigue, neuropathy), financial counseling, cognitive screening and rehabilitation as well as access to social work and psychologists or other mental health professionals skilled at providing empirically supported interventions for insomnia and worry. Physical therapy would also be useful to address patient weakness – an under-identified stressor in the current literature. Disease-specific teams may benefit from further education on managing symptoms most relevant to their patient population. RESEARCH IMPLICATIONS: This study identifies the most common and distressing problems/symptoms of patients with a variety of types of cancer allowing the development of more tailored interventions. This project moves the distress screening literature forward from identifying the average distress level of patient groups to defining the key symptoms and problems to address to ensure screening is successful at reducing distress. CLINICAL IMPLICATIONS: This information is especially pertinent to individuals charged with the development of Supportive Care Services or Survivorship Clinics in cancer settings as well as providers working with patients with the identified types of cancer. This information may help these providers to develop core supportive care services and tailored symptom/problem services for their specific disease groups. FUNDING: None. 21–5 Psychosocial Services: Increasing Awareness Jennifer Harsh, Kristy Everette, Cheyenne Corbett Duke Cancer Institute, Durham, NC, USA PURPOSE: Staying up to date with available psychosocial resources and connecting patients with the appropriate service can be a challenge. Due to this concern, coupled with the Commission on Cancer’s mandate that distress screening become part of cancer care by 2015, we created an interactive, web-based tool and associated education Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Paper Abstracts of the APOS 11th Annual Conference

program that aims to increase awareness of psychosocial issues, expand knowledge regarding related resources, and improve appropriateness of psychosocial referrals. METHODS: Discussion around distress screenings revealed a lack of knowledge and underutilization of available psychosocial services. Because of this lack of knowledge, we created and distributed a survey for medical providers and asked for the three most common patients needs for which they make psychosocial service referrals. We also asked for the ways they would like information on psychosocial services displayed. RESULTS: Based on survey results, we created a web-based, interactive, decision-tree tool listing the top indicators for referral and the appropriate psychosocial provider for each of the identified needs. Additionally, the decision-tree tool includes hyperlinks to summaries of each psychosocial service and referral information for each provider. Provider emails, displayed on the summary page, are linked to the internal email system for referral requests. Further, to increase awareness of available services and the process for making referrals, we created education sessions for biomedical providers and associated staff. Ongoing education sessions, which are tied into utilization of distress screening, highlight ways to access the tool and help to increase awareness of services and appropriateness of referrals to psychosocial resources. CONCLUSIONS: The web-based decision-tree design is easily accessible and can assist providers in locating psychosocial services, and can improve providers’ ability to connect patients to the appropriate resources. This easily accessible tool, in conjunction with ongoing education opportunities can maintain more consistent, appropriate psychosocial referrals. RESEARCH IMPLICATIONS: Information gained through the biomedical provider surveys, given both before and after the decision tree tool was launched, have assisted in providing a greater understanding of the most helpful ways to provide information about available psychosocial resources and referral processes. The process we undertook to create the decision tree tool can be applied in a variety of other settings, to develop site-specific psychosocial referral information. CLINICAL IMPLICATIONS: The decision-tree tool, in conjunction with ongoing education opportunities can assist biomedical providers and staff in learning more about psychosocial services and in utilizing more consistent, appropriate psychosocial referrals. FUNDING: None. 22–1 Effects of Patient and Caregiver Literacy on Preference for Physician-Led Medical Decisions Nicole Cranley1, Evelyn King-Marshall1, Shahnaz Sultan2, Thomas George2, Barbara Curbow1 1 Department of Behavioral Science and Community Health, University of Florida, Gainesville, FL, USA, 2 Department of Medicine, University of Florida, Gainesville, FL, USA © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.


PURPOSE: Colorectal cancer is the fourth most commonly diagnosed form of cancer, and the second leading cause of cancer-related death. The majority of patients who receive a colorectal cancer diagnosis undergo colonoscopy at the beginning of the treatment process. Health literacy has been shown to be associated with a patient’s ability to make informed and independent cancer treatment decisions. Patients with a low level of health literacy may weigh more heavily on the treatment recommendations of their physician. Thus, the purpose of the present study was to determine the effect of patient and caregiver literacy on patient’s desire to have their medical decisions made by their physician. METHODS: Patients who were scheduled for a colonoscopy were recruited from a university hospital medical center and a university-affiliated freestanding clinic. A pre-colonoscopy survey was distributed to patients (n = 1132) that assessed perceived health literacy and questions that determined their desire to have medical decisions made by their physician (termed, “doctor decide”). RESULTS: A multiple linear regression analysis was used to test if patient and caregiver literacy were predictors of the doctor-decide variable. Results indicated that both patient (beta = .117, p < .001) and caregiver (beta = .087, p < .05), literacy were significant predictors of the doctor decide variable. Additionally, highest level of patient education was also a significant predictor of the doctor decide variable, beta = .234, p < .001. The same analyses were also conducted for spousal patientcaregiver relationships, with similar findings showing patient literacy (beta = .131, p < .05) and patient education (beta = .271, p < .01) as significant predictors of doctor decide. Caregiver literacy was not shown to be significant within the spousal subgroup. CONCLUSIONS: Patients with low literacy and lower levels of education and caregivers with low literacy were shown to have a higher desire for their physician to make their treatment decisions. Among spousal patient-caregiver relationships, caregiver literacy was not a significant predictor. Future research should identify strategies to facilitate the process of providing information and treatment decisionmaking assistance to colonoscopy patients and caregivers. RESEARCH IMPLICATIONS: Aid in a greater understanding of the relationship between patient-caregiver literacy and its effects on a patient’s desire to have their medical decisions made by their physician. CLINICAL IMPLICATIONS: Potential to improve patient care by finding better methods to help patients make better informed decisions regarding their medical care. FUNDING: Bankhead-Coley Cancer Research Program. “Health Disparities in Colorectal Cancer Treatment Decision Making. Goal: to investigate factors that promote or impede the decision to have adjuvant chemotherapy for colorectal cancer.” July 1, 2010 to June 30, 2015 ($1,185,984). Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


22–2 Cancer Family Caregiver Depression: Are ReligionRelated Variables Important? Anna-leila Williams1, Jane Dixon2, Richard Feinn1, Ruth McCorkle2 1 Frank H. Netter MD School of Medicine at Quinnipiac University, Hamden, CT, USA, 2Yale University School of Nursing, New Haven, CT, USA PURPOSE: Prevalence estimates for depression among cancer family caregivers (CFCs) range upwards to 39% -- approximately 7x the general population. Descriptive research inconsistently reports risk for depression among CFCs when evaluating age, gender, ethnicity, or length of time as caregiver. The discrepant findings, coupled with emerging literature indicating religiosity may mitigate depression in some populations, led us to investigate religion-related variables to help predict depression risk among CFCs. METHODS: We conducted a cross-sectional study of 150 caregivers of patients with lung or colon cancer receiving chemotherapy. Predictor variables included age, gender, length of time as caregiver, frequency of attendance at religious services, and prayer. The outcome variable was the Center for Epidemiological Studies–Depression Scale (CES-D) score. RESULTS: The sample is approximately two-thirds female; mean age 52.3 years (SD = 16.1); 8% Latino/Hispanic and 8% African-American. Mean length of time as caregiver is 13.9 months (SD = 18.5). Compared to large national datasets, our sample has lower representation of individuals with no religious affiliation (10.7% versus 16.1% p = 0.07), higher rate of attendance at religious services (81.3% versus 67.2% p < 0.001), and higher rate of prayer (65.3% versus 42.9% p < 0.001). In unadjusted and adjusted models, prayer is not significantly associated with caregiver depression. Frequency of attendance at religious services is associated with depression (p = 0.004) with an inversely linear trend (p = 0.002). CONCLUSIONS: Our study is consistent with growing evidence that certain religion-related variables can mitigate depression in some populations. The significant association between frequency of attendance at religious services and depression, despite no association between prayer and depression, indicates social or other factors, independent of religion, may accompany attendance at religious services and contribute to the influence on depression. The cross-sectional design hinders interpretation of the higher rates of attendance at religious services and prayer among the study sample as compared to national samples. It’s possible that individuals who attend religious services and have an active prayer life self-select to be caregivers. Alternatively, one’s prayer practices may change when one assumes the role of caregiver. While further research with CFCs is needed, clinicians can consider supporting a CFC’s attendance at religious services as a potential preventive measure for depression. RESEARCH IMPLICATIONS: This study indicates the © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Paper Abstracts of the APOS 11th Annual Conference

influence of religion-related variables in predicting cancer family caregiver depression. These results can help researchers parse the potential confounders that may have contributed to discrepant results in earlier cancer family caregiver depression investigations. Future research will be improved by including assessment of cancer family caregiver religionrelated variables. CLINICAL IMPLICATIONS: Caregiver depression is prevalent with consequences that extend to both the cancer family caregiver and their patient. It is vitally important that clinicians prevent and/or mitigate depression among cancer family caregivers since caregiver depression affects patient health outcomes. By supporting the cancer family caregiver, clinicians in turn support the patient who receives higher quality, more conscientious care at home. FUNDING: The study was supported by the National Institute of Health, National Center for Complementary and Alternative Medicine (F31AT003535; PI Williams). 22–3 Characteristics, Feasibility and Acceptability of a Meaning-Based Intervention for Patients Facing Terminal Cancer and Their Spouses Christina Wagner1, Silvia Bigatti2, Nasser Hanna3 1 DePauw University, Psychology Department, Greencastle, IN, USA, 2IUPUI, School of Public Health, Indianapolis, IN, USA, 3Indiana University Simon Cancer Center, Indianapolis, IN, USA PURPOSE: Diagnosis of a late-stage cancer is associated with distress in both patients and their partner, yet there remains a dearth of research on psychological interventions targeted at the couple. The present study tested the feasibility and satisfaction with a brief, couples-based intervention focused on jointly exploring meaning in life and transcendental concerns. METHODS: The Couples-based intervention was developed based on Existential Psychotherapy, Terror Management Theory, and a Developmental Approach that recognizes stages of life and their relationships to readiness for death. Session content involved a life review, open expression of values and preferences related to end of life and death, discussions of impact on family and friends and reaching closure, and exploring sources of meaning. Patients with late-stage cancer were recruited with their spouses from a cancer center in coordination with the treating oncologist, and completed 4 sessions of activitybased therapy with a clinical psychologist. Baseline and post-intervention assessments were completed by the patient and spouse via survey and qualitative interview assessing psychological symptoms, anticipatory grief, meaning in life, hope, transcendence, QOL, and satisfaction. RESULTS: Recruitment rate was 41% (N = 12 couples). All participants were White and Christian and 2 couples were female, same sex couple. Most were college educated with incomes ranging from $10-20K to over $70k. More detailed demographic characteristics and recruitment procedures Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Paper Abstracts of the APOS 11th Annual Conference

will be reported. Most patients and spouses denied histories of depression or anxiety (4 reported history of anxiety disorder and 2 reported history of depression). Patients reported overall health of 2.92 (SD = 1.31) on a 1–5 scale, partners reported a mean of 3.25 (SD = 0.97). One patient died during the study and her partner discontinued participation; all remaining couples completed the study. During the post-intervention qualitative assessment interview, all couples reported high satisfaction with the intervention. Couples reported different types of gains related to their initial concerns prior to study, and reported preferences for various components of the intervention which will be detailed further in presentation. CONCLUSIONS: This pilot study shows a brief, tailored intervention focused on meaning in life and transcendental concerns is both feasible and acceptable for couples confronting terminal cancer. RESEARCH IMPLICATIONS: This research characterizes recruitment dilemmas, feasibility, and satisfaction with a couples based end of life intervention as well as characteristics of individuals interested in completing such an intervention. CLINICAL IMPLICATIONS: This study shows that couples do desire opportunities to discuss end of life concerns and do benefit from such encouragement. This study also demonstrates that late-stage cancer patients (despite multiple physical limitations) do prioritize the opportunity to discuss their fears (as well as spouses) with the help of structure activities to broach the subject. FUNDING: IUPUI RESPECT Center. 22–4 Evaluation of an Online, Educational Group Intervention for Oncology Patients and Caregivers: Pillars4Life Sophia K. Smith1, Amy P. Abernethy1, Tina Staley2, Kristin MacDermott2, Jonathan O’Donnell1, Gregory P. Samsa1 1 Duke University, Durham, NC, USA, 2Pillars4Life, Inc./ Reimagine, Los Angeles, CA, USA PURPOSE: Psychosocial distress is a prevalent outcome of the cancer experience (e.g., diagnosis, treatment, caregiving); new interventions are needed. Pillars4Life is an online educational program that teaches coping skills in a group format. This presentation will report on the impact of participation in the LiveStrong-funded Pillars4Life program on key psychosocial outcomes and resources targeted by the intervention. METHODS: Cancer patients and unrelated caregivers were recruited from hospitals that received the LiveStrong Community Impact Project Award to enroll in a pilot study of Pillars4Life. Consenting participants participated in 10 weekly sessions and completed surveys at Baseline and Months 1–3, 6, 9, and 12. Surveys were administered electronically to assess for distress (DT, PCM v2), depression (PHQ-9), anxiety (GAD-7), posttraumatic stress (PCL-C), quality of life and despair (PCM v2), fatigue (FACIT-Fatigue), and cancer-related wellbeing (FACT-G) outcomes. In addition, instruments © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.


were used to examine the Pillars4Life intervention’s targeted resources such as coping (Brief COPE), selfefficacy (Self-efficacy for Managing Chronic Illness Scale and Preparedness for Caregivers Subscale), and spirituality (FACIT-SP). RESULTS: Participants (n = 80) were: mean age 55.5 ± 11.1 years; 90% female; 87% white; 58% married; 46% employed; and 91% cancer patients. Among cancer patients, 54% were breast cancer survivors and 72% were receiving treatment. Mean scores improved from Baseline to Month 3 on all key outcome measures: DT ( 0.8, p = .01); PCM Distress ( 2.9, p = .01); PHQ-9 ( 2.7, p < .001); GAD-7 ( 2.2, p < .001); PCL-C ( 4.9, p < .001); PCM QOL (3.8, p < .001); PCM Despair ( 3.6, p < .001); FACIT-Fatigue (3.7, p = .004); and FACT-G (5.7, p = .002). Similarly, mean scores improved from Baseline to Month 3 on key targeted resource measures: Brief COPE (2.2, p = .01); Self-efficacy for Managing Chronic Illness Scale (4.8, p < .001); Preparedness for Caregivers Subscale (4.7, p = .006); and FACIT-SP (4.2, p < .001). Among patient participants who reported distress (DT > =4) at Baseline (n = 43), clinically significant improvements (moderate to strong effect sizes ranged from 0.5 to 1.0 standard deviation units) were reported in distress, depression, anxiety, posttraumatic stress, QOL and cancer-related wellbeing, spirituality, despair, and selfefficacy. CONCLUSIONS: Participation in the Pillars4Life program was associated with statistically and clinically significant improvements in scores on key psychosocial and QOL outcomes and targeted resources. RESEARCH IMPLICATIONS: Given the findings of strength of association between participation in Pillars4Life and improvement in outcomes, additional research is recommended to establish causality. CLINICAL IMPLICATIONS: Results from this Phase II study of the Pillars4Life program indicate that the administration of an online, group educational program is feasible and participants found it to be helpful. FUNDING: National Cancer Institute (KM1-CA156687). 22–5 A Randomized Controlled Trial of Psychological Intervention for High Distress Cancer Patients and Carers Suzanne K Chambers1,2, Afaf Girgis3, Stefano Occhipinti1, Sandy Hutchison2, Jane Turner4, Michelle McDowell1, Catherine Mihalopoulos5, Rob Carter5, Jeff Dunn1,2 1 Griffith Health Institute, Griffith University, Brisbane, Queensland, Australia, 2Cancer Council Queensland, Brisbane, Queensland, Australia, 3University of Newcastle, Newcastle, New South Wales, Australia, 4School of Medicine, University of Queensland, Brisbane, Queensland, Australia, 5Deakin Health Economics, Deakin University, Melbourne, Australia PURPOSE: Over the past ten years numerous meta-analyses have provided evidence to support the effectiveness Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


of psychological interventions to reduce distress after cancer. However, with contractions in health and social services budgets and increasing demand the question arises as to the comparative effectiveness of low intensity approaches. A pragmatic randomized control trial was undertaken to compare the effectiveness of two low intensity approaches for distressed cancer patients and carers who had called Cancer Helplines seeking support. METHODS: 690 high distress participants (354 patients and 336 carers) were randomized to a single session nurse or five session psychologist telephone delivered intervention. Assessments included psychological and cancerspecific distress and post- traumatic growth at baseline, 3, 6 and 12 months follow up. Baseline distress, age and educational level were considered as moderators. RESULTS: Overall psychological and cancer-specific distress decreased over time for all study participants with moderate to large effect sizes for cancer-specific distress. There was no significant moderation by baseline cancer-specific distress. For Low Education patients, only the psychologist intervention was associated with a significant drop in distress. All other participants improved over time in both arms with small to large effect sizes (Cohen’s ds .05 -.82). CONCLUSIONS: Many distressed cancer patients and carers will benefit significantly from a single session nurse psychoeducation intervention that can be delivered remotely by telephone and supported by quality self-management materials. RESEARCH IMPLICATIONS: Research is needed to develop an algorithm or triage process that moves beyond distress as the only indicator for referral to specialist psychological services and further assess mechanisms of change. CLINICAL IMPLICATIONS: Brief contact self-management approaches at little or no cost can significantly improve overall psychological and cancer specific distress. FUNDING: This project was funded by beyondblue, Cancer Australia (APP561701), Cancer Council Queensland and New South Wales. 23–1 The Effects of Thoracic Radiotherapy on Shortness of Breath and Fatigue in Lung and Breast Cancer Patients Anita Peoples1, Charles Heckler1, Joseph Roscoe1, Charles Kamen1, Luke Peppone1, Michelle Janelsins1, Karen Mustian1, Jacqueline Williams1, James Aktins2, Raymond Lord3, Howard Gross4, Patrick Flynn5, Gary Morrow1 1 University of Rochester Medical Center, Rochester, NY, USA, 2Southeast Cancer Control Consortium, Inc., CCOP, Winston-Salem, NC, USA, 3West Michigan Cancer Center, CCOP, Kalamazoo, MI, USA, 4Dayton Clinical Oncology Program, CCOP, Dayton, OH, USA, 5 Metro-Minnesota Community Clinical Oncology Program, CCOP, Minneapolis, MN, USA © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Paper Abstracts of the APOS 11th Annual Conference

PURPOSE: Thoracic radiotherapy (RT) and chemotherapy can produce interrelated symptoms of fatigue and shortness of breath (SOB), which are frequently reported by cancer patients during and after treatment. It is unknown how changes in these symptoms over time differ by cancer and treatment type. We examine SOB and fatigue in lung and breast cancer patients receiving thoracic RT and /or chemotherapy at baseline (pre-treatment), post-treatment, and 6 months post-treatment time points. METHODS: Analyses were performed on 133 lung (mean age 65, 42% female) and 454 breast (mean age 57, 99% female) cancer patients from a previous University of Rochester Cancer Center Community Clinical Oncology Program (URCC CCOP) survey study. Patients completed a modified version of M.D. Anderson Symptom Inventory (SI) at baseline, post-treatment, and 6 months follow-up. The SI scale ranged from 0 (no symptom) to 10 (as bad as you can imagine). Mean SOB and mean fatigue were calculated at all three time points for patients who received RT with or without chemotherapy versus those who received only chemotherapy. Pearson’s correlations and linear mixed model (LMM) analyses were performed. RESULTS: SOB was significantly associated with fatigue in all patient groupings (all R’s = approximately 0.4, all p’s < 0.0001), and SOB was higher in lung than in breast cancer patients. Mean SOBs from post-treatment to 6 months post-treatment for lung cancer patients with and without RT were 5.1+/ 0.4 to 5.3+/ 0.5 and 5.8+/ 0.6 to 4.1+/ 0.7 respectively; and for breast cancer patients for RT only were 2.0+/ 0.2 to 1.3+/ 0.1. LMM showed that both mean SOB and mean fatigue for cancer patients increased significantly from baseline to post-treatment and then decreased to almost baseline values at 6 months post-treatment for chemotherapy alone (all p’s < 0.0007). A similar trend was observed for mean fatigue for RT (all p’s < 0.0001). However, mean SOB for cancer patients who received RT did not return to baseline values but remained elevated even after 6 months post-treatment (p = 0.769). CONCLUSIONS: These findings suggest that thoracic RT has a much longer lasting detrimental effect on SOB than chemotherapy; whereas the detrimental long-term effect of RT is not seen for fatigue. RESEARCH IMPLICATIONS: No study to date has examined how changes over time in cancer treatment-induced symptoms of SOB and fatigue differ by cancer type and treatment type. This understanding will contribute more towards the etiology of symptoms of SOB and fatigue, which are poorly understood. CLINICAL IMPLICATIONS: The finding from the present study that SOB will be much worse in cancer patients receiving thoracic RT and more so for lung cancer patients has clinical implications such that it will help clinicians make better treatment decisions for SOB based on cancer and treatment type. FUNDING: Funding: R25CA102618-05. Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Paper Abstracts of the APOS 11th Annual Conference

23–2 Mild Distress and Physical Symptoms Marie Flannery, Charles P. Heckler, Charles Kamen, Mohamedtaki Mohamedtaki Tejani, Gary R. Morrow University of Rochester Cancer Control, Rochester NY, USA PURPOSE: Current clinical practice guidelines recommend routine screening for both distress and physical symptoms. Clinicians have been alerted to cut points of 4 or higher on a 0–10 scale as clinically significant severity scores. The relationship between distress and physical symptoms is complex; symptoms may cause distress and those who are distressed may have more difficulty tolerating symptoms. Sources of distress are multi-factorial and include many aspects unrelated to symptoms. We examined the relationship between distress and symptoms with a data set that included a single distress item embedded in a symptom inventory and interference scale. METHODS: Secondary analysis was conducted on a data set of 1,106 individuals with cancer (all diagnoses mean age 60.2Y, 50.4% female, 92.3% Caucasian) at week 1 of radiation therapy. Measures included a symptom inventory and interference scale (6 items i.e.: quality of life, activity level). Variables were 1) distress (0–10), 2) the #of physical symptoms (pain, fatigue, difficulty sleeping, dyspnea, and trouble remembering), 3) severity of symptoms mean and 4) interference mean (0–10). Descriptive statistics and ANOVA were conducted. RESULTS: Descriptive: 79.5% reported symptoms, 45.3% reported distress (63.7% mild, 36.3% moderate to severe distress). Examining together: 43.7% reported physical symptoms and distress; 37.8% physical symptoms and no distress, 17% no symptoms and no distress and 1.6% no symptoms and distress (Chi Square < .001). ANOVA was conducted for 3 groups {1) no distress, 2) mild distress (1–3), 3) moderate/severe distress (4–10)}. All groups comparisons were significantly different (p < .001) for # symptoms, group means were: 1.7 (no distress), 3.4 (mild distress), 4.4 (mod/severe distress). Significant group comparisons also were found for symptom severity (group means 0.9, 1.7, 3.8) and interference (group means 1.7, 3.4, 4.4). CONCLUSIONS: The symptom experience was significantly related to distress. An important finding is that even when experiencing mild levels of distress individuals had significantly increased physical symptoms as compared to individuals with no distress. Because the direction of effect remains elusive quality outcomes will be enhanced by resources devoted to both symptom and distress screening and interventions. RESEARCH IMPLICATIONS: Researchers will be interested in prevalence data because the sample from this study was large (1,100). The findings on mild distress and the increased report of physical symptoms provide new information. CLINICAL IMPLICATIONS: Oncology clinicians will be interested in the prevalence of symptoms when individuals report mild distress. As NCCN guidelines identify the oncology care team © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.


as responsible for mild distress interventions this alerts clinicians to the prevalence of mild distress and the association with symptoms. FUNDING: Funding: NCIR25CA10618. 23–3 Individual Physical Symptoms and Their Associations With Physical and Mental Health in Colorectal Cancer Survivors Elizabeth J. Siembida, Keith M. Bellizzi, Shelby Borowski University of Connecticut, Department of Human Development and Family Studies, Storrs, CT, USA PURPOSE: Many colorectal cancer survivors report physical symptoms following treatment for their cancer, and these symptoms can adversely affect health related quality of life. The purpose of this study was to examine the relationship between specific physical symptoms and symptom clusters and physical and mental health. METHODS: A survey-based study was conducted to examine common physical symptoms affiliated with cancer treatment (measured with the Rotterdam Symptom Checklist) and their association with both physical and mental health (as measured by the SF-12) in colorectal cancer survivors (N = 106 M Age = 69.22, SD = 11.37). To discern a unique pattern of symptoms associated with each outcome, ANOVAs were conducted examining each individual symptom and its association with both physical health and mental health. These results guided the construction of two hierarchical regression models to discern the most influential symptoms (and clusters) associated with physical and mental health. RESULTS: Bi-variate analyses found a different pattern of symptoms was associated with physical health than was associated with mental health. The regression analyses further found that the specific symptoms, along with demographic and clinical factors, explained 46.3% of the variance in physical health and 21.0% of the variance in mental health. For example, shivering (b = 8.492, p = .036) and shortness of breath (b = 8.287, p = .002) emerged as unique predictors of physical health, and vomiting (b = 18.36, p = .043) and difficulty concentrating (b = 6.329, p = .011) emerged as unique predictors of mental health. CONCLUSIONS: These results found that a different constellation of symptoms is associated with physical health than with mental health. Additionally, different symptoms emerged as unique predictors of physical and mental health after controlling for other demographic and medical factors. RESEARCH IMPLICATIONS: These results suggest the importance of examining the patterns of symptoms related to physical and mental health in larger diverse samples of colorectal survivors to examine generalizability of findings. CLINICAL IMPLICATIONS: Clinically, these results demonstrate the importance of recognizing and managing specific physical symptoms when working to improve a survivor’s physical and mental health. FUNDING: UConn Faculty Large Grant. Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


23–4 Sleep Quality as a Predictor of Cortisol Diurnal Rhythm in Gynecological Cancer Patients Chandylen Nightingale, Diego Esparza Duran, Laura Telepak, Rachel Fox, Shan Wong, Deidre Pereira University of Florida, Gainesville, FL, USA PURPOSE: Sleep disturbance is a common symptom experienced by cancer patients and has been implicated in negative health outcomes, possibly via dysregulated diurnal cortisol rhythm. Little research has explored these relationships in gynecological cancer patients. This study evaluated (1) changes in sleep quality variables from pre- to post-surgery and (2) the relationship between poor sleep quality and diurnal cortisol rhythm in gynecological cancer patients undergoing surgery. For Aim 1, it was hypothesized that sleep quality would be worse at postsurgery compared with pre-surgery; for Aim 2, it was hypothesized that poorer sleep quality at post-surgery would predict more dysregulated diurnal cortisol rhythm at postsurgery. METHODS: Forty-four gynecological cancer patients with self-reported poor sleep quality were recruited prior to surgery. Sleep quality was assessed prior to surgery (T0) and 6–8 weeks following surgery (T1) via the Pittsburg Sleep Quality Index (PSQI). Cortisol concentrations were assessed from salivary samples collected four times a day over three consecutive days prior to T1. Cortisol slopes (unstandardized betas) were calculated by regressing cortisol concentrations on collection times. For Aim 1, paired samples t-tests were conducted to test changes in sleep quality variables from T0 to T1. For Aim 2, linear regression analyses were used to predict T1 cortisol slope from each T1 sleep quality variable individually, while controlling for age, weight class (obese versus other), and sleep medication use. RESULTS: Contrary to hypotheses, sleep quality and sleep duration were significantly greater at post- compared to pre-surgery; however, consistent with hypotheses, sleep disturbance was marginally worse at post- compared to pre-surgery. Of the sleep quality variables examined, only post-surgical sleep disturbance was significantly associated with post-surgical cortisol slope (beta = .39, p < .05); the direction of this relationship indicated greater sleep disturbance was associated with a flatter diurnal cortisol slope. CONCLUSIONS: This study augments the limited literature on sleep quality and diurnal cortisol rhythm in cancer patients. Results suggest that gynecologic cancer patients report better sleep quality and greater sleep duration but more sleep disruption at post- compared to pre-surgery. In addition, at post-surgery, greater sleep disturbance predicts a more dysregulated diurnal cortisol slope. RESEARCH IMPLICATIONS: These relationships should be examined using sleep quality data obtained from sleep diaries and actigraphy in a larger sample. CLINICAL IMPLICATIONS: Psychosocial interventions that improve © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Paper Abstracts of the APOS 11th Annual Conference

post-surgical sleep disturbance may results in improved clinical outcomes in gynecological cancers, possibly via regulation of cortisol slope. FUNDING: The sponsor of this study is the National Institutes of Health (NIH) (R01 CA138808). 23–5 Physical Quality of Life Post-Hematopoietic Cell Transplant: Patients’ Perspective Morgan Lee1,2, Melissa Rose2, Brian Gonzalez2, Gwendolyn Quinn2, Clement Gwede2, Mallory Cases2, Anna Barata2, Juliette Christie2, Luis Gonzalez2, Alexis Koskan2, Joseph Pidala2, Heather Jim2 1 University of South Florida, Tampa, FL, USA, 2Moffitt Cancer Center, Tampa, FL, USA PURPOSE: The physical side effects of hematopoietic cell transplantation (HCT) are well-documented, but patients’ preparedness for and experience of these symptoms is less understood. This qualitative study explored allogeneic HCT recipients’ perceptions regarding post-HCT physical quality of life (QoL). METHODS: Four focus groups were conducted with a total of 24 allogeneic HCT recipients [50% male; median age: 53 yrs (range 23–73)] who had been transplanted 1–4 years prior and had no evidence of primary disease relapse. Focus groups were audiotaped, verbatim transcripts were analyzed using a combination of hand coded content analysis and the crystallized immersion method, and resulting codes were entered into ATLAS.ti for organization. RESULTS: Participants described many symptoms including weight gain and edema, diabetes, graft versus host disease-related symptoms (GVHD; particularly dry eyes and mouth), cataracts, mouth sores, sleep difficulties, fatigue, inability to concentrate, loss of hair and/or nails, neuropathy, and avascular necrosis necessitating joint replacement. A major theme was participants’ emphasis on the symptoms that interfered with daily life, especially mouth sores in the immediate post-transplant period and long-term eye problems and fatigue. Information needs were another area of focus: Participants said they received general information about GVHD prior to transplant, but many felt specific GVHD symptoms and other possible symptoms (e.g., those resulting from certain medications) were not adequately discussed. A theme of physical rehabilitation also emerged: Some participants noted renewed motivation to exercise post-transplant, while others resisted physical therapy. Finally, duration of recovery was a major concern: Though most participants were prepared for the physical difficulties of the immediate post-transplant period, many were unprepared for the length of their recovery and the impact of chronic symptoms on their QoL for years post-transplant. CONCLUSIONS: Findings suggest a need to educate HCT patients about the possible range and duration of post-transplant symptoms, the symptoms’ potential to interfere with daily life, and how to minimize the Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Paper Abstracts of the APOS 11th Annual Conference

symptoms’ impact. After transplant, HCT patients should be connected with sources of psychosocial support to aid in coping with long-term physical QoL concerns. RESEARCH IMPLICATIONS: The results of this study may inform further research on how best to educate patients about the symptoms they may experience after HCT. CLINICAL IMPLICATIONS: The results of this study may help clinicians appreciate the importance of assisting transplant patients with coping strategies related to their posttransplant symptoms. FUNDING: Miles for Moffitt Milestone award (PI: Jim) NCI K07 CA 138499 (PI: Jim). 24–1 Developing, Implementing and Disseminating the Psychosocial Assessment Tool Anne Kazak1, Stephanie Schneider1, Stephen DiDonato1, Ahna Pai2 1 Nemours Children’s Health System, Wilmington, DE, USA, 2 Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA PURPOSE: Although screening for psychosocial risk in pediatric cancer is widely recommended, there are few user-friendly psychometrically viable approaches available.1 The Psychosocial Assessment Tool (PAT) is a brief parent report screener of psychosocial risk in pediatric cancer based on a social ecological framework of family risk and resilience. 2 The PAT maps on to the Pediatric Psychosocial Preventative Health Model (PPPHM) with three levels of risk – Universal, Selected, Clinical. 3 This presentation will focus on the process of developing the PAT and the current status of implementation and dissemination of the PAT. METHODS: The history and process of developing the PAT will be described briefly followed by a demonstration of PAT in its paper and pencil, REDcap, web-based and EHR formats. Current adaptations and translations will be reviewed. Data on the number of sites using PAT, number of administrations, characteristics of the patient populations and risk scores obtained across sites from 2007–2013 will be presented along with discussion of implementation at two children’s hospitals. The final portion of the presentation will focus on general “lessons learned” in the process of implementation and dissemination. RESULTS: 40 programs in 19 states and the District of Columbia (22 in oncology) currently use the PAT, 85% for clinical care. Since 2007, nearly 3000 PATs have been completed, representing a diverse sample with regard to race and ethnicity (55% white, 28% African-American, 5% Hispanic) and age. Risk levels were 52% Universal, 37% Selected, and 12% clinical. CONCLUSIONS: A brief parent report psychosocial screener has been used for both research and practice in pediatric cancer. The results support predicted levels of risk on the PPPHM. Factors that influence the uptake of screening include the identification of champions for screening, determination © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.


of staff responsible for screening, delivery modality, and mechanisms for communicating results to clinical teams. * Data presented are through 2012 and will be updated to include 2013 for the presentation. RESEARCH IMPLICATIONS: Current research on the PAT includes validation of the Spanish version and identification of risk patterns over time that may be indicative of health disparities and adaptations for sub populations in pediatric cancer, such as bone marrow transplantation and survivorship. CLINICAL IMPLICATIONS: Brief screening identifies areas for psychosocial intervention matched to specific risks indicated by families. FUNDING: The PAT is disseminated by the Center for Pediatric Traumatic Stress in the National Child Traumatic Stress Network (SM058139). Current research on the PAT is supported by the American Cancer Society (RSG-13-015), and prior studies by the National Cancer Institute (CA98039) and St. Baldrick’s Foundation. 24–2 Screening Throughout the Trajectory: Development and Validation of the Distress Thermometer for Parents of a Chronically Ill Child Martha Grootenhuis, Lotte Haverman, Hedy van Oers, Perrine Limperg, Heleen Maurice-Stam Emma Children’s Hospital, Amsterdam, The Netherlands PURPOSE: Parents of a chronically or life-threatening child frequently report distress. A short screening-tool that identifies parents with serious distress and need for support would be useful in clinical practice. The aim of the present study is to develop and validate a Distress Thermometer for Parents (DT-P) and to determine a cutoffscore for clinical distress. METHODS: Parents of a chronically ill child (0–18 years) were recruited using announcements or were actively approached at the outpatient clinics of the Emma Children’s Hospital and VU medical centre. Development of the DT-P was based on the Distress Thermometer used in oncology medical care. The DT-P consists of a Thermometer-score from 0 (no distress) to 10 (extreme distress) and a Problem List (practical, social, emotional, physical, cognitive and parenting domains). The DT-P was validated with the Hospital Anxiety and Depression Scale (HADS) and the Parenting Stress Index (PSI). RESULTS: The mean Thermometer-score of the 706 participating parents was 3.7 (SD 3.0), ranging from 2.6 for parents of children with an admission to the IC tot 4.8 for parents of children with cancer and juvenile idiopathic arthritis (JIA). The Thermometer-score and the scores in the practical, emotional, physical and cognitive problem domains were strongly related to anxiety, depression and the total score of the HADS (.55 ≤ r ≤ .72). The Thermometerscore and all problem domain scores were moderately to strongly related to the PSI (.38 ≤ r ≤ .63). A cutoff-score of 4 correctly identified 86% of ‘clinical-HADS-cases’ Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


(sensitivity) and 67% of ‘non-clinical-HADS-cases’ (specificity). CONCLUSIONS: The DT-P appears to be a useful short screening-tool that facilitates providing support for those parents who most need and want it. As Parent Reported Outcome, it is now also an additional component in the implementation of the KLIK portal in the Netherlands ( and is being used by social workers. RESEARCH IMPLICATIONS: With this new instrument available it is possible to study distress in different groups of parents and compare their distress. More research is needed into the factors which determine parental distress, both from the child, the family as the parents themselves. CLINICAL IMPLICATIONS: With the use of the DT-P, parents’ functioning can be followed over time. The answers to the questionnaires can be provided to and discussed by the social worker of the multidisciplinary team. If parents report to have problems or a high level of distress a referral can be made. If a social worker is not part of the multidisciplinary team, the pediatrician or nurse can discuss the parents’ answers. FUNDING: None. 24–3 The Use of a Distress Thermometer in a Pediatric Outpatient Setting: Evaluating Validity, Acceptability and Feasibility Sima Zadeh1, Lori Wiener1, Maryland Pao2, Janet Osherow3, Mary Lane3 1 National Cancer Institute, Bethesda, MD, USA, 2 National Institute of Mental Health, Bethesda, MD, USA, 3 Medstar Georgetown University Hospital, Washington, DC, USA PURPOSE: The National Comprehensive Cancer Network (2003) designated emotional distress as a 6th vital sign to be recognized, documented, and treated during every patient visit. This led to development of a pediatric Distress Thermometer (DT) and problem checklist (Patel, 2011) which was adapted for this study. Objectives include assessing: 1) the validity of a pediatric DT; 2) inter-rater reliability among respondents; and 3) acceptability/feasibility of outpatient administration. METHODS: Enrollment is ongoing: N = 254. Youth, aged 7–21 diagnosed with cancer and other chronic illnesses are eligible. Youth and 1 caregiver complete the DT and measures of depression (CDI/BSI), anxiety (STAI), pain (FACES), and fatigue (CCFS). The primary provider rates the patient’s distress and performance status based on interactions during that same visit. All raters assess acceptability and researchers assess administration feasibility. RESULTS: For patients, the DT is significantly correlated with standardized measures of depression (p < .001), anxiety (p < .001), pain (P < .001), and fatigue (P < .011). For caregivers, the DT is significantly correlated with depression (p < .001) and fatigue (P < .011). For both patients and caregivers, the ‘pain,’ ‘sad/depressed,’ ‘worry,’ and ‘fatigue’ DT checklist items are significantly associated © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Paper Abstracts of the APOS 11th Annual Conference

with the FACES, CDI/BSI, STAI, and CCFS, respectively. Although numeric concordance rates between DT raters demonstrated significant correlation between the caregiver and patient (P < .001), the caregiver and provider (P < .001), and the patient and provider (p < .01), patients identified different distress symptoms than caregivers. Providers (97%), caregivers (89%) and patients (93%) found the DT to be ‘very easy’ or ‘somewhat easy.’ Likewise, providers (96%), caregivers (96%), and patients (89%) stated the DT ‘didn’t bother me at all.’ Researchers indicated DT administration was ‘very feasible’ or ‘feasible’ for both caregivers (99%) and patients (98%). CONCLUSIONS: The DT is a viable option for brief and clinically meaningful screening in a pediatric outpatient setting. RESEARCH IMPLICATIONS: Further research needed to refine the DT, collect longitudinal data and determine physician needs. CLINICAL IMPLICATIONS: Distress screening can provide quick identification of those in need of further evaluation, triage appropriate services, and potentially enhance patient care and quality-of-life. FUNDING: The work was supported by the intramural programs of the National Cancer Institute and the National Institute of Mental Health. 24–4 Patient-Oncologist Alliance as Protection Against Suicidal Ideation in Young Adults With Advanced Cancer Kelly Trevino1, Caroline Abbott2, Michael Fisch3, Robert Friedlander4, Paul Duberstein5, Holly Prigerson2 1 Rowan University, Glassboro, NJ, USA, 2Dana-Farber Cancer Institute, Boston, MA, USA, 3MD Anderson Cancer Center, Houston, TX, USA, 4Memorial Sloan-Kettering Cancer Center, New York, NY, USA, 5University of Rochester Medical Center, Rochester, NY, USA PURPOSE: Young adults (YAs) with cancer are at increased risk for suicidal ideation. The impact of the patient-oncologist alliance on suicidal ideation has not been examined. This study examined the relationship between the patient-oncologist therapeutic alliance (TA) and suicidal ideation (SI) in YAs with advanced cancer. METHODS: YA patients (age 20–40 years; n = 93) with incurable, recurrent, or metastatic cancer were evaluated by trained interviewers. SI was assessed with the Yale Evaluation of Suicidality, dichotomized into a positive and negative score. The Human Connection Scale, dichotomized into strong (upper third) and weak (lower twothirds) TA assessed strength of the patients’ perceived oncologist alliance. Logistic regression models examined the effect of TA on suicidal ideation, controlling for confounding influences. RESULTS: 22.6% of the sample screened positive for suicidal ideation. Patients with a strong TA were at reduced risk for SI after controlling for cancer diagnosis, performance status, number of physical symptoms, physical quality of life, Major Depressive Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Paper Abstracts of the APOS 11th Annual Conference

Disorder, Post-Traumatic Stress Disorder, and social support (OR, .13 [95% CI, .02, .85]). In bivariate analyses, six items from the Human Connection Scale were significantly associated (p ≤ .05) with SI: your oncologist takes the time to listen to your concerns, you understand your oncologist’s explanations and suggestions, your oncologist offers hope, your oncologist asks how you are coping with cancer, your oncologist is concerned about your quality of life, and your oncologist is open-minded. A strong TA was also associated with reduced risk for SI after controlling for mental health discussions with healthcare providers (OR, .25 [95% CI, .06, .97]) and use of mental health interventions (OR, .22 [95% CI, .05, .93]). CONCLUSIONS: The alliance with the oncologist appears to be important to the experience of suicidal ideation in young adults with advanced cancer, independent of young adults’ physical and mental health status. Therapeutic alliance also remained a significant predictor of suicidality after controlling for social support, providing additional evidence of the unique importance of patients’ relationships with their oncologist. This study also offers insight into the aspects of therapeutic alliance most relevant to suicidal ideation including communication strategies such as listening and providing clear explanations, expressions of concern for the patient’s wellbeing, positivity, and openness. Oncologists working to build a strong therapeutic alliance with their patients may benefit from attention to these aspects of their relationships. RESEARCH IMPLICATIONS: Longitudinal analyses that examine TA across the illness trajectory and in various age groups within young adulthood will provide a more specific understanding of the relationship between therapeutic alliance and SI. Examination of the relationship between communication skills, therapeutic alliance, and SI will inform development of targeted interventions to promote strong patient-oncologist TA. CLINICAL IMPLICATIONS: Oncologists may significantly influence patients’ mental health and may benefit from training and guidance in building strong alliances with YAs. Attention to factors such as communication strategies, expressions of concern for the patient’s well-being, positivity, and openness may be particularly important. Guidelines for developing an effective therapeutic alliance with YAs that consider the unique developmental characteristics of this population may be valuable. FUNDING: Prigerson (PI): MH63892, CA106370, CA156732. 25–1 Assessment of Cancer Survivors’ Needs Through the Survivorship Screening Tool Jennifer Hydeman1, Lynda Beaupin1, Pamela Paplham1,2 1 Roswell Park Cancer Institute, Buffalo, NY, USA, 2 University at Buffalo, Buffalo, NY, USA PURPOSE: Several types of survivorship program models exist for cancer patients, however, how they assess ongoing © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.


needs vary. It remains uncertain how effective these program models are in regard to addressing patients’ needs. The Survivorship Screening Tool (SST) is a measure of distress/ concern across a number of areas. The tool was developed by a multidisciplinary team, including Physical Therapy, Occupational Therapy, Social Work, Psychology, Case Management, Pastoral Care, and Nutrition, and includes empirically-validated and clinically-relevant questions. METHODS: All questions are answered using a Likert-type scale, with 0 = No problem and 4 = Severe problem. Two questions measuring general emotional distress and sexuality/intimacy issues use a 0–10 Likert-type scale, consistent with the distress screening literature. Additionally, questions eliciting feedback regarding the clarity of the instructions were included, as well as open-ended questions to share areas that were not addressed, length of time to fill out the measure, and any additional comments. Cutoffs for clinical intervention were developed by each discipline based on research literature. This measure was piloted in an outpatient Bone Marrow Transplant clinic to determine the clinical utility of each question and the burden on patients. Assessments were completed by 215 patients at least 1 year post-transplant over a 1-year period. RESULTS: Patients were 51% female, aged 22 to 76 years, with a mean age of 55 years. The areas most commonly reaching clinical thresholds include: worry about the future, fatigue, finances, managing work/school/home life, and sexuality/intimacy. While 60% of patients reached the threshold for clinical intervention in at least one area, 33% declined consults. The majority (46%) of consults triggered by the measure were for psychosocial oncology (Psychology & Social Work). The majority of patients (80%) took less than 5 minutes to complete the measure. Ninety-seven percent of patients indicated that the measure adequately addressed their concerns. Confirmatory factor analysis will be completed to examine the fit of each variable into constructs of emotional, practical, and physical functioning. CONCLUSIONS: Many cancer survivors continue to struggle with the emotional and physical sequelae of treatment. We have developed an efficient, focused assessment of these areas that is easily completed in a busy clinic. RESEARCH IMPLICATIONS: This information adds to the research literature on the assessment of ongoing needs of cancer survivors. While great progress has been made in the acknowledgement of cancer patients’ needs after treatment ends, no clear model has been developed for addressing these concerns in a consistent manner. This tool will help to quickly assess the ongoing physical and psychosocial needs of our survivors in an effort to better guide intervention. CLINICAL IMPLICATIONS: This tool will assist clinicians in focusing their assessment of cancer survivors’ ongoing needs after treatment. By providing clinically-relevant thresholds for necessary intervention, the provider is guided through a concise problem-focused evaluation of symptoms and potential problem areas to be addressed. FUNDING: None. Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


25–2 Developing a Cancer Survivorship Care Plan Template Auto-populated by Electronic Health Record and Patient-Reported Data Sofia Garcia1,2, Mallory Snyder1, Rebekah Abel1, Aubri Veneruso2, Judith Abramson3 1 Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA, 2Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA, 3Department of Medicine, Northwestern University, Chicago, IL, USA PURPOSE: Leading oncology professional societies and accrediting agencies have recommended the provision of survivorship care plans (SCPs) at the end of primary cancer treatment to improve ongoing clinical care and to address survivors’ needs during this “re-entry” period. However, SCPs have yet to be broadly adopted or empirically investigated. Chief among implementation barriers is the time spent by providers completing them. We are attempting to reduce that burden by designing an SCP template that auto-populates fields using electronic health record (EHR) and patient-reported data. METHODS: We conducted a pre-implementation evaluation of the Lynn Sage Breast Cancer Survivorship clinic where the SCP template will be used. Next, we conducted a review of existing SCP templates and recommendations, gathering over 200 clinical data fields from which we selected those that best met clinic needs and existing recommendations. After drafting our SCP template from the chosen fields, we created sample patient reports to gather input from a multidisciplinary group of clinicians who provide care to breast cancer survivors. Concurrently, we established the informatics infrastructure for auto-population of the SCP template with patient data. RESULTS: Our pre-implementation evaluation indicated that clinicians in the Lynn Sage Breast Cancer Survivorship clinic were spending unsustainable amounts of time abstracting patient data from medical records (M = 107 minutes per patient, SD = 40 minutes) and drafting individual SCPs (M = 122 minutes, SD = 43 minutes). Our SCP template was wellreceived by clinicians across disciplines. We developed and are testing an informatics workflow model in which programming within the cancer center’s data warehouse applies information from the EHR and our web-based patient-reported data collection platform to produce individualized SCPs. CONCLUSIONS: We created an SCP template that meets the needs of the Lynn Sage Breast Cancer Survivorship Program at the Robert H. Lurie Comprehensive Cancer Center. We expect that by autopopulating a majority of the SCP template using EHR and patient-reported data, we will significantly decrease the amount of time clinicians spend completing SCPs. We will be piloting the SCP template in a feasibility study with breast cancer survivors. If successful, our informatics © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Paper Abstracts of the APOS 11th Annual Conference

model will inform SCP implementation in other cancer populations. RESEARCH IMPLICATIONS: Despite the abundance of recommendations for the use of SCPs in standard clinical practice, there is limited empirical evidence of their feasibility and efficacy. This study contributes to that growing body of research, focusing on ways health information technology can allow for the auto-population of fields in SCP templates with electronic health record and patient-reported data. CLINICAL IMPLICATIONS: The American College of Surgeons’ Commission on Cancer (CoC) has included in its new standards for patient-centered care that by 2015 all accredited institutions must deliver SCPs to patients when they complete primary cancer treatment. Our study is investigating how a breast cancer survivorship clinic in a CoCaccredited comprehensive cancer center can leverage health information technology to do so feasibly. FUNDING: This study is funded by an award from the Lynn Sage Cancer Research Foundation. A portion of Dr. Garcia’s time is also supported by a National Institutes of Health-funded supplement to the Patient-Reported Measurement Information System initiative (U54AR057951-S1). 25–3 Returning to Work Following Cancer Treatment: Perspectives of Survivors and Employers Margaret Fitch1, Irene Nicoll2 1 Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada, 2Canadian Partnership Against Cancer, Toronto, Canada PURPOSE: There are late and long-term effects cancer survivors experience that can compromise quality of life. In particular, survivors can experience challenges in returning to work. This work explored perspectives of cancer survivors (employees), employers, and insuring agencies about the challenges of returning to work. METHODS: An environmental scan identified existing programs and resources to assist survivors in their return to work. A literature review and on-line survey documented the perspectives of cancer survivors about the challenges in returning to work after cancer treatment. Focus groups with employers gathered their perspectives about employees returning to work after cancer. RESULTS: 8,385 websites were scanned for relevant materials and 90 were identified with resources to support patients in their return to work. There are a range of program delivery modalities making it difficult to identify best practices. Patients (n = 410) described reduction in income, a range of positive and negative experiences in returning to work, and work-related issues dealing with side-effects (fatigue and loss of energy, cognitive changes). Employers acknowledged issues related to return to work. They reported there are few employees at any one point in time who are returning to work after cancer making it challenging for Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Paper Abstracts of the APOS 11th Annual Conference

managers to know how best to support these individuals. CONCLUSIONS: Return to work is a growing concern and individuals clearly experience challenges in making this transition. There is a need for resources to be developed to help survivors, health care professionals, and employing agencies become more aware of the challenges survivors experience and be able to deal more effectively with the situation. RESEARCH IMPLICATIONS: There is a need to design, disseminate and test effective tools to aid health care professionals in helping cancer survivors in returning to work; there is a need to design, disseminate and test effective tools for employers/managers to aid cancer survivors in returning to work. CLINICAL IMPLICATIONS: Clinicians need to open a discussion with cancer survivors about return to work, identify relevant issues, and make appropriate referrals as necessary. FUNDING: None. 25–4 Self-Management Strategies of UK Cancer Survivors Catherine Shneerson1, Nicola Gale1, Sheila Greenfield1, Roger Holder1, Taina Taskila2, Inigo Tolosa3 1 University of Birmingham, West Midlands, UK, 2 The Work Foundation, London, UK, 3University Hospitals Birmingham, West Midlands, UK PURPOSE: To map patterns of self-management (SM) from pre-diagnosis into survivorship. To explore any associations that might exist between SM uptake and quality of life (QOL), health beliefs, and ability to work. METHODS: A cross-sectional survey was sent to 957 UK cancer survivors identified from a UK teaching hospital. Ethical approval was obtained. The questionnaire gathered information on their use of SM practices (diet, exercise, complementary therapies, psychological therapies, spirituality/ religion, support groups) and whether these had changed from pre-diagnosis, during treatment and into survivorship. Their health beliefs (health locus of control), QOL (EQVAS & EQ-5D), and their ability to work (ability to work scale) were also measured. RESULTS: Across all categories of SM uptake was highest in the survivorship phase. Sub-group analyses revealed differences relating to the categories of SM, income, age, gender, ethnicity, cancer type, and treatment type. A significant positive association between SM uptake and the EQ-VAS (p = 0.004), and SM uptake and internal health locus of control (p = 0.043) was found. However no significant association was found between SM uptake and the EQ-5D (p = 0.109) or SM uptake and ability to work (p = 0.550). CONCLUSIONS: The positive correlation between SM uptake and EQ-VAS suggests that cancer survivors using SM generally have a more positive health outlook. Likewise, those with a high internal locus of control may be more willing to make health decisions involving SM practices on a day-to-day basis. Differing levels of work ability may affect the utilization of certain © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.


SM practices, potentially affecting cancer survivors’ occupational satisfaction. RESEARCH IMPLICATIONS: A growing ageing cancer population has emerged alongside increasing clinical, financial and political pressure on health services. Research into the use of SM strategies to promote patient health and wellbeing, while also easing pressure on resources, and promoting patient choice, is of increasing relevance due to the increase of long term chronic conditions, such as cancer, in society. CLINICAL IMPLICATIONS: These findings have implications for providing support to cancer survivors in clinical and community settings. A tool for screening/profiling cancer survivor patient preferences will be designed, including an educational pack for clinicians. FUNDING: The NIHR School of Primary Care is funding this study. 25–5 Cancer During Adolescence: Positive and Negative Consequences Experienced by Survivors 10 Years After Diagnosis Vicky Lehmann1, Helena Grönqvist2, Gunn Engvall2,3, Malin Ander2, Marrit A. Tuinman1, Mariët Hagedoorn1, Robbert Sanderman1, Elisabet Mattsson2,3, Louise von Essen2 1 Health Psychology Section, Department of Health Sciences, University of Groningen/ University Medical Center Groningen, Groningen, The Netherlands, 2 Psychosocial Oncology and Supportive Care, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden, 3Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden PURPOSE: To provide insight into long-term consequences of cancer during adolescence and to explore whether distress shortly after diagnosis is related to the type of reported consequences 10 years after diagnosis. METHODS: Adolescents diagnosed with cancer were followed longitudinally from diagnosis up to 10 years later (8 time points). Six months after diagnosis, adolescents were interviewed by telephone and rated 20 distressing aspects related to disease and treatment. Three, four, and 10 years after diagnosis, survivors were interviewed about positive and negative consequences due to their cancer experience. The interviews 10 years after diagnosis were analyzed by means of manifest content analyses to identify categories of positive and negative consequences. Categories were compared to consequences reported three and four years after diagnosis (previously published). Regression analyses were used to test whether early cancer-related distress predicts the number of different categories of positive and negative consequences 10 years later. RESULTS: Initially, 61 adolescents were included of which 42 were alive and 28 participated ten years after diagnosis (67%). Six categories of positive consequences were identified: positive view of life, positive view of self, compassion for others, Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


close relationships, gained knowledge about disease and health care, and financial gains, and seven negative categories: bodily concerns, unpleasant thoughts, psychological problems, difficulties interacting with others, living with uncertainties, concerns about fertility and sexuality, and frustrations about health care. Consistent with previous time points, bodily concerns were reported most often. New categories emerged: concerns about fertility, frustrations about health care, and compassion for others. The majority of survivors (n = 19) reported both positive and negative consequences of their former disease. Few survivors reported only negative (n = 2) or only positive consequences (n = 4). Female gender, but not distress six months after diagnosis predicted reporting more categories of negative consequences 10 years later. CONCLUSIONS: Ten years after diagnosis, most survivors reported both positive and negative consequences. New themes, relevant to young adulthood, were detected. Health care professionals treating young adult survivors may anticipate and address problems regarding physical health status, fertility, health care, and mood, but may also reinforce positive affect by addressing survivors’ positive views of life, self, and close relationships. RESEARCH IMPLICATIONS: Overall, we hope to give impulses on a variety of topics that should be dealt with in longterm young adult survivors of cancer during adolescence. By identifying new themes relevant to young adult cancer survivors 10 years after diagnosis, we hope to trigger future research on, for example, fertility issues and how they influence romantic relationships; health care provision for long-term survivors; and many more. CLINICAL IMPLICATIONS: Based on the positive and negative consequences identified in our study, health care professionals treating young adult survivors may anticipate and address problems regarding physical health status, fertility, health care, and mood. They may also reinforce positive affect by addressing survivors’ positive views of life, self, and close relationships. FUNDING: None. 26–1 Mindfulness-Based Stress Reduction for Breast Cancer Survivors With Fatigue and Related Symptoms: Outcomes From a Randomized Controlled Trial Shelley A. Johns1,2, Linda F. Brown1, Kathleen BeckCoon3, Patrick O. Monahan4, Yan Tong4, Karen Schmidt1, Kurt Kroenke1,2 1 Indiana University School of Medicine, Indianapolis, IN, USA, 2Regenstrief Institute, Inc., Indianapolis, IN, USA, 3 Indiana University School of Nursing, Indianapolis, IN, USA, 4Indiana University School of Medicine, Division of Biostatistics, Indianapolis, IN, USA PURPOSE: Cancer-related fatigue (CRF) is one of the most prevalent, persistent, and disabling symptoms associated with cancer and its treatment. Discovery of its etiology has been elusive, evidence is inconclusive about its © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Paper Abstracts of the APOS 11th Annual Conference

physiological mechanisms, and it frequently clusters with other troubling symptoms (e.g., sleep disturbance, attentional dysfunction, depression). Pharmacologic interventions for CRF remain investigational. Non-pharmacologic interventions such as exercise have proven helpful; however, 70% of cancer survivors are not meeting current physical activity guidelines, and many cite CRF as a key barrier. There is a critical need to develop, test, and disseminate additional interventions for CRF and related symptoms that are accessible, efficacious, and acceptable to survivors. METHODS: Mindfulness-Based Stress Reduction (MBSR) is an 8-week group meditation and yoga-based intervention that targets stress reactivity. MBSR effectively reduced CRF severity (d = 1.53, p < .0001) and functional interference (d = 1.43, p < .0001) compared to wait-list control in our pilot study of 35 cancer survivors, and these benefits were maintained through 6-month follow-up. The current trial provides a more rigorous test of MBSR as compared to a fatigue education/control condition structurally equivalent to MBSR. Breast cancer survivors (N = 60; stage 0-III) who were 9 months to 5 years post chemotherapy and/or radiation therapy and reporting clinicallysignificant CRF for ≥2 months were randomized to MBSR or education control. Primary outcome was fatigue interference. Secondary outcomes included fatigue severity, attentional dysfunction, sleep disturbance, depression, anxiety, and pain. RESULTS: Both interventions were equally helpful in reducing fatigue interference and severity immediately post intervention. The only significant group difference favoring MBSR at post was in attentional dysfunction (d = 0.54, p < .05). At 6-month follow-up, outcomes from the trial’s first cohort (N = 18) reveal that positive effects of MBSR continue to accumulate over time, resulting in a statistically and clinically significant difference favoring MBSR in reducing fatigue interference (d = 0.98, p = .03), attentional dysfunction (d = 1.58, p < .001), depression (d = 1.25, p < .05), anxiety (d = 1.15, p < .05), and sleep disturbance (d = 0.77, p < .05). Final results from the remaining cohorts will be presented. CONCLUSIONS: Findings from this trial support the use of MBSR in caring for breast cancer survivors with persistent cancer-related fatigue and associated symptoms. RESEARCH IMPLICATIONS: Although the investigation of mindfulnessbased interventions is advancing, this study is the first, to our knowledge, to test MBSR in a randomized controlled trial compared to an attention control condition using fatigue as the primary outcome. A definitive phase III trial, including cost-effectiveness, is needed testing MBSR for cancer-related fatigue. CLINICAL IMPLICATIONS: Clinicians caring for fatigued cancer survivors can use the evidence from this randomized controlled trial to support the use of MBSR as an efficacious approach to managing fatigue and related symptoms. FUNDING: Indiana Clinical and Translational Sciences Institute Walther Cancer Foundation. Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Paper Abstracts of the APOS 11th Annual Conference

26–2 Improved Perceived Cognitive Function and Cognitive Performance Tests in Response to Qigong/Tai-ChiEasy in Fatigued Breast Cancer Survivors Linda Larkey, Julie McNulty, Sunny Kim Arizona State University, Phoenix, AZ, USA PURPOSE: It has been estimated that as many as onethird of breast cancer survivors (BCSs) experience cognitive dysfunction as a persistent symptom. Because of the broad spectrum of potential etiologies of this symptom (endogenous hormones, genetic predisposition, cytokines, cancer treatment, sedentariness, and clotting in small blood vessels) and possible covariates (depression, fatigue, anxiety), treatment modalities that operate across several mechanisms are important to explore. Meditative Movement practices, such as Qigong and Tai Chi, are known to influence health through physical activity effects (albeit low intensity) as well as the stress-reducing effects of meditative states. In a study designed to test Qigong/TaiChi-Easy (QGTCE) in BCSs experiencing persistent cancer-related fatigue, we conducted analyses of impact of the intervention on cognitive function and a small set of blood biomarkers to explore potential mechanisms. METHODS: Forty post-menopausal BCSs, 6 months to 5 years post-primary treatment (n = 40, mean age, 57.7) who completed a 12-week QGTCE intervention were assessed for self-reported cognitive function (using FACTCog, three subscales), and objective cognitive performance tests(WAIS-II: Letter-Number Sequencing (LNS) and Forward-Backward Digit Span (FBDS) to examine memory and executive function) before and after the intervention. Blood was drawn pre- and post-intervention for CBC/differential tests, including WBC, RBC, hematocrit, neutrophils and lymphocytes. RESULTS: The three FACTCog sub-scales (perceived cognitive impairment, perceived impact of cognition on QOL, perceived cognitive abilities) were all significantly improved (p < .05). LNS did not demonstrate significant differences from pre- to post-intervention, but FBDS was significantly improved, with mean scores increased from 17.41 (SD 4.12) to 18.26 (SD 3.76); p < .05. Comparisons of blood components showed that all but the RBC and hematocrit were significantly changed (increased lymphocytes; and decreased neutrophils and WBC) from pre- to postintervention. Linear regression analyses indicated that these same blood components are related strongly to the objective test of cognitive performance, FBDS (p = < .01 for WBC, hematocrit, lymphocytes and neutrophils; only p = .08 for RBC). CONCLUSIONS: Meditative movement practice (e.g., QGTCE), incorporating physical movements with a focus on the breath and meditative states, may combine the benefits of physical activity with stress reduction to reverse cognitive dysfunction. Blood profiles showing boosted immunity and calmed inflammatory responses © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.


may provide clues regarding the mechanism of these effects. Meditative movement practices hold promise for improving persistent cognitive symptoms in breast cancer survivors. RESEARCH IMPLICATIONS: The link between physical activity and cognitive function has been examined in the elderly population, and interventions designed to boost cognitive function generally pose mental tasks (e.g., math). This study combines a model of stress factors with the more physiological explanations for cognitive dysfunction, and tests an intervention designed to reach both aspects of this symptom. Research would well proceed to examine further the impact of meditative movement forms on "chemobrain". CLINICAL IMPLICATIONS: Although in early phases for examining effects on cognitive function, previous studies (including our own) have demonstrated a high level of safety and efficacy for meditative movement practices (tai chi, Qigong, yoga) for improving a wide range of symptoms affecting BCSs. With the potential for also making a difference for this difficult-to-reverse symptom, cognitive dysfunction, alongside a body of evidence for efficacy to alleviate other symptoms common among cancer survivors (e.g., fatigue, sleep dysfunction, anxiety, depression), it makes sense to recommend some form of mind-body practice, with a possible advantage to those practices that also include movement. FUNDING: This work was supported by the National Institutes of Health (National Center for Complementary and Alternative Medicine and Office of Women’s Health) grant number 5 U01 AT002706-03 and the Arizona Cancer Center Support Grant (P50 CA023074). 26–3 Effects of Exercise Dose and Type on Sleep Quality During Breast Cancer Chemotherapy: A Multicenter Randomized Trial Kerry Courneya1, Roanne Segal2, John Mackey1, Karen Gelmon3, Christine Friedenreich4, Yutaka Yasui1, Robert Reid5, Diana Jesperson3, Diane Cook1, Carolyn Proulx2, Linda Trinh1, Lianna Dolan3, Evyanne Wooding2, Cynthia Forbes1, Donald McKenzie3 1 University of Alberta, Edmonton, AB, Canada, 2The Ottawa Hospital Cancer Center, Ottawa, ON, Canada, 3 University of British Columbia, Vancouver, BC, Canada, 4 Alberta Health Services, Calgary, AB, Canada, 5University of Ottawa Heart Institute, Ottawa, ON, Canada PURPOSE: Sleep disturbance is a common problem in cancer patients that is associated with fatigue, pain, depression, poor functioning, and reduced quality of life. Exercise may improve sleep quality in cancer patients; however, most exercise studies have been limited by small sample sizes, heterogeneous samples with mixed cancer diagnoses, unsupervised exercise interventions, and brief exercise interventions. Moreover, no study to date has examined the effects of different doses and types of exercise on sleep quality. Here, we report what we believe to be the largest exercise trial to date to Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


examine sleep quality in cancer patients, and the first to examine different doses and types of exercise. METHODS: A multicenter trial in Canada randomized 301 breast cancer patients between 2008 and 2011 to thrice weekly, supervised exercise during chemotherapy consisting of either a standard dose of 25–30 minutes of aerobic exercise (STAN; n = 96), a higher dose of 50–60 minutes of aerobic exercise (HIGH; n = 101), or a combined dose of 50–60 minutes of aerobic and resistance exercise (COMB; n = 104). The primary sleep endpoint was global sleep quality assessed by the Pittsburgh Sleep Quality Index (PSQI) at baseline, twice during chemotherapy, and postchemotherapy. Secondary endpoints were the PSQI component scores. RESULTS: Complete sleep data were available from 296/301 (98.3%) patients. Repeated measures analyses of variance showed that the HIGH group was statistically superior to the STAN group for the primary sleep outcome of global sleep quality (mean group difference = 0.90; 95% CI = 0.05 to 1.76; p = 0.039) as well as subjective sleep quality (p = 0.028) and sleep latency (p = 0.049). The COMB group was borderline statistically superior to STAN for global sleep quality (mean group difference = 0.76; 95% CI = +0.11 to 1.62; p = 0.085) as well as sleep duration (p = 0.051); and statistically superior for sleep efficiency (p = 0.040), and percentage of poor sleepers (p = 0.045). CONCLUSIONS: Compared to a standard volume of aerobic exercise, higher volumes of both aerobic and combined exercise improved sleep quality during breast cancer chemotherapy. Exercise may be an attractive option to manage sleep dysfunction in cancer patients because of its favorable safety profile and other documented health benefits. RESEARCH IMPLICATIONS: Higher dose exercise interventions are feasible and safe in breast cancer patients receiving chemotherapy and appear to provide additional sleep benefits. The maximally tolerated dose of exercise and the optimal exercise prescription for improving sleep outcomes in breast cancer patients receiving chemotherapy are still unknown. Additional exercise dose and type trials targeting sleep outcomes are warranted. CLINICAL IMPLICATIONS: Clinicians can recommend higher doses of exercise to improve sleep quality in breast cancer patients receiving chemotherapy without concerns of interfering with chemotherapy completion rate or exacerbating other symptoms such as fatigue, hot flashes, or pain. Clinicians should refer these patients to qualified exercise trainers. FUNDING: This research was funded by a grant from the Canadian Breast Cancer Research Alliance. Kerry Courneya is supported by the Canada Research Chairs Program.

Paper Abstracts of the APOS 11th Annual Conference

cancer want to self-manage, but may be hindered by symptom burden, uncertainty of their role in self-management, limited knowledge of care options (curative, palliative, and hospice care), communication skills, and ability to negotiate transitions. Guided by the Self and Family Management Framework, this study tested the feasibility and acceptability of a self-management intervention, Managing Cancer Care: A Personal Guide (MCC), to address these concerns. Seven modules cover the topics of general self-management, symptom management, care options, communication with clinicians and with family, managing transitions, and coping with uncertainty. METHODS: In this one-group, pre-post-test study, women with Stage I-III breast cancer (n = 110) were recruited from a cancer center. Following baseline data collection, participants received the MCC. Participants were phoned at one month to discuss its use. Desire to self-manage, knowledge of care options, management of transitions, communication skills, self-efficacy, anxiety, depression, and uncertainty were measured at two months, followed by a structured interview. Descriptive statistics were calculated. Paired t-tests were used to examine pre-post changes in outcome variables. RESULTS: Participants were mostly White (78.2%), and married (61.8%), with a mean age of 52.4 years (SD = 10.7; range 27–74). 23 (21%) had Stage I, 60 (54.5%) Stage II and 27 (24.5%) Stage III breast cancer. 106 participants (95%) completed the intervention. Desire to self-manage (Delta = .28 (1.08), p = .01) and actual self-management (Delta = .28 (1.67), p = .04) significantly increased. Knowledge of care options (Delta = 0.40 (1.10), p = .0005) and medical communication (Delta = 1.58 (7.31), p = .03) also improved significantly. Participants reported improved management of social transitions (Delta = .80 (4.26), p = .05). Self-efficacy, anxiety, and depression did not change. Median ratings (0–10 best/ worst) of the MCC were 8 (range 1–10) on content and 9 (range 2–10) on appearance. Interviews revealed enhanced communication with family caregivers and clinicians. CONCLUSIONS: The MCC is a feasible, acceptable means of improving key aspects of self-management, and enables informed selfmanagement discussions. RESEARCH IMPLICATIONS: The MCC requires testing in a robust RCT design with a more diverse sample. CLINICAL IMPLICATIONS: The MCC is an easily implemented tool to facilitate patient-family caregiverclinician relationships and self-management plans. FUNDING: This work was supported by the American Cancer Society (MRSG08-292-01-CPPB, D. Schulman-Green, PI).

26–4 A Psychoeducational Intervention for Women With Breast Cancer Improves Self-Management Dena Schulman-Green, Sangchoon Jeon Yale School of Nursing, New Haven, CT, USA

26–5 Providing Quality Breast Cancer Care to Individuals With Schizophrenia: Barriers and Facilitators Kelly Irwin1, Helen Knight1, William Pirl1,2 1 Massachusetts General Hospital Cancer Center, Boston, MA, USA, 2Harvard Medical School, Boston, MA, USA

PURPOSE: Self-management is individuals’ engagement in the activities of managing their health care. Women with breast

PURPOSE: Individuals with schizophrenia experience significantly increased cancer-specific mortality, particularly

© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Paper Abstracts of the APOS 11th Annual Conference

due to breast cancer. Contributing factors include lower rates of mammography and presentation with advanced stage cancer. Preliminary research suggests that individuals with schizophrenia may be less likely to receive recommended cancer-directed treatment, although little is known about how schizophrenia may influence cancer outcomes. METHODS: We conducted a retrospective cohort study of 34 patients with a prior diagnosis of a schizophrenia spectrum disorder who were diagnosed with breast cancer after 2000, and treated at the same comprehensive cancer center. Using a mixed methods approach, we gathered data on the quality of cancer treatment and used content analysis to explore factors associated with care disruptions. The medical charts were reviewed independently by two researchers; all discrepancies were resolved by consensus. RESULTS: Approximately 40% of patients (14/34) had documented interruptions to cancer care. Common themes included missed appointments, refusal of recommended treatment, and impaired capacity for medical decision-making. Patients with disruptions in cancer care were significantly more likely to have psychiatric hospitalizations during cancer treatment (p = .0014). Despite the severity of mental illness, oncologists may not have access to information about psychiatric care. It is rare for oncologists to document if a patient has a psychiatrist. Additionally, while 79% of patients had PCP notes in the medical record, only 27% had psychiatry notes. CONCLUSIONS: Many patients with schizophrenia receive high quality cancer care. In a subset of patients, however, active psychiatric illness may impact the ability of patients to complete treatment. Communication among oncology and mental health providers may be one strategy to promote the delivery of quality cancer care. RESEARCH IMPLICATIONS: Patients with schizophrenia are a relatively understudied population who experience significant disparities in breast cancer outcomes. A mixed methods approach can generate hypotheses about specific barriers and facilitators to care that can be replicated in larger prospective studies. CLINICAL IMPLICATIONS: This research can inform the development of care models for patients with schizophrenia and cancer. There may be unique value in involving psychosocial oncology clinicians when cancer is diagnosed. One key role may be facilitating communication among oncologists, PCPs, and psychiatrists. FUNDING: Dupont-Warren Fellowship, Harvard Medical School. 27–1 Evaluation of a Coordinated Symptom Assessment and Management Intervention System for Patients With Lung Cancer: Patient Perspectives Mary Cooley1,2, Manan Nayak1,2, David Lobach3, Janet Abrahm1, Michael Rabin1, Barbara Halpenny1, Sindy Ortiz Pimentel1, Kathleen Finn4, Donna Berry1 © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.



Dana-Farber Cancer Institute, Boston, MA, USA, University of Massachusetts-Boston, Boston, MA, USA, 3 Duke University Medical Center, Durham, NC, USA, 4 Boston Medical Center, Boston, MA, USA 2

PURPOSE: Patients with lung cancer frequently experience multiple, concomitant symptoms impairing their quality of life. We tested an outpatient computer-based symptom self-report program with individualized, evidence-based recommendations for clinicians. This project evaluated an electronic coordinated-Symptom-Assessment-andManagement-Intervention-system for patients with Lung cancer (SAMI-L). The specific aims of the study were to (a) evaluate acceptability of SAMI-L, (b) describe patient preferences for the frequency and location for completion of SAMI-L (c) identify facilitators and barriers to SAMI-L use, and (d) gather suggestions to improve the system. METHODS: Patients completed a symptom self-report questionnaire on a tablet computer in the waiting room before in-person visits. Additional information was collected about medications and laboratory values; all data were sent electronically to a decision support system that generated real-time specific suggestions for clinicians to enhance symptom management. Data were collected from 43 lung cancer patients using standardized questionnaires, observation and structured interviews. Descriptive statistics were used to analyze quantitative data using the E-acceptability scale and scoring with preset threshold of 4 on the 1–5 response scale. Qualitative data were content analyzed using NVivo. RESULTS: Participants were 58% female, mean age 60 (range 34–81), 93% were Caucasian, and 70% had some college. Acceptability item scores for SAMI-L ranged from 4.21 to 4.97.The average total score for the acceptability questionnaire was 28 (90%) exceeding the a priori threshold criteria of 80%. Most patients (71%, 32/45) would prefer assessments at every clinic visit, versus < once/ month (10/45, 22%) or at least once/week (3/45, 7%). The majority (90%, 34/45) indicated that they would prefer completing assessments during clinic visits because it gave them something to do while waiting for the visits. SAMI-L use facilitated communication with clinicians, reflection on symptoms, and helped pinpoint problems before the visit. The main barrier to use was unclear/limited options on SAMI-L questionnaires. Patients suggested having openended questions to allow them to identify additional issues of concern if needed. CONCLUSIONS: SAMI-L was acceptable to users. Patients preferred completing questionnaires at each clinic visit and found it useful to reflect on symptoms to prepare for their clinic visit. RESEARCH IMPLICATIONS: Developing clinical decision support systems that enhance communication and management of distressing symptoms is an important avenue for research. As we develop these systems, however, it is essential to ensure that they are valid and adequately reflect patient preferences. CLINICAL IMPLICATIONS: Providing evidence-based Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


symptom management is important to ensure quality cancer care. As we develop systems to assess and manage distressing symptoms, incorporation of patient preferences for how often and where they complete these self-report questionnaires is essential. FUNDING: National Cancer Institute. 27–2 Long-Term Sustainment of Therapeutic Gains of Two Formats of Cognitive-Behavioral Therapy for Insomnia Comorbid With Cancer Josée Savard1,2, Hans Ivers1,2, Marie-Hélène Savard2, Charles Morin1,2 1 Université Laval, Québec, QC, Canada, 2Laval University Cancer Research Center, Québec, QC, Canada PURPOSE: This presentation aims at comparing the long-term efficacy of two different formats of cognitivebehavioral therapy for insomnia, a professionallyadministered format (PCBT-I) and a video-based format (VCBT-I), to that of a no-treatment control condition (CTL).We previously reported that, both PCBT-I and VCBT-I were associated with significantly greater sleep improvements, assessed subjectively, as compared to CTL at post-treatment, but that, compared to VCBT-I, PCBT-I was associated with significantly greater improvements of Insomnia Severity Index (ISI) scores and early morning awakenings (EMA). METHODS: A sample of 242 women with breast cancer was randomized to: 1) video-based CBT-I (VCBT-I; n = 80), composed of a 60-min animated video + 6 booklets; 2) professionally-administered CBT-I (PCBT-I; n = 81), composed of 6 weekly sessions of 50 min; and 3) no treatment (n = 81). The main study variables, collected at pre- and post-treatment, as well as at 3-, 6-, and 12-month follow-ups, were the ISI total score and sleep parameters derived from a daily sleep diary: sleep onset latency (SOL), wake after sleep onset (WASO), EMA, total wake time (TWT), and sleep efficiency (SE). RESULTS: Mixed models analyses revealed that, except for WASO, no significant differences were found between the post-treatment and follow-up assessments in PCBT-I and VCBT-I groups (time effects). Time effects found in CTL were significant on several variables (ISI, WASO, TWT, SE), with post-hoc comparisons showing significant improvements from post-treatment to the 3-month followup. Between group differences at 3-, 6-, and 12-month follow-ups generally revealed larger treatment effects in PCBT-I when compared to CTL alone (ISI, WASO, EMA, SE) or both VCBT-I and CTL (SOL, TWT). CONCLUSIONS: Results of these analyses indicated an excellent sustainment of therapeutic gains up to 12 months following the intervention in both PCBT-I and VCBT-I. While CTL patients had shown no significant improvements from pre- to post-treatment, they experienced some during follow-up, an effect that is probably attributable to © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Paper Abstracts of the APOS 11th Annual Conference

the passage of time. These effects narrowed the differences that were found between CTL and VCBT-I at post-treatment on many sleep parameters. Although VCBT-I remains a valuable alternative, long-term findings confirm the superiority of PCBT-I over VCBT-I. RESEARCH IMPLICATIONS: Future analyses of this study will compare the cost-effectiveness of PCBT-I and VCBT-I. CLINICAL IMPLICATIONS: Although VCBT-I appears to be a valuable alternative when PCBT-I is not available, future studies should investigate whether it would be more appropriate to use self-help interventions for insomnia as part of a stepped care model of care. FUNDING: This research was funded by the Canadian Breast Cancer Research Alliance (grant #017738) and a research scientist award from the Fonds de la recherche en santé du Québec to the first author. 27–3 Usability and Acceptability of a Web-Based Program for Chemotherapy-Induced Peripheral Neuropathy Cindy Tofthagen1, Ian Loy1, Denise Passmore1, Donna Berrry2 1 University of South Florida, Tampa, FL, USA, 2Dana Farber Cancer Institute, Boston, MA, USA PURPOSE: Chemotherapy–induced peripheral neuropathy is a long-term side effect of many frequently prescribed chemotherapy drugs. It may cause significant distress and interfere with patients’ ability to conduct usual activities, leading to diminished quality of life. Health care providers often lack knowledge in assessment and management of chemotherapy-induced peripheral neuropathy, resulting in inadequate symptom management. There are currently no Web-based interventions to assist patients with selfmanagement of chemotherapy-induced peripheral neuropathy. Advantages of Web-based interventions include instant access to anyone with an Internet-enabled device and the ability to customize information to specific patient needs. The aim of this study was to evaluate the usability and acceptability of a Web-based intervention for assessing and managing chemotherapy-induced peripheral neuropathy, called the COPE-CIPN, using a framework of Creativity, Optimism, Planning, and Expert guidance. METHODS: This study employed both qualitative and quantitative approaches to test the usability and acceptability of the COPE-CIPN. Participants (n = 14) were instructed to complete the COPE-CIPN program in the presence of a member of the research team, providing verbal responses with regard to: comments and questions, explanations of hesitation at certain screens or skipped screens, and overall impressions. All responses were written down by a research assistant. Participants also completed the Post-Study System Usability Questionnaire (PSSUQ), a 19-item instrument for assessing user satisfaction with system usability. Iterative changes were made to the COPE-CIPN, based upon participant Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Paper Abstracts of the APOS 11th Annual Conference

feedback, including enlargement of font and control buttons and consolidation and rearrangement of information. Following revisions, participants were asked to provide feedback on the revised COPE-CIPN and evaluate acceptability using the Acceptability e-Scale, which contains 9 Likert-type items evaluating the ease, helpfulness and overall satisfaction a user experiences from using a computer program. RESULTS: The COPE-CIPN demonstrated high usability and acceptability. Comments indicated that the COPE-CIPN interface was easy to use and the information was helpful and applicable. CONCLUSIONS: The COPE-CIPN may be a useful intervention to assist with self-management of chemotherapy-induced peripheral neuropathy. RESEARCH IMPLICATIONS: Future studies should evaluate the efficacy of the COPE-CIPN in improving neuropathic symptoms and quality of life. CLINICAL IMPLICATIONS: Clinicians may eventually be able to recommend the COPE-CIPN to patients who are suffering with chemotherapy-induced peripheral neuropathy. FUNDING: This publication is supported by Institutional Research Grant number 93-032-16 from the American Cancer Society. 27–4 Home-Based Mindfulness Therapy for Lung Cancer Symptom Management: A Feasibility Trial Rebecca Lehto1, Gwen Wyatt1, Alla Sikorskii2, Irena Tesnjak2 1 Michigan State University College of Nursing, East Lansing, MI, USA, 2Michigan State University Department of Statistics and Probability, East Lansing, MI, USA PURPOSE: Patients with advanced lung cancer who are undergoing radiation and/or chemotherapy are shown to have high symptom and illness burden and lowered health-related quality of life (HRQOL). Novel supportive approaches are needed that patients can use to self-manage symptoms during conventional medical treatment. Mindfulness therapies, incorporating meditation training and gentle yoga movements have demonstrated benefits towards improving symptom management and HRQOL in some cancer groups. A targeted home-based mindfulness protocol was developed using patient focus group input. Study purposes were to test acceptability/feasibility and early efficacy of the home-based mindfulness therapy on symptom and HRQOL outcomes for patients receiving treatment for advanced lung cancer. METHODS: 40 patients with lung cancer [mean age: 66.2 + 9.4 years; sex: 27(67.5%) females, 13(32.5%) males; disease stage: III, 10(25%); IV, 30(75%)] receiving radiation and/or chemotherapy were randomized to receive six weekly mindfulness therapy sessions (N = 20) or the attention control condition of six weekly telephone calls to assess symptoms (N = 20). HRQOL data were obtained at baseline, following the intervention, and at week 11. Acceptability/feasibility were determined via rates of patient © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.


retention and adherence to the intervention. Preliminary evaluation of efficacy was performed for the outcomes of physical function (measured using SF-36) and symptom severity and interference (measured using MD Anderson symptom inventory). Analysis included comparisons of study groups at weeks 8 and 11 using general linear models. Effect sizes (Cohen’s d) were estimated in addition to p-values for statistical tests. RESULTS: 32 patients completed the study (16 intervention, 16 control) resulting in a 20% attrition rate. The mindfulness group had significant improvement in physical function at week 8 (p = .03, d = .80) with large effect sizes at week 11 (p = .08, d = .64). Symptom severity and interference were also lowered in the mindfulness group compared to controls with moderate to large effect sizes. CONCLUSIONS: Findings suggest that a home-based mindfulness intervention is both acceptable and feasible for patients during treatment. RESEARCH IMPLICATIONS: The study provides preliminary efficacy data for development of a larger scale randomized control trial. CLINICAL IMPLICATIONS: If benefits are demonstrated with a larger sample, vulnerable lung cancer patients may gain access to a scientifically sound supportive intervention for symptom management and HRQOL improvement. FUNDING: FUNDING: MSU CTSI Grant-GA013811. 27–5 Results From a Pilot Study of a Strength and Balance Training Program for Persons With Oxaliplatin Induced Peripheral Neuropathy Cindy Tofthagen, Ian Loy University of South Florida, Tampa, FL, USA PURPOSE: Oxaliplatin based chemotherapy causes neuropathy in the lower extremities and resulting problems with walking and balance. Strength and balance exercises may help alleviate neuropathic symptoms and improve strength and balance. The purpose of this study was to pilot a 12 week, bi-weekly, group exercise program designed to improve lower extremity strength and balance with persons with oxaliplatin induced peripheral neuropathy and evaluate its 1) feasibility 2) tolerability 3) effects on strength, balance, and neuropathic symptoms. METHODS: Colorectal cancer survivors with oxaliplatin induced peripheral neuropathy within driving distance to the University of South Florida were recruited. Patients were contacted by postcard mailings, telephone, and advertisements were placed in local newspapers distributed throughout the community. Lower extremity muscle strength was measured using a dynamometer. Balance was measured using unipedal stance time, Timed Up and Go, Modified Clinical Test for Sensory Interaction in Balance, and Dynamic Gait Index. Neuropathy symptoms were measured using the Chemotherapy Induced Peripheral Neuropathy Assessment Tool. Data was analyzed using descriptive statistics. RESULTS: Even though 311 colon cancer survivors were contacted by mail and telephone Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


regarding the study and advertisements were placed in local newspapers on two occasions, only 12 patients expressed interest, 8 were unavailable at the time of the intervention, 4 enrolled, and 3 people completed the study. Patients reported that the exercise intervention was tolerable and difficulty level was appropriate. Neuropathic symptoms, balance, and strength showed a trend toward improvement but the study was underpowered to detect statistically significant differences. CONCLUSIONS: Recruiting cancer survivors for this study was challenging even though results indicate improvements in neuropathy symptoms, balance and strength. Participants found the exercises appropriately challenging but not difficult or strenuous. RESEARCH IMPLICATIONS: The strength and balance protocol showed promise for improving balance and reducing neuropathic symptoms among patients who completed the study however numerous barriers to recruitment occurred. Future studies should take into account barriers such as transportation problems, scheduling issues, and time commitment. CLINICAL IMPLICATIONS: Colon cancer survivors with oxaliplatin induced peripheral neuropathy are likely to benefit from strength and balance training. FUNDING: This study was funded by the Oncology Nursing Society. 28–1 Does Parental Cancer Affect the Associations Between Parental Health Status and Psychosocial Problems in Teenagers? A HUNT Study Elisabeth Jeppesen1,2, Ingvar Bjelland3,4, Sophie D. Fosså1,2, Jon Håvard Loge1,2, Øystein Sørebø5, Alv A. Dahl1,2 1 Oslo University Hospital, Oslo, Norway, 2University of Oslo, Oslo, Norway, 3Department of Child and Adolescent Psychiatry, Haukeland University Hospital, Bergen, Norway, 4Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway, 5School of Business and Social Sciences, Buskerud University College, Hønefoss, Norway PURPOSE: Chronic and serious illnesses in a parent are associated with psychosocial problems in their children. Using cancer as a moderator we cross-sectionally investigate whether health-related factors in parents were associated with psychosocial problems among teenagers living in cancer families and cancer-free families. Based on the literature, we hypothesized that parental cancer would show strong moderating effects on the associations between parental and teenager variables. METHODS: Questionnairebased variables were collected from the Health Survey of Nord-Trøndelag County of Norway (HUNT). We selected families where both parents were living with their teenagers. All parents participated in the adult HUNT-2 study and all teenagers in the Young-HUNT study. The Norwegian Cancer Registry identified 71 parental cancer families with 81 teenagers that were compared to 322 control families © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Paper Abstracts of the APOS 11th Annual Conference

with 328 teenagers. RESULTS: Anxiety and depression in a parent had significant effects on teenagers’ anxiety and depression, school problems, somatic stress symptoms, poor health and loneliness. The effect was more powerful when parental cancer was absent, and less when parental cancer was present. Direct effects of self-rated parental poor health on anxiety and depression and school problems in teenagers were observed. The effect decreases for both outcomes when parental cancer was present. CONCLUSIONS: Our hypothesis that parental cancer would show a strong moderating effect on the associations between parental health variables and psychosocial problems in teenager was not supported. Parental cancer showed some significant moderating effects on these associations and also some significant direct effects on anxiety/depression and school problems in teenagers. RESEARCH IMPLICATIONS: Chronic medical conditions (CMC) including cancer in parents have been associated with significantly more psychosocial problems in their children compared to families without CMC. Previous studies of CMC, self-rated health and parental depression have examined the associations with psychosocial problems in the teenagers without studying the effects of moderating factors. In this study we are using the presence or absence of parental cancer as a moderator. CLINICAL IMPLICATIONS: Our findings indicate that psychosocial problems among teenagers affected by parental cancer are best assessed broadly including general health related risk factors in their parents. FUNDING: Elisabeth Jeppesen, MPH holds a PhD grant (no #2011032) donated by the “Helse Sør-Øst Regional Health Trust”. 28–2 A Phenomenological Study of the Family, Social, and Interpersonal Experience of Pediatric Cancer Patients Shannon La Cava1, Betty Gonzalez-Morkos2, Suzanne Merlis1, Leslee Brown1 1 The Chicago School of Professional Psychology, Los Angeles, CA, USA, 2Children’s Hospital Los Angeles, Los Angeles, CA, USA PURPOSE: Current literature highlights the difficulties faced by a cancer patient and the benefits of support for emotional well-being. Healthy siblings, however, are often reported in the literature as the least supported and least researched members of a family receiving care for pediatric cancer. The researcher believes there is a need to hear directly from the siblings to fully understand the experiences they are having growing up with a brother or sister diagnosed with cancer. METHODS: The primary objective of the current research was to compare and contrast information obtained from semi-structured interviews of 5 school-age participants across the domains of social, family, and intrapersonal experience. Each participant had a brother or sister, between birth and 20 years of age, receiving active or maintenance cancer treatment at Children’s Hospital Los Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Paper Abstracts of the APOS 11th Annual Conference

Angeles. The research followed a qualitative design, utilizing phenomenological analysis to define the essence of the experience of being a sibling of a brother or sister with cancer. RESULTS: The experience of being a sibling of a pediatric cancer patient incorporates feelings of support and resiliency, fear and isolation, empathy and increased selfawareness. These children consider their ill brothers and sisters as confidants. The siblings turn to their peers for emotional support. However, they also become introspective when confronted with emotions of fear and sadness. Each sibling recognized a positive element of personal growth during the brother or sister’s cancer treatment. CONCLUSIONS: The findings revealed that being a sibling of a pediatric cancer patient is not easy, but there are recognized strengths within the group. Having friends is a huge support. In addition, recognizing positive changes in one’s own personality can be actualizing and motivating. Existing obstacles include the physical absence of the ill sibling from school causing distress for the sibling. Isolation rather than personal connection can impair family communications. The findings are supported by much of the literature available regarding domains of healthy sibling functioning. However, findings of the current phenomenological research did not identify a decreased social quality of life. The participants reported the importance of having friends as positive sources of support. RESEARCH IMPLICATIONS: The findings create a foundation for continued research comparing multiple siblings in a family, distinguishing siblings of patients on active and maintenance treatment from siblings of a patient no longer receiving medical treatment secondary to remission or death, and relating the personal experiences of the siblings to their observed behaviors by parents and teachers. Additional research is warranted to compare the academic and emotional functioning of healthy siblings that attend the same school. CLINICAL IMPLICATIONS: The findings indicate that school-based support programs be implemented to foster supportive relationships between healthy siblings and their friends, classmates, and teachers. In addition, adapted visitation restrictions or alternative means of communication for inpatient hospital care is indicated. Implementation of a “sibling-only” area in Children’s Hospitals that offers behavioral health services and promotes the sibling as the identified client can reduce distress and facilitate an increase in sibling quality of life. FUNDING: No funding was received to support this abstract.


has not been well explored. Perceived changes in parenting may contribute to distress in cancer patients. Also, children with a medically ill parent are at increased risk for distress, perhaps mediated by parenting style. This exploratory study documents patients’ concerns about the impact of cancer on their children, and their perceptions about their ability to meet children’s needs. METHODS: Participants included 194 adult oncology outpatients, with children ≤ 18 years old, 73% female, 95% Caucasian, and 89% living with a partner. They completed the HADS, FACT-G, and Parenting Concerns Questionnaire (PCQ), a 15-item questionnaire rated on a 5point Likert-type scale that yields a total score and 3 subscales scores: Practical Impact of the illness on children, Emotional Impact of the illness on children, and Co-parent Concerns. RESULTS: 36% of patients were “somewhat” to “extremely” concerned about the Practical Impact of the illness on their children, and 26% of patients were similarly concerned about the Emotional Impact. Perception of ability to meet children’s needs was significantly worse after (M = 3.4, SD = .88), vs. before cancer diagnosis (M = 4.5, SD = .63; t(192) = 16.89, p < .0001). Change in ability to meet children’s needs correlated with PCQ, Practical Impact and Emotional Impact scores, even after controlling for ability to meet needs pre-diagnosis (partial r’s = .46, - .55, -.40, all p’s < .001). Perceived change in co-parent’s ability to meet children’s needs correlated with the same scales, after controlling for co-parent’s ability to meet needs pre-diagnosis (partial r’s = .34, -.25, -.18, all p’s < .05). Parents with a child who had an emotional or behavioral problem prior to the parent’s cancer diagnosis had higher PCQ scores than parents without such a child (M = 2.28, SD = .67 vs. M = 2.24, SD = .63, t(174) = 3.53, p < .001). CONCLUSIONS: A subset of parents report high levels of concern about the impact of cancer on their children. Parents who perceive bigger declines in their ability to meet children’s needs have more concerns about their children. RESEARCH IMPLICATIONS: Changes in a parent’s perception of ability to meet children’s needs is worthy of further study as a potential risk factor for children’s distress in the context of parental cancer. CLINICAL IMPLICATIONS: These results underscore the importance of systematically inquiring about parenting concerns, and suggest the utility of the PCQ in doing so. Also, parents with children already vulnerable due to preexisting emotional challenges may experience more distress in the context of parenting with an illness. FUNDING: Research supported by National Institutes of Health grant R03 CA126394-01 to Anna Muriel, MD.

28–3 An Assessment of Parenting Concerns in Adults With Cancer Cynthia Moore1, Anna Muriel2, Paula Rauch1 1 Massachusetts General Hospital, Boston, MA, USA, 2 Dana Farber Cancer Institute, Boston, MA, USA

28–4 Advancing a Quality of Life Agenda: Innovation, Ingenuity and Advocacy Rebecca Kirch American Cancer Society, Washington, DC, USA

PURPOSE: Although cancer is recognized to affect role functioning and close relationships, its impact on parenting

PURPOSE: Palliative care is hitting its stride as one of the nation’s fastest growing health care trends, with a

© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


robust evidence base building, associated quality standards and measures being implemented, increasing health professional and consumer understanding and interest, and activation of a new public policy legislative agenda. Building on this momentum, the American Cancer Society has taken extensive concerted and collaborative action with key partners through research support, program delivery, and advocacy to propel prominence of palliative and psychosocial care as fundamental aspects of delivering high quality person-centered and goaldirected oncology care for all adults, children and youth. This energizing podium presentation will highlight essential elements of the new Quality of Life agenda featuring palliative & psychosocial care, providing practical tips and available resources for researchers and clinicians to get engaged in helping build and implement this new nationwide QOL campaign. METHODS: This podium presentation presents a practical case study and describes steps required for successfully building a QOL national movement to advance high quality cancer care that integrates palliative and psychosocial care from the onset of serious illness like cancer. It includes highlights of consumer research conducted by ACS in partnership with the Center to Advance Palliative Care and specific info about the emerging federal and state QOL legislative platform. It is intended to inform APOS membership on the activities underway, invigorate them, and inspire their active involvement. RESULTS: Outcomes of this podium presentation will inform, invigorate, and inspire APOS membership to improve their research and clinical practice, engage patients and colleagues, and become part of the Quality of Life movement. CONCLUSIONS: As a result of this podium

Paper Abstracts of the APOS 11th Annual Conference

presentation, APOS membership will be equipped to understand and explain to others the QOL-focused health reform initiatives currently underway to advance palliative and psychosocial care as essential elements of quality oncology care delivery. They will improve proficiency in effectively using findings from recent consumer research to explain palliative and psychosocial care to patients, families, and professional colleagues; understand sources of psychosocial & palliative care research and training grant support available from ACS and others; hear about resources available to help with professional and facility uptake and compliance in achieving various quality care improvement measures and initiatives (such as the CoC standard) associated with integrated palliative and psychosocial care; and learn practical tips about how they can engage and take action. RESEARCH IMPLICATIONS: Presentation will inform about specific sources of research and training grant support available from ACS and others to build the evidence base for delivering high quality cancer care, and also explain how their research outcomes have directly influenced development and advancement of the new QOL public policy agenda. Presentation will also provide specific tips on how research community can be involved in taking action to advance the QOL agenda. CLINICAL IMPLICATIONS: Presentation will provide practical tips on how to use consumer research findings to explain palliative and psychosocial care effectively to patients, families, professional colleagues, and policymakers to help promote integrated care and achievement of new Commission on Cancer and other quality standards, as well specific steps for clinical community to get involved in taking action to advance the QOL agenda. FUNDING: None.

Poster Abstracts of the APOS 11th Annual Conference P1-1 Cancer Patient Perspectives on Nursing Assessment of Psychosocial Concerns Rebecca Ahern, Lisa Kennedy Sheldon University of Massachusetts - Boston, Boston, MA, USA PURPOSE: Psychosocial concerns of cancer patients must be addressed as part of the provision of comprehensive care. Nurses spend the greatest amount of time with patients, provide holistic care including assessing patients for psychosocial distress. By 2015, cancer centers must meet the new Commission on Cancer’s accreditation standard that requires cancer centers to implement an on-site program to provide distress screening and referrals at least once during treatment. Operationalization of this program is determined by each facility. Establishing rapport and assessing patients is foundational to nursing practice so © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

nurses should be instrumental in the implementation of Standard 3.2. However, evidence suggests that nurses may be challenged in responding to patients who express distress and communicating about psychosocial concerns. METHODS: This paper is a review of the literature to determine the evidence for nursing assessment of psychosocial distress, trends in holistic patient care and the increasing emphasis on psychosocial assessment, screening for distress, and provision of appropriate referrals. The literature review will inform a case study of a person with cancer regarding experiences, psychosocial concerns and expectations of nurses around these concerns. RESULTS: A review of the literature established the effects cancer on patients’ psychosocial health as well as the relationship between psychosocial wellbeing and physical health during cancer care. CONCLUSIONS: Semi-scripted interviews will be conducted with one patient in the inpatient Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Poster Abstracts of the APOS 11th Annual Conference

setting over the course of a four to six week period. The case study will describe a patient perspective on psychosocial assessment and the provision of psychosocial nursing care. RESEARCH IMPLICATIONS: The paper makes suggestions for the implementation of Standard 3.2 that will optimize the experience of patients and guide nursing practice. CLINICAL IMPLICATIONS: The evidence supports the need for a systematic method of addressing psychosocial concerns of all cancer patients in order to optimize quality of life from diagnosis and treatment to survivorship. The literature also describes the challenges of psychosocial assessment for health care providers, particularly nurses. The literature suggests further education on communication techniques must be provided to oncology nurses to facilitate therapeutic communication. The case study described the patient’s perspective and experience and informs the nursing practice. FUNDING: None. P1-2 Preparing Children for a Parent’s Cancer Surgery Martha A. Askins1, Erin Buck2 1 The Department of Pediatrics at the University of Texas MD Anderson Cancer Center, Houston, TX, USA, 2The Department of Behavioral Science at the University of Texas MD Anderson Cancer Center, Houston, TX, USA PURPOSE: When parents are faced with changes to their appearance or bodily functioning due to cancer and its treatment, they often struggle with what to tell their children. In an attempt to protect their children emotionally, parents sometimes delay or avoid the conversation altogether. However, such withholding of information can lead to the unintended negative consequences of confusion, isolation, and anxiety for children. This strategy can also leave parents feeling alone at a time when they would benefit from familial support. Therefore, wider dissemination of information regarding how to communicate with children about a parent’s cancer treatment, in a developmentally appropriate manner, and the psychological benefits of open, on-going discussions surrounding treatment is needed. METHODS: The presentation will review: 1) common body image concerns among adult cancer patients; 2) dilemmas faced by parents when deciding what to communicate to their children about their treatment; and 3) how and when to provide developmentally appropriate information and psychosocial support to children whose parents will undergo surgery as a part of their cancer treatment. Discussion of strategies for communicating about appearance-related and functional changes with three specific age groups will occur: very young children (2–5), school-aged children (6–10), and adolescents (11–17). Anecdotal case examples illustrating the use and effectiveness of these strategies with each age group will be shared. RESULTS: This presentation will enhance oncology healthcare professional awareness about how to advise © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.


parents on talking with their children about cancer treatment, as well as how to assist parents in managing their own emotional responses to children’s questions and comments. Key considerations in guiding a parent through this communication with their children will be highlighted. CONCLUSIONS: Psychosocial adjustment to disfigurement is facilitated by parent–child communication that is open, age-appropriate, and reassuring. RESEARCH IMPLICATIONS: The recent state of the literature will be examined, along with research questions that remain unanswered regarding this topic. CLINICAL IMPLICATIONS: Attendees will be provided with information that is immediately applicable to clinical use, including therapeutic techniques for managing parental resistance to communicating with children about cancer treatment. The growing number of clinical resources for assisting patients and children in navigating changes due to cancer will be briefly reviewed. FUNDING: None. P1-3 has been withdrawn. P1-4 Distress Is More Than a Score Susan Berman1, Jennifer Dimick1, Jennifer Smith1, Lisa Arfons1,2, Polly Mazanec2, Sonya Curry1 1 Louis Stokes Cleveland VAMC, Cleveland, OH, USA, 2 Case Western Reserve University, Cleveland, OH, USA PURPOSE: The purpose of this abstract is to discuss eighteen months of distress screening, evaluation and treatment for veterans in a cancer clinic within a large Midwestern academic Veteran’s Affairs Medical Center. This clinic received a grant to provide patient-centered cancer care in an interprofessional clinic and educate interdisciplinary learners in interprofessional collaboration. Distress screening is a priority, as evidenced by screening veterans for distress with the NCCN Distress Thermometer at every visit. This allows for identification of the source(s) of distress, in addition to overall distress level. The Commission on Cancer (CoC) has mandated as of 2015 all facilities accredited by the CoC screen patients with a cancer diagnosis for distress at diagnosis and subsequent appropriate times as well as provide appropriate follow-up. Parameters for when patients should be screened have not yet been established. METHODS: Veterans complete the NCCN Distress Thermometer (DT) at clinic visit check-in. 525 distress screenings have been completed, some of which represent multiple visits for the same veteran. Screening scores are reviewed by the oncology nurse; those with scores of = or > 4 are seen by the appropriate provider (psychologist, social worker, and/or nurse practitioner), depending on the source(s) of distress. When a veteran endorses multiple issues on the emotional component of the DT, the psychologist is notified regardless of the distress score. RESULTS: Of the 525 screenings, 192 (37%) were > 4. Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


Sources of distress were: emotional (136; 72%), practical (65; 34%), family (44; 23%), spiritual (15; 9%), and physical (176; 92%). The majority (59%) of screenings contained two or more emotional concerns. More specifically, emotional concerns endorsed were: worry (54.8%), nervousness (46.2%), depression (43.3%), fears (36.7%), sadness (36.4%), and loss of interest (27.8%). 325 (63%) had DT scores of 3 or below. Within this “minimal distress” group, 30% reported at least one emotional issue regardless of their DT score. CONCLUSIONS: This project underscores the complexity of distress. To ensure that the appropriate discipline will provide treatment, the source(s) of distress must be identified. Future analyses will investigate peaks and trends of individual veteran’s distress scores over time. RESEARCH IMPLICATIONS: Distress screening is an essential component of providing quality cancer care and ensuring treatment of the entire individual. This abstract highlights findings of over 500 distress screenings of veterans diagnosed with cancer, utilizing the NCCN Distress Thermometer. Descriptive statistics of components of distress are presented and emphasize the role of anxiety and worry in this population. CLINICAL IMPLICATIONS: Findings suggest that there are multiple sources that contribute to distress. In order to best meet the needs of the individual with cancer, it is essential that an interprofessional team provides discipline specific interventions to ensure appropriate utilization of resources. This abstract describes the feasibility of distress screening and management at every clinic visit. FUNDING: This clinic is funded by the Office of Academic Affiliations of the Veteran’s Administration in a Center of Excellence of Specialty Care (2011–2014). P1-5 LILAC: A Positive Affect Intervention for Women With Metastatic Breast Cancer to Address Stress, Positive Affect and Quality of Life Stefana Borovska1,2, Martha Pietrucha1, Jen Hult1, Michelle Melisko3, Laura B. Dunn3, 4, Dianne Shumay3, Judith T. Moskowitz1 1 University of California San Francisco, Osher Center for Integrative Medicine, San Francisco, CA, USA, 2University of Michigan Medical School, Ann Arbor, MI, USA, 3 University of California San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA, 4University of California San Francisco, Department of Psychiatry, San Francisco, CA, USA PURPOSE: Women with metastatic breast cancer face uncertainty and burdensome treatment regimens, leading to worsening quality of life and depressive symptoms. Positive affect is critical in stress adaptation and is uniquely associated with lower mortality risk. Previously, we developed a positive affect intervention, covering eight skills: noticing positive events, capitalizing/savoring, © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Poster Abstracts of the APOS 11th Annual Conference

gratitude, mindfulness, positive reappraisal, personal strengths, attainable goals and acts of kindness. The purpose of this study is 1) to adapt the positive affect intervention for women with metastatic breast cancer and 2) determine its feasibility, acceptability and preliminary efficacy for improving positive affect, depression, and quality of life. METHODS: Patients with stage IV breast cancer diagnosis and ability to communicate in English were recruited through the UCSF Helen Diller Family Comprehensive Cancer Center. We adapted the positive affect intervention to consist of five 60-minute in-person weekly sessions. We also developed an online version of the program. Women were randomized to one of three conditions: in-person intervention, online intervention, or in-person attention control. Assessments consisted of validated questionnaires including the Differential Emotions Scale, conducted at baseline, one week post-intervention and five weeks post-intervention, We also obtained feasibility and acceptability data including attendance, skill use and recommendation rates. RESULTS: Among the 30 participants (ten in each of the three conditions), mean age was 54.5 years (±11.6; range 29–73) and time since metastatic diagnosis averaged 35.2 months (±40.0; range 1–144 months). Approximately 80% completed both postintervention assessments and 80% attended/viewed all intervention sessions. We compared pre-post changes of both intervention conditions to the control but no differences reached statistical significance. However, we obtained medium effect sizes for positive affect, mindfulness and quality of life. Qualitatively, participants reported high recommendation rates, usefulness, and improved stress management. No adverse study-related events occurred. CONCLUSIONS: Recruitment, attendance and survey completion demonstrated both feasibility and acceptability of the positive affect intervention. Good efficacy and positive qualitative findings confirmed the value of the program to participants. However, due to study design limitations (e.g., small heterogeneous sample, broad inclusion criteria), we cannot draw definitive conclusions and further research is needed to examine the usefulness of positive affect for metastatic cancer patients. RESEARCH IMPLICATIONS: Further research addressing the efficacy and limitations of the positive affect intervention is needed to examine the usefulness of positive affect and other interventions for metastatic cancer patients dealing with distress and diminished quality of life. CLINICAL IMPLICATIONS: Optimal care of metastatic breast cancer patients should include attention to stress management and psychological wellbeing. This pilot study highlights the feasibility, acceptability, and tolerability of a psychological intervention that focuses on positive affect, specifically tailored for metastatic cancer patients. FUNDING: Ms. Borovska was supported by the Osher Center Training in Research in Integrative Medicine (TRIM) T32 predoctoral program. The positive affect intervention was Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Poster Abstracts of the APOS 11th Annual Conference

funded by a grant to Dr. Moskowitz from the Mt. Zion Health Fund/UCSF. P1-6 Beyond the Numbers: Qualitative Analysis of an ACT Intervention for Fear of Cancer Recurrence (The WiLLoW Study) Stefana Borovska1,2, Dianne M. Shumay3, Donna Tran1, Molly Berman3,4, Jennifer Gregg5, Michelle Melisko3, Laura B. Dunn3, 4 1 University of California San Francisco, Osher Center for Integrative Medicine, San Francisco, CA, USA, 2 University of Michigan Medical School, Ann Arbor, MI, USA, 3University of California San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA, 4The Wright Institute, Berkeley, CA, USA, 5San Jose State University, San Jose, CA, USA, 4University of California San Francisco, Department of Psychiatry, San Francisco, CA, USA PURPOSE: Cancer survivors often battle persistent fear of cancer recurrence (FCR); however few targeted treatments address this insidious symptom. Acceptance and Commitment Therapy (ACT) has gained growing evidence in anxious and medically ill individuals. We recently adapted ACT to address FCR in a pilot sample of breast cancer survivors known as the WiLLoW study. (Quantitative results were reported previously.) The purpose of this study was to report qualitative findings from WiLLoW and provide an in-depth investigation of ACT’s impact on the FCR of individual participants. METHODS: We conducted audio-recorded, semi-structured, in-person followup interviews with 13 breast cancer survivors six months after the WiLLoW study. Six women in the intervention provided detailed narrative feedback on their experiences with ACT and FCR. Mean age was 52.1 (+13.1) years (range 39–69) and average time since treatment completion was 12 months. Women were diagnosed with stage I, II or III breast cancer. Three coders used directed content analysis to identify themes related to participant uptake of ACT for FCR. RESULTS: The women described how FCR impaired their quality of life before WiLLoW, how they applied ACT to FCR and daily life, barriers to implementation, changes of the impact of FCR during and after WiLLoW, mechanisms of the positive changes, memorable ACT exercises and comments on logistics, group experience and timing. Mechanisms identified included: mindfulness (six women), values (four women), committed action, acceptance, defusion, addressing negative thoughts, lack of pressure to engage in “positive thinking”, change in perception of cancer recurrence odds. Five women reported WiLLoW was helpful in reducing the impact of FCR on their lives. Three women commented ACT produced significant changes in their lives, using phrases like: “Ah-ha moment”, “liberating”, and “enriching”. © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.


Four women would have preferred a longer/ongoing ACT intervention and two participants recommended that psycho-oncology treatments be made available to all cancer patients. CONCLUSIONS: The findings enhance the understanding of individual participants’ experience with ACT and their perceptions of helpful approaches to living as a breast cancer survivor with FCR. The findings help further characterize the varied ways that breast cancer survivors may respond to, use, and make sense of ACT for FCR. RESEARCH IMPLICATIONS: Qualitative research such as this study will help to define the variety of responses that individual patients may have to ACT and its impact on cancer survivors, leading to improved assessment tools and intervention design. CLINICAL IMPLICATIONS: Providers may be better able to support cancer survivors by understanding the complexity of the phenomenon of fear of cancer recurrence. Understanding which treatment components resonated with individual participants will help providers personalize treatment based on patient characteristics and preferences. FUNDING: The ACT intervention study was funded by the Bradley grant from the UCSF Osher Center for Integrative Medicine and a REAC grant from the UCSF School of Medicine. Ms. Borovska was supported by the Osher Center Training in Research in Integrative Medicine (TRIM) T32 pre-doctoral program. P1-7 Setting Limits With Cancer Patients: A Challenge for Oncology Staff Karen Fireman, Robert Dreicer, Isabel Schuermeyer, Christa Poole, Barbara Savage Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA PURPOSE: Patients often make requests that vary in nature. These can be pertaining to medications, additional diagnostic testing, treatment options or more personal in nature such as a practitioner’s cell phone number or referring to physicians by their first names. Oncology clinicians, who are accustomed to cancer related distress value being able to respond sympathetically to their patients.1 This can have an impact on the relationship between the patient and the professional as well as on the care provided. Although limit setting is often raised in response to situations where a person’s behavior is creating a disturbance, it should be remembered that limits are a part of everyday life.2 However, the positive outcomes of setting limits do not seem to diminish a sense of discomfort among practitioners. Refraining from setting limits may not only prevent patients from changing negative behavior it also tends to split teams which can lead to conflict in providing optimal care for the patient. The purpose of this research is to improve comfort level in setting limits. METHODS: A survey administered by email to 186 staff members from various disciplines of Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


an academic ambulatory cancer center. The survey was prefaced by a written explanation that the anonymous results could help us develop programs to improve their skills to better manage patients. RESULTS: According to the findings, of the 119 who completed the survey, a large percentage reported limit setting important to patient care. However, 83% reported the need to help patients with all of their requests. 76% reported having ability to set limits. 64% reported interest in developing or improving their limit setting skills. CONCLUSIONS: This presentation will help attendees understand challenges providers face in trying to meet patients’ needs while setting limits around expectations and requests. They will gain awareness of options for skill building. RESEARCH IMPLICATIONS: Additional research following skill building interventions to clarify inconsistencies between importance of limit setting and desire to help patients with all of their requests may ensure a better response rate. CLINICAL IMPLICATIONS: Dealing with uncomfortable feelings and acknowledging the need for interventions will impact improved skills and instill confidence in setting limits. FUNDING: None. P1-8 was withdrawn. P1-9 Insult on Top of Injury: Psychosocial Challenges for Men With Histories of Child Sexual Abuse Diagnosed With Prostate Cancer Les Gallo-Silver LaGuardia Community College, City University of New York, NY, USA PURPOSE: Childhood sexual abuse (CSA) is not a rare occurrence and estimated to affect the lives of one in four women and one in six men in the United States (Johnson, 2004). Using these statistics, of the 238,590 newly diagnosed men with prostate cancer expected in 2013, potentially 14,315 could have a history of CSA (ACS 2012). The research on cancer screening of women and women with cancer indicates that a history of CSA can negatively affect the timelines of accessing treatment, treatment compliance and relationships with the medical team (Ackerson, 2012; Cadmen et al., 2012; Clark et al., 2011; Kelly, 2012). The mental health literature reports that men and women survivors of CSA experience difficulties in intimate relationships, self-destructive thoughts and are at risk of developing PTSD (Tuunard et al., 2013; Lamoureux, et al. 2012; Sugaya et al., 2012). There are no specific studies of men with cancer and a history of CSA. METHODS: This presentation based on clinical case studies of a convenience sample of subjects identifies the ways the psychosocial sequelae of prostate cancer and CSA intersect requiring psycho-oncology clinicians to address issues of masculinity, gender identity, sexual functioning, suicidal © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Poster Abstracts of the APOS 11th Annual Conference

ideation, and resurgent PTSD for a subgroup of at risk patients. RESULTS: The issues of CSA and Prostate Cancer could exacerbate the sexual and gender challenges known to affect men with histories of CSA (Cour et al., 2013; Dorahy & Clearwater, 2012; Easton et al., 2013). Case study materials indicate that men are unlikely to disclose information about sexual abuse. Case study materials report several incidents of acting-out behaviors that negatively affect treatment. CONCLUSIONS: The American Urologic Association develops the core curriculum in medical education in urology. None of the 51 sections of the core curriculum addresses the issue of CSA and its potential impact on adult male patients (AUA, 2013). The prostate cancer psychosocial literature describes the emotional impact of the surgery/radiation/ androgen treatments and loss of erectile function on selfesteem and body image of affected men without addressing the potential issue of sexual abuse in contrast to the literature on women’s cancers (Ervik & Asplund, 2012; Wiechno et al., 2013; Zaider et al., 2012).The training of medical and mental health professionals specializing in helping men with prostate cancer needs to include a training module on male survivors of sexual abuse. RESEARCH IMPLICATIONS: The incidence of male childhood sexual abuse and the incidence of prostate cancer indicate that there is a substantial patient population to study. The psychosocial literature requires further study of the intersection of these two issues affecting men. CLINICAL IMPLICATIONS: Screening, assessment and intervention strategies are needed to address this at risk population. FUNDING: None. P1-10 Mindfulness Based Stress Reduction During Active Surveillance for Prostate Cancer: A Clinical Case Study Vered Hankin1, David Victorson1, Carly Maletich1, Charles Brendler2 1 Northwestern University, Chicago, IL, USA, 2Northshore University Health System, Chicago, IL, USA PURPOSE: Several Mindfulness Based Stress Reduction (MBSR) studies have been conducted specifically with cancer patient populations and have demonstrated reduced emotional distress and improved QOL MBSR teaches both philosophical and experiential skills to combat stress. The 8 week course teaches exercises that cultivate Eastern philosophical principles such as non-judgment, non-striving, and equanimity. Our MBSR research focuses on men with prostate cancer on active surveillance, in order to reduce anxiety related to treatment decisions. This particular case study highlights one patient’s journey (Patient J). METHODS: Patient J is a 60 year old married Caucasian male on active surveillance for prostate cancer. When he and his wife began the MBSR course he reported euthymic mood with consistent affect. He denied experiencing anxiety related to being on active surveillance however he did mention physical Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Poster Abstracts of the APOS 11th Annual Conference

aches and pains. The MBSR course was part of a clinical research study. Overall treatment goals included lowering both general and disease specific anxiety for patients and partners. RESULTS: Patient J exhibited resistance to the exercises at first, as he reported finding them “boring” and therefore not completing them. The instructor helped him incorporate course principles of nonreaction and nonjudgment and encouraged him to implement neutral mind to re-engage. In the next session Patient J reported a newfound excitement not only for the exercises, but for life. “I give up too quickly in life,” he said. By the end of the 8-week course, he reported being more engaged in his well-being and thus ultimately less worried about the future. He and his wife also reported better communication. He viewed the class as a key component of his medical treatment. CONCLUSIONS: At the course’s end, Patient J reported feeling empowered in taking on a challenge. Ultimately, he felt calmer, more alert, and engaged. While a majority of men verbally denied stress, pilot results showed a significant improvement in fear of disease progression. This in turn could improve QOL of both patients and partners both in general and in reducing the impact of anxiety on treatment decisions. RESEARCH IMPLICATIONS: The case above illustrates an example that leads to some of our findings in our pilot study on MBSR and prostate cancer. Our results showed that an MBSR intervention led to reports of significantly reduced fear of cancer progression (p = 0.043) at 6 months, which was a large effect size (d = 1.04). As a result, we are currently in the midst of a follow up study 3 year study focusing on MBSR and urological cancers. CLINICAL IMPLICATIONS: Research has shown that individuals and spouses facing cancer undergo a great deal of stress – both directly and indirectly related to illness. While a majority of men verbally denied stress, pilot results showed a significant improvement in illness related stress. This in turn could improve QOL of both patients and partners both in general and in reducing the impact of anxiety on treatment decisions. FUNDING: NorthShore University Hospital. P1-11 Feasibility of Patient-Created Wordles® to Support "Being Known" in an Outpatient Chemotherapy Setting Kathy Johnson University of Wisconsin, Madison, WI, USA PURPOSE: Patients value "being known" by their health care providers, and "hearing the patient’s story" is an important component of psychosocial care. However, communication time is limited in the high-tech, fast-paced oncology clinic setting. Semantic field representations (e. g., a word picture) may efficiently capture the patient’s story and could be used to stimulate nurse-patient conversation. The purpose of this study was to test the feasibility of patients creating a Wordle® to communicate their personal stories with a clinic nurse. Outcomes included participation © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.


rate, patients’ ability to audio-record personal stories and create Wordles, and their perception of the experience. METHODS: Ten patients at a Midwestern oncology clinic were asked to make 3 audio-recordings in their homes, over a 1-week period. They were instructed to speak about anything they wanted the nurse to know, and were provided with prompt questions, if necessary. Audio-recordings were returned by mail and transcribed. At the next clinic visit, the researcher and the patient created a Wordle® together, in which word size increased with word frequency. Semistructured interviews were conducted immediately after the participants shared their Wordle with their nurse. Content analysis was used to identify themes in patients’ perceptions of the experience. RESULTS: Eighty three percent of those approached agreed to participate (n = 10). Nine patients made recordings. Seven successfully created Wordles; two did not return to the clinic within the study period. Six were able to share them with the nurse; one did not because his treatment was postponed. Recording was not reported as distressing; however one patient was too ill to make them. One participant reported being particularly glad to be using an audio-recorder; one noted that she would have preferred writing. Patients reported that they appreciated the opportunity to talk, and believed that this intervention could introduce topics that would not have come up in normal conversation. CONCLUSIONS: The intervention appears feasible in the clinic setting. RESEARCH IMPLICATIONS: Further research is needed to understand the impact of the intervention on nurse-patient communication and psychosocial outcomes. CLINICAL IMPLICATIONS: Patient stories may be incorporated in the clinical record to facilitate psychosocial care for patients with cancer. FUNDING: None. P1-12 Bringing Baby on Board: Using Acceptance and Commitment Therapy to Treat Anxiety in a Cancer Survivor Amanda Kracen1,2 1 Siteman Cancer Center at Barnes-Jewish Hospital, St Louis, MO, USA, 2Washington University, St Louis, MO, USA PURPOSE: Many individuals have a premorbid history of an anxiety disorder prior to cancer diagnosis, and psychological problems can be exacerbated by diagnosis and treatment (Hahn, 2011). Acceptance and Commitment Therapy (ACT; Hayes et al., 2012) has been found to be an effective intervention for people who have coped with cancer (Feros et al., 2011). This presentation demonstrates ways that ACT principles can be incorporated into the treatment of anxiety in cancer survivors; the principles are illustrated using a case study of a woman with premorbid Generalized Anxiety Disorder and Specific Phobia. METHODS: The 48-year-old married Caucasian female was referred for “ongoing anxiety.” She had been diagnosed with breast cancer a year earlier, had recently completed treatment, and was getting diagnostic scans every 6 Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


months. Intake data indicated anxious symptoms, and she endorsed fear of recurrence. She was unable to identify where she derived meaning in life. The patient met criteria for Generalized Anxiety Disorder and Specific Phobia, Situational (airplanes), which she reported struggling with for years. Within ACT, the patient was conceptualized as suffering with anxious symptoms that impaired daily functioning and overwhelmed her ability to engage in valued behaviors. She consistently avoided her internal experiences and believed that she needed to “feel better” to improve her mental health. The patient was seen for 13 sessions during which ACT-consistent interventions were employed. RESULTS: While the patient continues to experience anxious symptoms and meet criteria for Specific Phobia, her emotional symptoms are manageable. More importantly, she has enriched life by becoming more mindful and accepting of her internal experiences, identifying personal values and goals, and engaging in activities of valued living including a family vacation that necessitated airplane flights. She has terminated this episode of care, requesting periodic maintenance sessions. CONCLUSIONS: Recognition that ACT is a suitable and effective treatment for cancer survivors is increasing (Angiola & Bowen, 2013). This case study illustrates the utility of ACT with cancer survivors, and especially highlights how treatment can address both premorbid anxiety disorders and more specific cancer-related worry. RESEARCH IMPLICATIONS: This case highlights the need for further research into the specific applications of ACT for cancer survivors. CLINICAL IMPLICATIONS: Clinicians interested in acceptance-based therapy approaches may benefit from reviewing a case in which premorbid and cancer-specific anxiety was treated using ACT with good treatment gains. FUNDING: None. P1-13 Creating a Psycho-oncology Service to Meet the Needs of Patients and Healthcare Providers Living in Rural Communities Susan Krigel1, Ashley Spaulding1, Hope Krebill1, Angela Banitt Duncan2, Melanie Leepers3, Eve-Lynn Nelson2 1 Midwest Cancer Alliance--University of Kansas Medical Center, Kansas City, KS, USA, 2Institute for Community Engagement--University of Kansas Medical Center, Kansas City, KS, USA, 3Tammy Walker Cancer Center, Salina, KS, USA PURPOSE: Meeting the psychosocial needs of cancer patients is an essential element of quality care. However, patients living in rural areas face many barriers to getting those needs fulfilled. This abstract will describe a psychooncology service delivered largely through interactive televideo (ITV) that was created in part to overcome the barriers faced by rural cancer patients. METHODS: A variety of programs and services were created for the Midwest Cancer Alliance (MCA) to meet © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Poster Abstracts of the APOS 11th Annual Conference

the needs of both cancer patients and their healthcare providers. The MCA is an organization that links the University of Kansas Cancer Center with healthcare providers and patients with cancer across the state of Kansas. The majority of programs are delivered by ITV; some are conducted in person (IP) or by teleconference (TC). Patient offerings include multi-week and one-time psychoeducational programs. Healthcare provider services include professional education programs, monthly group calls, conceptual and technical assistance in implementing national guidelines, and program development. These offerings will be discussed in more detail on the poster. A vital element of the psychooncology service is individual counseling for cancer patients via ITV. The initiation of this service presented many challenges for implementation, including issues regarding credentialing, referrals, billing, suicide protocol, and privacy. Steps required for successful initiation and additional barriers to implementation will be described. RESULTS: Forty-five patients participated in a multi-week survivorship program delivered via ITV to four sites. One-time presentations on “Chemobrain;” Coping with Anxiety, Depression, and Fatigue; and Depression and Anxiety in Breast Cancer Survivors have been offered 18 times to 400 total participants.Three professional education programs on Breast Cancer Survivorship and Depression, Anxiety, and Suicide among Cancer Patients have been offered to 49 healthcare provider participants. CONCLUSIONS: Several delivery mechanisms (ITV, IP, and TC) have been employed to provide essential psychooncology services to rural cancer patients and healthcare providers. Ideally, these services will help reduce some of the barriers that patients living in rural areas encounter when attempting to address psychosocial needs. Future directions will include expanding the individual counseling service and measuring participant satisfaction levels and outcomes. RESEARCH IMPLICATIONS: The model presented is an example of the extension of the services of an academic medical center to rural communities through the use of technology. Evidence is presented regarding the variety of services offered, number of participants, and level of satisfaction of participants. Previous research has documented comparable levels of satisfaction between psychosocial services delivered via interactive televideo (ITV) and in person. Future research may examine specific aspects of satisfaction in more detail as well as explore possible differences in therapeutic outcomes. CLINICAL IMPLICATIONS: Multiple barriers must be overcome when addressing the need for psychosocial services to rural cancer patients. Delivery of services via ITV can help overcome barriers to accessing services, including geographical distance and the shortage of mental health providers. Evidence is presented concerning challenges faced when implementing psychooncology services via Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Poster Abstracts of the APOS 11th Annual Conference

collaboration between an academic medical center and rural cancer centers, including institutional, provider, and patient concerns. FUNDING: Kansas Masonic Foundation. P1-14 Quality Psychosocial Care for Persons Who Support Women With Breast Cancer: An Integrative Review of Intervention Literature Robin Lally1, Catherine Brooks2 1 University at Buffalo, The State University of New York, Buffalo, NY, USA, 2D’Youville College, Buffalo, NY, USA PURPOSE: Families, spouses and friends who provide support and care for people with cancer experience emotional distress equal to that of patients. Persons providing support and care report unmet psychosocial needs and are at risk for significant levels of anxiety and depression. The purpose of this integrative review was to identify and describe intervention studies published between 2003 and 2013 that addressed the psychological adjustment needs of individuals (family, spouse or friend) supporting women with early stage breast cancer. METHODS: CINAHL, PubMed and PsychINFO databases were searched comprehensively using keywords and MeSH terms derived from a conceptual model of adjustment to cancer. Authorsearches and hand-searches of files were also conducted. Studies were retained for review by the research team if the sample was from a Western culture and outcomes were reported separately for supporters (family/spouse/friend) of women with early stage breast cancer after an intervention focused on supporter or supporter/patient psychological adjustment. RESULTS: Six studies met criteria for inclusion in the review; three were pre-experimental and three randomized controlled trials (RCTs). Samples were primarily Caucasian. Three studies reported outcomes of family/friend/spouse and three of male spouses only. Intervention delivery included phone counseling/exercise encouragement (1), face-to-face counseling (2), psychoeducational video/phone counseling (1) and group education/counseling (1) to patients and supporters (3) or supporters only (3). Effects of interventions on psychological wellbeing were mixed, however all results showed improvement in at least one variable. CONCLUSIONS: Few RCTs have addressed the psychological needs of individuals who provide support to women with early stage breast cancer. Intervention delivery and measured outcomes vary among studies although benefits of interventions for supporters and/ or patients were reported. RESEARCH IMPLICATIONS: RCTs with consistent intervention and outcome measures and culturally diverse samples are needed to build the body of evidence pertaining to psychological care of persons who support women with early stage breast cancer. CLINICAL IMPLICATIONS: The studies reviewed indicate that intervening with © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.


supporters of women with early stage breast cancer may be beneficial. More research is needed to produce stronger evidence to support use of one intervention over another in clinical practice. FUNDING: American Cancer Society MRSG 11-101-01CPPB & University at Buffalo. P1-15 Group Cognitive-Existential Pilot Intervention to Address Fear of Cancer Recurrence Among Women With Cancer Christine Maheu1,2, Sophie Lebel3, Monique Lefebvre4, Scott Secord5, Christine Courbasson2, Mina Singh6, Lynne Jolicoeur4, Aronela Benea2, Cheryl Harris3,4, Michael Fung Kee Fung4, Zeev Rosberger7, Pamela Catton2 1 McGill University, Montreal, Canada, 2The Princess Margaret Cancer Centre, Toronto, Canada, 3University of Ottawa, Ottawa, Canada, 4The Ottawa Hospital, Ottawa, Canada, 5Canadian Partnership Against Cancer, Toronto, Canada, 6York University, Toronto, Canada, 7Jewish General Hospital, Montreal, Canada PURPOSE: To present pilot data on the the feasibility and preliminary efficacy of a 6-week cognitive-existential (CE) group intervention designed to address fear of cancer recurrence in women with breast or ovarian cancer. METHODS: This study was a single-arm multi-site study with prepost, and 3-month follow-up measurement occasions. RESULTS: A total of 56 breast or ovarian cancer survivors enrolled in the study; 44 completed the CE group intervention. The intervention reduced the primary study outcome measure of FCR and secondary study outcome measures of cancer-specific distress and uncertainty. There were also improvements in secondary study outcome measures of quality of life and coping. The effect sizes of the observed changes were for the most part in the medium to large effect range; furthermore almost all changes were sustained at 3-month follow-up. CONCLUSIONS: This brief intervention appears feasible and has shown promising results in addressing FCR and related secondary outcomes of cancer-specific distress, uncertainty, quality of life and coping; however, it should be further tested using a randomized controlled study design to more definitively assess its efficacy. RESEARCH IMPLICATIONS: This pilot study provides preliminary evidence towards the planning of a RCT. CLINICAL IMPLICATIONS: Fear of cancer recurrence is still poorly unaddressed in clinics. Few evidence base intervention exist to provide guidance for clinicians to support their patients experiencing high fear of cancer recurrence. This study provides preliminary guidance towards the potential use of a group therapy to help patients deal with fear of cancer recurrence. FUNDING: Canadian institute of health research; nursing care partnership program of the Canadian nurses association. Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


P1-16 A Case Study of Psychodynamic Therapy for Distress Related to Body Image Concerns About Mastectomy and Breast Reconstruction Mark Moore Abramson Cancer Center at Pennsylvania Hospital, Philadelphia, PA, USA PURPOSE: There is a lack of research on the effectiveness of psychodynamic therapy (PDT) with oncology patients, but Shedler (2010) reported an effect-size of 1.17 for short-term PDT with non-oncology patients. In this case PDT was effectively used to treat emotional distress related to body image concerns evoked by breast surgery. This case study seeks to highlight gaps in the existing psychooncology literature on the use of PDT and will argue for the importance of researching psychodynamic techniques. METHODS: The patient was a 45 year-old woman who had the BRAC1 gene and a history of cancer in her family. She presented with anxiety about the decision to undergo a prophylactic mastectomy. She also reported pre-existing depression, impulsivity, self-consciousness and poor selfimage. The therapy focused on how childhood obesity caused her to defend against low self-esteem by convincing herself that looks did not matter. By clarifying this as a recurrent theme, the therapist was able to show how it affected her decisions about breast reconstruction as she feared being seen as vain. Therapy also helped her tolerate her anxiety about surgery, by encouraging her to express the feelings associated with her anxiety. Elaboration of fantasies about men’s response to her post-surgery helped her question a lifelong assumption that she was unattractive. RESULTS: Over the course of 45 weekly sessions, the patient had a complete remission of depressive symptoms and she was able to face her reconstructive surgery without anxiety. Increased self-understanding brought about positive changes in her dating and work life. Follow-up at one-year indicated that these changes remained in effect. CONCLUSIONS: N/A. RESEARCH IMPLICATIONS: This case study illustrates specific PDT techniques that warrant further research. Potential questions of interest include how expression rather than suppression of affect may reduce distress, the value of exploring fantasies in therapy and how clarification of psychological defenses promotes coping. CLINICAL IMPLICATIONS: This case outlines how PDT can be used effectively with cancer patients who, due to poor body image, are struggling with the decision to have a mastectomy, and expands treatment options for clinicians. FUNDING: None. P1-17 Psychosocial Telephone Interventions for Cancer Patients: A Systematic Review Sonia Okuyama, Whitney Jones, Christine Ricklefs, Al Marcus University of Colorado Cancer Center, Aurora, CO, USA © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Poster Abstracts of the APOS 11th Annual Conference

PURPOSE: More than one third of cancer patients experience elevated psychosocial distress. As screening for distress becomes more common, the number of patients being referred for psychosocial care will increase. Psychosocial telephone interventions have been recommended as a convenient and exportable alternative to in-person interventions to address psychosocial distress. The present study seeks to review the efficacy of psychosocial telephone interventions for cancer patients as studied in randomized controlled trials (RCTs). METHODS: We conducted a systematic review of RCTs published in peer-reviewed journals that evaluated psychosocial telephone interventions in adult cancer patients across the survivorship continuum. The search was last updated in March 2013. RESULTS: 480 articles were identified through the initial database search. After manual review, 13 were included, with an additional 7 studies identified by back-citation, for a total of 20 studies. Participants were largely Caucasian, highly educated, with mean age ranging from 49 to 75 years. Most participants were breast cancer patients (n = 13). Sample sizes were generally small, with most patients recruited from large hospitals, including multi-site clinics and academic medical centers. Only one screened on the basis of psychosocial need. Interventions varied greatly in length and intensity. 8 studies reported significant effects post-intervention in the hypothesized direction on at least one psychosocial outcome measure. Of these 8 studies, 5 included more than one follow-up assessment, and of these only 1 reported significant effects on the last follow-up assessment. No clear commonalities were found among those studies that reported significant effects. CONCLUSIONS: Many methodological concerns and lack of consistency in adherence to CONSORT reporting guidelines were identified. This body of research would benefit from well-designed, theory-based RCTs with sufficient statistical power to provide more definitive evidence for intervention efficacy. This will probably require multi-institutional collaborations, guided by intervention and research methodology best practices. RESEARCH IMPLICATIONS: Psychosocial telephone interventions may decrease distress in cancer patients but larger RCTs are needed to demonstrate their efficacy, likely requiring multi-institutional collaborations, using rigorous methodology. CLINICAL IMPLICATIONS: Psychosocial telephone interventions are potentially effective in alleviating distress in cancer patients. FUNDING: None. P1-18 Building a Better Lung Cancer Support Group: Experiences From the United States, Australia and the United Kingdom Maureen Rigney Lung Cancer Alliance, Washington DC, USA Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Poster Abstracts of the APOS 11th Annual Conference

PURPOSE: People diagnosed with lung cancer experience high levels of distress and their unmet physical and emotional needs are greater than those diagnosed with other types of cancer. One significant unmet need is social support. An important way for patients to connect is through in-person support groups, and the benefits to participation extend beyond support and may include an increase in feelings of control and confidence and a decrease in depression and distress. Most lung cancer patients prefer lung cancer-specific support groups rather than general cancer groups. However, facilitators report that starting and maintaining lung cancer-specific groups can be challenging. As a result, the number of such groups is insufficient to meet the need. METHODS: To understand the challenges of starting and maintaining lung cancer groups, as well as the ways facilitators have tried to overcome those challenges, a survey of 20+ questions was sent to over 130 lung cancer support group facilitators, mostly in the United States but also those in the United Kingdom and Australia. RESULTS: The overall response rate was 56%. The survey results have been turned into a guide for developing successful lung cancer groups. Suitable for facilitators at all skill levels, the guide includes creative solutions for overcoming barriers and resource constraints. Armed with the guide, professionals interested in starting lung cancer support groups will learn what to consider as they organize their group and will have at the ready tried and true techniques for making their groups successful. Facilitators struggling with groups will gain fresh perspectives on the practices that helped others to succeed. Also presented will be the results of a small formative research project currently underway to test the usefulness and feasibility of the guide in the real world in a small sample of struggling lung cancer support groups in the US. CONCLUSIONS: Lung cancer patients benefit from in-person support groups in immeasurable ways but many do not have access due to the lack of available groups. While challenges to initiating and maintaining successful lung cancer support groups exist, expert facilitators have found creative ways to advertise their groups, engage participants and keep their groups thriving. RESEARCH IMPLICATIONS: Researchers will be interested in hearing about the challenges that support group facilitators face, how they have overcome them and about the small study implemented to test the guide. Further research to understand the components that make a support group successful and sustainable is needed. CLINICAL IMPLICATIONS: Clinicians interested in starting not just lung cancer groups but groups for any cancer of poor prognosis will benefit from learning how successful support group facilitators have overcome challenges and barriers. Those running groups that are struggling or are interested in hearing innovative ways others have used to make their groups successful will also benefit. FUNDING: None. © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.


P1-19 Psilocybin-Assisted Psychotherapy in the Treatment of Cancer-Related Psychosocial Distress/Anxiety Lisa Sevanick1,2,3 1 NYU Langone Medical Center, New York, NY, USA, 2 NYU Clinical Cancer Center, New York, NY, USA, 3 New York University School of Medicine, New York, NY, USA PURPOSE: Psilocybin-assisted psychotherapy is currently being studied as method to help alleviate cancer related existential anxiety in several academic settings in the United States (New York University School of Medicine, JohnsHopkins University). The authors served as co-therapists in the NYU Cancer Anxiety Psilocybin project, working with a patient with metastatic breast cancer who suffered from marked passivity, accompanied by mixed anxiety and depression symptoms. We will present a rationale for this approach, several vignettes from the eleven-session treatment and the benefits derived from this type of intervention. METHODS: GS is a 70 year-old married woman with one adopted daughter. She has a 12-year history of breast cancer, with multiple recurrences. The decreasing length of time between each recurrence led to a deep fearfulness and passivity regarding her ongoing cancer treatment. After a thorough clinical engagement, our therapy functioned to prepare her for a single, daylong meditative session guided by us with psilocybin, a serotonergichallucinogen, known to occasion mystical-type experiences with personal meaning and spiritual significance. Therapy sessions followed, in which we explored how her remarkably intense experience with the psilocybin affected her. We will present clinical material from her sessions, including our efforts to integrate her psilocybin experience with her presenting symptoms and family dynamics. RESULTS: There were notable shifts in self-identity, recovery of lost and abandoned strengths, and changes in her narratives regarding the psychological effects of cancer treatment in her life. CONCLUSIONS: Currently available interventions for cancer related existential anxiety are limited in both scope and effectiveness. We will describe an innovative paradigm for treatment, one that has a medication-assisted spiritual experience at its core. We will discuss clinical material, our therapeutic approach to this type of work and its impact on our patient’s quality of life. Specifically, we will highlight the reduction in her anxiety and passivity, affective stabilization and the recovery of a sense of meaning and purpose in life. RESEARCH IMPLICATIONS: Currently available interventions for cancer related existential anxiety are limited in both scope and effectiveness. We will describe an innovative paradigm for treatment, one that has a medication-assisted spiritual experience at its core. CLINICAL IMPLICATIONS: We will discuss clinical material, our therapeutic approach to this type of work and its impact on our patient’s quality of life. Specifically, we will Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


highlight the reduction in her anxiety and passivity, affective stabilization and the recovery of a sense of meaning and purpose in life. FUNDING: None. P1-20 Interpersonal-Relational-Existential Therapy in Oncology Settings Nicole Taylor1,2, Emily Newman1,3 1 University of Denver, Denver, CO, USA, 2Exempla Healthcare, Denver, CO, USA, 3Colorado Blood Cancer Institute/Presbyterian-St. Luke’s Medical Center, Denver, CO, USA PURPOSE: In this presentation, we will discuss how utilizing an integrative theoretical approach that draws upon interpersonal, relational, and existential theories can be beneficial with cancer patients. METHODS: The use of empirically supported treatments and cognitive-behavioral therapy are well established in health settings, however in practice, many clinicians adhere to a more integrative model of conducting psychotherapy. We will discuss how to balance the demands for empirically supported treatments within a health setting with relational approaches that are especially necessary and beneficial in working with cancer patients. RESULTS: Drawing upon common factors research (e.g. Wampold), interpersonal psychotherapy (e.g. Teyber), existential therapy (e.g. Yalom), and relational psychotherapy (e.g. Wachtel), we will share a new model for integrating theory in oncology settings. CONCLUSIONS: Common factors research has shown that the relationship between therapist and client is the most important predictor of outcome in psychotherapy. In addition, the trans-theoretical tenets of symptom explanation and confrontation of negative emotions are particularly important in working with cancer patients. We will share our clinical experiences working with cancer patients in both inpatient and outpatient settings. Since the traditional therapeutic “frame” is often not present in oncology settings and therapy can be done “chair-side” while patients are receiving chemotherapy, waiting for an appointment, or bedside in hospital rooms, the unique factors in applying these theories to work in psychosocial oncology will be emphasized. We have found that taking a more relational approach can occur even with time and space constraints placed on psychotherapy. RESEARCH IMPLICATIONS: The research implications of a more interpersonal-relational approach in health settings, especially as managed care and medical centers place restrictions on time spent with patients, will be discussed. Additionally, research ideas for testing this theory will be explored. CLINICAL IMPLICATIONS: This presentation will be relevant to psychologists, social workers, and other clinicians who provide counseling to cancer patients. Some specific techniques we will describe include: using the here-andnow to process both physiological and emotional changes, © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Poster Abstracts of the APOS 11th Annual Conference

utilizing the therapeutic relationship to understand relational themes, discussing how cancer treatments and medications have impacted relationships, showing unconditional positive regard for patients through potentially disfiguring treatments, and creating a space to discuss existential and mortality-related concerns. FUNDING: None. P1-21 Development of a Multimedia Psychoeducational Intervention to Increase Uptake of BRCA Genetic Counseling Among High Risk Breast Cancer Survivors Susan T. Vadaparampil1, Kelli Nam1, Teri Malo1, Meghan Sherman Caldwell1, Courtney L. Scherr1, Rachael Linder1, Hyo S. Han1, Jongphil Kim1, Cathy D. Meade1, M. Catherine Lee1, Tuya Pal1, Christian Ledford2, Rebecca Rhodes2, Gwendolyn Quinn1 1 H. Lee Moffitt Cancer Center & Research Institute Health Outcomes and Behavior, Tampa, FL, USA, 2Silent Records, Inc., Lakeland, FL, USA PURPOSE: This abstract describes a series of iterative steps that led to the development of a multimedia PEI to increase uptake of genetic counseling targeted to high-risk breast cancer survivors. METHODS: This project utilized a multiphase approach. In Phase 1, our team developed PEI content guided by the Health Belief Model and informed by prior pilot studies, scientific literature, and a review of existing cancer education materials. In Phase 2, an interdisciplinary team with expertise in clinical oncology, genetics, health education, psychology, and health communication developed a working creative brief, from which multimedia companies could generate concept proposals. In Phase 3, the multimedia PEI was produced (video) and refined (accompanying booklet). In Phase 4, the suitability of the PEI will be evaluated with survivors and health care providers using principles of Learner Verification. RESULTS: The PEI content addressed factors that may influence uptake of genetic counseling including: incomplete knowledge (e.g., misperceptions about genetic counseling), health beliefs (e.g., perceived benefits), and psychosocial factors (e.g., feeling overwhelmed). The selected concept proposal focused on genetic counseling as a means to help survivors engage in their own health and use information for empowerment. The resultant PEI is a 12 minute video and accompanying booklet. The learner verification interviews are being conducted with breast cancer survivors (n = 24) and health care providers (n = 9) recruited through medical oncology, surgical oncology, and survivorship clinics. CONCLUSIONS: This project produced a multimedia tool to facilitate uptake of genetic counseling among high-risk breast cancer survivors. If evaluated favorably by survivors in the current study and deemed effective in future studies, this PEI can be adapted for use in clinical settings. Also, the processes described Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Poster Abstracts of the APOS 11th Annual Conference

for creating, testing, and adapting materials is highly transferable for the development of other cancer content-specific PEIs. RESEARCH IMPLICATIONS: This information will provide researchers with an approach to moving observational findings toward the development and assessment of the acceptability of a psychoeducational intervention to promote behavior change. The topic of this project is to increase uptake of genetic counseling among high-risk breast cancer survivors meeting National Comprehensive Cancer Network criteria for referral to a genetic professional. CLINICAL IMPLICATIONS: Clinicians will learn more about patient barriers to uptake of genetic counseling services when they are referred at or near the time of a cancer diagnosis and potential strategies for addressing these barriers. FUNDING: This project was supported by a grant from the National Human Genome Research Institute (1 R21 HG006415-01; “Genetic Education to Promote Counseling Attendance After Surgical Treatment”). P1-22 Perceived Benefits of Participation in a Psychotherapy RCT Among Patients With Advanced Cancer Rebecca James1,2, Julia Kulikowski2, Barry Rosenfeld1,2, Hayley Pessin2, William Breitbart2 1 Fordham University, Bronx, NY, USA, 2Memorial Sloan Kettering Cancer Center, New York, NY, USA PURPOSE: Psychological distress is common among patients with advanced cancer. However, very few psychotherapy interventions have been developed for patients with advanced cancer. In part, this may reflect a lack of awareness by clinicians and researchers about the emotional needs of advanced cancer patients and specifically, what they seek to gain from participating in psychotherapy at the end of life. We sought to explore the anticipated benefits of participating in a group psychotherapy RCT for patients with advanced cancer. METHODS: Upon providing informed consent to participate in a group psychotherapy RCT, stage III and IV patients in an ambulatory care cancer hospital (N = 253) were asked “How do you think your participation in group psychotherapy will benefit you?” A Thematic Content Analysis (TCA) was used to code participant responses. Relationships between anticipated benefit and demographic variables, physical functioning, distress, social support, optimism, and treatment adherence were also explored. RESULTS: Five main themes emerged from the TCA, including a desire to obtain perspectives from others with the same life experience regarding coping skills; advice on logistical aspects of illness management (e.g., balancing treatment with work, new treatment possibilities); a place to speak about issues that they feel that they cannot share with family; strength and courage to continue fighting the illness and a sense of purpose and motivation to achieve future goals; the opportunity to teach others from one’s own life © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.


experience. Additional analyses will explore the relationship between patients’ desired benefits and physical and psychological characteristics. CONCLUSIONS: The consistency of responses from participants indicates that there are common concerns and needs among patients with advanced cancer. Interventions should be developed to target these needs, recognizing that patient-centered variables such as distress level likely moderate the patient’s needs and response to psychological intervention. RESEARCH IMPLICATIONS: The information included in this presentation informs the development of psychotherapy research, highlighting what should be the major features of such interventions. CLINICAL IMPLICATIONS: The information included in this presentation is relevant to clinicians as it sheds light on concerns that patients might have in palliative care. FUNDING: This research was funded by the National Cancer Institute. P1-23 Exploring the Utility of DSM Criteria for Depression in Older Adults With Cancer Rebecca James1,2, Barry Rosenfeld1,2, Allison Hourani1, Christian Nelson1 1 Memorial Sloan Kettering Cancer Center, New York, NY, USA, 2Fordham University, Bronx, NY, USA PURPOSE: Identifying depression in older cancer patients presents a unique challenge as it combines the difficulty of diagnosing depression in cancer patients with the complexities of detecting depression in older adults. The primary source of difficulty lies in the overlap between the DSM criteria for depression, and many side effects of cancer treatment and problems associated with advancing age. As a result, many DSM criteria may not differentiate depression in older cancer patients. We conducted an extensive literature search to help delineate which DSM criteria and if any alternative criteria may be useful in diagnosing Major Depressive Disorder (MDD) in older cancer patients. METHODS: We conducted a literature search of several databases using key search terms. Articles were also identified by a manual search of references from all retrieved articles. Several book chapters were identified and included in the review. We explored the literature focusing on diagnosing depression in three separate groups: adults with cancer, older adults, and older adults with cancer. We categorized potential diagnostic criteria under three categories of affective, cognitive, and somatic symptoms. RESULTS: Unique depression profiles emerged for adults with cancer and older adults. The literature suggests that only 7 DSM criteria may be useful in adults with cancer and only 4 DSM criterion may be useful in older adults. Considering the overlap in older adults with cancer, only four DSM symptoms appeared to have consistent efficacy: Anhedonia, concentration difficulties, insomnia/hypersomnia, and psychomotor agitation/retardation. Additional possible symptoms that Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


were supported across the literature for this unique clinical population were: Loneliness/social withdrawal, hopelessness/ helplessness, malaise/despair/weariness of living, irritability, lack of usefulness/purpose/mastery, fearfulness, pessimism, feeling overwhelmed, bodily pain, and activity restriction beyond illness/functional ability. CONCLUSIONS: Many DSM criteria were not supported in the literature to be useful to differentiate depression in older cancer patients, and are potentially replaced by what might be more sensitive, relevant criteria. These alternative criteria may not only provide more clinical utility for diagnosing MDD in this population, but may also be instrumental in identifying milder forms of depression, which are recognized as highly prevalent and clinically significant across these groups. Future research should be aimed at identifying the symptoms that differentiate classic MDD from that experienced by older depressed cancer patients. Improving our conceptualization of depression in older cancer patients will increase the accuracy of clinician assessment and subsequently, will provide the opportunity for more effective treatment and better quality of life for these patients. RESEARCH IMPLICATIONS: The information presented in this abstract has implications for researchers working with older adults who have cancer. Measurement of depression in intervention research may require a new approach in order to better conceptualize the construct. CLINICAL IMPLICATIONS: The clinical implications of exploring the phenomenology of depression in older adults with cancer are extensive. The information contained in this presentation sheds light on the more subtle but perhaps more sensitive signs and symptoms of depression that clinicians should be assessing for in their older adult patients with cancer. FUNDING: This research was funded by a grant from the National Cancer Institute. P1-24 Barriers to Providing Oral Health and Oral Cancer Screening in Long-Term Care Facilities Peter Maramaldi1,2, Tamara Cadet1 1 Simmons College School of Social Work, Boston, MA, USA, 2 Harvard School of Dental Medicine, Boston, MA, USA PURPOSE: Oral cancer will be diagnosed in an estimated 40,000 Americans in 2011 and will cause approximately 8,000 deaths. Nearly half of the people diagnosed with oral cancer were over age 65 and about 60% of those who died of oral cancer were over age 65. Early diagnosis —through screening—is key to survival. Approximately 25% of patients with oral cancer die because of delayed diagnosis and treatment. In comparison to elders in community settings, nursing home residents are more likely to experience poor dental care, which predicts late stage diagnosis of oral cancer. This paper examines the perceived benefits, barriers, and capacity of long-term care facilities to provide oral health care and oral cancer screening. © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Poster Abstracts of the APOS 11th Annual Conference

METHODS: An integrated theoretical model incorporating the Health Belief Model, Transtheoretical Model and Implementation Science framed the qualitative interviews and analysis. Ten focus groups were held with long-term care administrators. RESULTS: Findings indicate that while long-term administrators are committed to excellent oral care for their residents, competing demands for resources combined with a lack of incentives make oral health a low priority issue. Other barriers include insurance regulations, funding, and low knowledge about oral cancer risk among nursing home residents, family members, and staff. Perceptions of low capability to provide screening for oral cancer, combined with high motivation to divert resources toward safety and nutrition contribute to low screening rates. CONCLUSIONS: Several approaches identified by the participants identify feasible low-cost approaches to improved oral care that administrators would likely support and implement. The study identified empirically determined feasible approaches to comprehensive oral health and cancer screening. RESEARCH IMPLICATIONS: This study demonstrated the utility of theory to identify those at risk for low participation, low cost opportunities to improve quality, and motivations for staff to provide oral cancer screening. CLINICAL IMPLICATIONS: Findings from this study provide formative data to aid in the development of interventions to promote oral cancer screening. The study also demonstrates the need to develop standards for oral cancer screening practices in long-term care facilities. FUNDING: National Institute of Dental and Craniofacial Research. P1-25 The Vintage Readers Book Club: A Novel Approach to Psychosocial Support for Elders Jimmie Holland1, Mindy Greenstein2, Christian Nelson1 1 Memorial Sloan-Kettering Cancer Cancer, New York, NY, USA, 2Private Practice, New York, NY, USA PURPOSE: Many elders with cancer complain they are not motivated to do anything: "I just look at the four walls all day.” Finding ways to combat social isolation, loneliness, depressed mood, and low self esteem is important with these elders who might potentially be in cancer treatment for many years. They often reject formal psychotherapy. We decided—as a variant of the standard support group--to try a book club as a way to reach elders at home alone. METHODS: In March, 2012, we began the Vintage Readers’ Book Club, vintage both because of the readers’ ages and because the selections were chosen from the Harvard 50 Classics of the Western World. The Club meets once/month. Participants are sent hard copies of the readings at least two weeks in advance, reprinted in large easily readable font. RESULTS: Over the year, participation jumped to 10-12/session and with 1–2 joining by phone. The first reading consisted of passages from the Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Poster Abstracts of the APOS 11th Annual Conference

Autobiography of Ben Franklin, followed by Cicero’s Essay on Old Age, which was written in 44 BC (stereotypes of elders have not changed). Other readings included selections from Plato’s Apology and Aesop’s Fables. Discussions are very animated, as group members relate the readings to history and to the world today--and then to their own situations. They enjoy the intellectual stimulation which they miss alone at home. There has been little attrition, and patients express their pleasure over this new modality. They joke they may not be able to read all 50, but like life, the journey is the thing, not the destination. CONCLUSIONS: The Vintage Readers’ Book Club has been a successful addition to a traditional support group for older patients with cancer. Although the effectiveness of this intervention still needs to be confirmed through more formal research settings, the clinical implications have been positive. RESEARCH IMPLICATIONS: This type of intervention provides another avenue to formally explore as a way help elders cope with cancer. CLINICAL IMPLICATIONS: This provides a concrete example of a practical way to engage older adults with cancer. FUNDING: Silbermann Foundation, and the Muriel Duenewald Lloyd Inspiration Fund. P1-26 Understanding Factors That Facilitate Treatment Decisions Among Latinos With Cancer Iraida Carrion1, Frances Nedjat-Haiem2, Lucia Franco Estrada3 1 University of South Florida, FL, USA, 2VA Greater Los Angeles Healthcare System, CA, USA, 3University of South Florida, FL, USA PURPOSE: The purpose of the study was to identify cancer treatment decisions and the gaps that influence decisions among Latino men and women. Limited studies exist regarding the psycho-social and cultural factors behind curative treatment decisions such as surgery, chemotherapy, and radiation. Although there is a preference for shared family decision-making among Latinos, cancer treatment decisions are multifaceted. Prior studies have ascertained that there is correlation between the number of years a person has resided in the US mainland and their knowledge about the US health system. In addition, it was found that Latino men have limited understanding of a cancer diagnosis; as a result, they become fearful and associated the diagnosis with death. Despite increasing incidences of cancer among Latinos in the United States, little is known about the factors that influence their treatment decisions. METHODS: We conducted qualitative semi-structured interviews (n = 60) with 45 women and 15 men to explore treatment decisions after a cancer diagnosis. The study used purposive sampling to select Latino participants, diagnosed with cancer within 5 years. The interviews were conducted in Spanish. All interviews were audiotaped, transcribed in Spanish, and © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.


then translated into English. Data were analyzed within ATLAS.ti, a qualitative software, using a mixed methods approach with thematic and content analysis. RESULTS: Among the Latinos interviewed, surgery was the treatment most often chosen. The main reason for this choice was the expectation of living longer and overcoming the cancer diagnosis. This study found that 65% of the participants would recommend, and reported satisfaction with, their medical treatment. Factors that facilitated treatment decisions included the involvement of family members, friends, and social workers. CONCLUSIONS: Only 43% of the participants did not recall being given treatment options, yet they accepted the recommended surgery. 98% indicated that Spanish was their preferred language. The assistance received from social workers with, translation, emotional support, and resources facilitated Latinos treatment decisions. RESEARCH IMPLICATIONS: Only 57% of the participants reported that they were given various treatment options. There is urgency for additional research to examine the existing barriers. CLINICAL IMPLICATIONS: Latinos indicated that they preferred physicians to suggest options and involve them in the treatment decision process. FUNDING: Funding for the research was sponsored by the Division of Population Sciences, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, the Center for Equal Health at the University of South Florida in Tampa, Florida, and by the National Institute of Health (NIH). Grant Number: 1 P20 MD003375-01. P1-27 Indicators of Poverty After a Cancer Diagnosis in a Multiethnic Sample Rosario Costas-Muniz, Julia Ramirez, Abraham Aragones, Jennifer Leng, Alina Kung, Victoria Blinder, Francesca Gany Memorial Sloan-Kettering Cancer Center, New York, NY, USA PURPOSE: Immigrants and ethnic minority patients are more likely to live in poverty than non-Hispanic white patients. Further, the cost of cancer care, overall, is increasing. Low-income cancer patients face a double burden: compromised health coupled with added financial pressures. This study describes the socioeconomic characteristics of a multiethnic sample of patients before and after a cancer diagnosis, and examines predictors of unemployment after cancer. METHODS: This is a descriptive cross-sectional study with 1,534 patients from the Portal Cancer Project, which provides assistance to medically underserved cancer patients in New York City. Participants completed a sociodemographic and needs assessment survey in their preferred language (English, Spanish, Mandarin, and Arabic). Patients reported information about their income and employment before and after being diagnosed with cancer. RESULTS: Patients’ mean age was 55, 62% were female, Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


43% were Latino and 41% African American or Blacks, 40% had breast cancer, 85% reported incomes below the national poverty level, and only 6% were born in the continental USA. Unemployment in this sample rose from 25% before to 69% after being diagnosed with cancer. Before diagnosis, 17% had no income, and after, 46% had no income. Before diagnosis 55% of patients were supported by their own earnings and 20% by their families. After diagnosis, 10% were supporting themselves and 53% depended economically on their families. After controlling for sociodemographics (age, gender, education, insurance status and time since diagnosis), gender, lower education, and currently receiving chemotherapy predicted higher current rates of unemployment. CONCLUSIONS: Our findings suggest that a large proportion of our ethnic minority cancer patients live in poverty due to a decrease in income and lost jobs due to being diagnosed with cancer. A diagnosis of cancer has a detrimental effect financially on low-income individuals, especially during the active phase of treatment. RESEARCH IMPLICATIONS: More research is necessary to establish the impact of specific indicators of poverty (income, employment, education, housing instability, food insecurity) on health outcomes. CLINICAL IMPLICATIONS: Interventions aiming to improve health equity and decrease cancer disparities should include culturally responsive comprehensive programs that address patients’ socioeconomic needs. FUNDING: New York Community Trust; NCI Support: U54-13778804-S2 & T32CA00946. P1-28 Prevalence of Food Insecurity Among Low-Income Latino Cancer Patients Rosario Costas-Muniz, Julia Ramirez, Abraham Aragones, Jennifer Leng, Serena Phillips, Josh Wessler, Francesca Gany Memorial Sloan-Kettering Cancer Center, New York, NY, USA PURPOSE: For Latino households, rates of food insecurity (lack of access to enough food for an active, healthy life) are substantially higher than the national average. Lack of access to a nutritious diet can complicate patients’ health status and response to treatment. The purpose of this study is to determine the prevalence of household food insecurity (FI) in a cohort of Latino cancer patients, to compare it to 2011 national rates, and to identify relevant demographic characteristics associated with food insecurity. METHODS: A nested cohort of 749 Latino cancer patients was recruited thorough the Portal Cancer Project, which addresses socioeconomic determinants of cancer treatment access and adherence in New York City. Participants completed a sociodemographic survey and the USDA Household Food Security Survey in their preferred language. RESULTS: Patients’ mean age was 55, 62% were females, 40% had © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Poster Abstracts of the APOS 11th Annual Conference

breast cancer, 85% reported income below the national poverty level, and only 6% were born in the continental USA. 66% of Latino patients reported FI, 48% of them without hunger, 14% with moderate hunger and 4% with severe hunger. This Latino sample had four times the US national rate of FI for 2011 (15% vs. 66%) and more than double the national rate in Latino households (26% vs 66%). Patients who reported FI were more likely to be younger, unemployed, uninsured, born in Latin America, a more recent immigrant, Spanish speaking, have no monthly income, and have Medicaid for emergency care. CONCLUSIONS: The prevalence of FI among Latino patients was extremely high. A high proportion of these cancer patients not only face the burden of their disease but also the burden of hunger. Latino patients who are most vulnerable to FI are the poor, uninsured or underinsured (Emergency Medicaid), and immigrants. RESEARCH IMPLICATIONS: More research in necessary to understand the impact of food insecurity on health outcomes of underserved cancer patients. CLINICAL IMPLICATIONS: Comprehensive programs that include assessment of patients’ food security and case management are greatly needed. FUNDING: New York Community Trust; New York State Health Foundation; Laurie Tisch Illumination Fund; NCI Support: U54-13778804-S2 & T32CA00946. P1-29 Beliefs About Cancer Risk Factors Among MexicanBorn and U.S.-Born Hispanics of Mexican Descent Rina Fox1,2, Tonya Pan1,2, Sarah Mills1,2, Alma Behar2,3, Vanessa Malcarne2,3, Georgia Robins Sadler2,4 1 SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA, 2UCSD Moores Cancer Center, San Diego, CA, USA, 3San Diego State University, San Diego, CA, USA, 4University of California, San Diego School of Medicine, San Diego, CA, USA PURPOSE: Few studies have examined how beliefs regarding cancer-specific risk factors may differ for Hispanics born in the United States (US) and those who have immigrated. Additionally, Hispanics are often studied in aggregate, rather than as individual subgroups. The present study examined the association between country of birth and beliefs about cancer risk factors, accounting for education, among Hispanics of Mexican descent living in the US. METHODS: Self-identified Mexican American adults born in Mexico (n = 142) and the US (n = 139) answered 14 items from the NCI HINTS questionnaire about cancer-related behaviors and exposures. Questionnaires were administered in participants’ preference of English or Spanish. Respondents rated the degree to which each item increases a person’s chance of developing cancer as “not at all” (1), “a little” (2), or “a lot” (3). Country of birth and education were provided by self-report. RESULTS: Overall, smoking, eating a high-fat diet, exposure to pesticides/ Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Poster Abstracts of the APOS 11th Annual Conference


food additives, sun exposure, and family history of cancer were the most strongly endorsed causes of cancer. Multivariate analysis of covariance (MANCOVA) demonstrated that, controlling for education, the combined 14 dependent variables resulted in a significant main effect for country of birth (F[14, 265] = 3.14, p < .001, partial eta squared = .142). Follow-up univariate ANCOVAs, using an adjusted alpha (.004), demonstrated few differences across groups. Mexican-born participants demonstrated statistically significantly stronger beliefs that smoking and pesticides/food additives increase the chances of developing cancer than participants born in the US (Mexico: Msmoking = 2.94, Mpesticides/food additives = 2.73; US: Msmoking = 2.82, Mpesticides/food additives = 2.51). CONCLUSIONS: These results demonstrate that overall, after controlling for education, Mexico-born and US-born Mexican Americans hold similar beliefs about causes of cancer. Where there were discrepancies, Mexico-born Mexican Americans expressed stronger concerns than US-born Mexican Americans about smoking and pesticides/food additives. Further research is needed to determine the sources of these different beliefs about cancer risk. RESEARCH IMPLICATIONS: These results suggest that it may be important to consider migration status and country of birth when developing and testing interventions targeting cancer risk beliefs among Hispanics of Mexican descent living in the US. CLINICAL IMPLICATIONS: Clinicians may also benefit from considering country of birth when discussing cancer risk with Hispanics of Mexican descent, as this may impact pre-existing beliefs. FUNDING: NIH #1R25CA130869-01A2; NIH R25CA65745; NIH P30CA023100; NIH U56CA92079/ U56CA92081; NIH U54CA132379/U54CA132384; NIH-NCMHD CRCHD (P60 MD000220); NIH-NCRR UL1 RR031980; NIH CURE Supplement #P30CA23100; UCSD San Diego Fellowship.

sample, and by age (young-old; 55–65 years and old-old; 66+ years) and race groups. Results showed an average trust score of 9.93 ±2.62 (range 0–28, high scores indicating less trust) for the total sample. Analyses showed no differences by age or race group on the trust scale. However, when single-item (trust) questions were assessed, more youngold patients reported believing their doctor would tell them the truth about their health (t = 2.17, p < .05) compared to the old-old patients. In assessing race differences, Blacks were less likely to trust in their doctors’ judgments (t = 2.05, p < .05) and believe that their doctors cared more about holding down cost than about doing what is needed for their health (t = 2.63, p < .05) than Whites. CONCLUSIONS: Few studies have examined the implications perceptions of trust have on patient-provider relationships among older cancer patients. Our results are consistent with the current literature suggesting the influence identified trust characteristics have on patient symptom disclosure and treatment adherence. RESEARCH IMPLICATIONS: Further research is needed to identify specific trust factors that may serve as facilitators and/or barriers to effective treatment among diverse populations (age, race). These data may begin to augment our knowledge in designing intervention programs that addresses the needs of patients across a continuum of medical care. CLINICAL IMPLICATIONS: These results endorse the importance social factors have in health maintenance among older adults in general and those from diverse race populations in particular. FUNDING: National Cancer Institute.

P1-30 Is it Age or Race? Examining Differences in PatientProvider Trust Among Older Cancer Patients Kelsey Harris, Rosalyn Roker, Tamara Baker University of South Florida, Tampa, FL, USA

PURPOSE: This study examines the scope and dynamics of the support network of African American cancer patients. The goal was to identify factors that may affect social support for African American cancer patients, particularly those suffering from depression. METHODS: 57 African American breast and prostate cancer survivors (34 were depressed and 23 were not depressed) were interviewed. The interviews were audiotaped and transcribed. Qualitative data analysis was conducted; themes were identified and coded. The codes were entered into SPSS software. The Fisher’s exact test was performed to examine group differences in the identified themes. RESULTS: African American cancer patients reported that their social network involves family, friends, colleague, church members, and professional encounters with therapists (e.g., social workers, psychologists) or support group peers. They also discussed both supportive and not supportive relations with family, friends, colleague, and support

PURPOSE: The purpose of this investigation was to examine age and race differences in patient-provider trust among older adults receiving outpatient treatment at a comprehensive cancer center. METHODS: Data were collected through structured interviews assessing social (discrimination, trust, communication), behavioral (selfefficacy), health (pain severity, comorbidities, pain interference), and demographic characteristics. RESULTS: The sample consisted of 149 non-Hispanic Black and White patients, with a mean age of 65.4 ± 7.6 years. The majority of the sample were female (57%) and nonHispanic White (82%). Data were examined for the total © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

P1-31 African American Cancer Patients’ Social Network and Support Virginia Ju, Amy Zhang Case Western Reserve University, Cleveland, OH, USA

Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


group peers. Compared to nondepressed patients, significantly more depressed patients reported that they did not receive family support (35% vs. 0; p ≤ .001). Further, significantly more depressed than nondepressed patients reported that they did not have a support system (26.5% vs. 0; p = .008). Narratives of self-reported experience with social support are presented to illustrate the meaning of these findings. CONCLUSIONS: Results suggest a significant association between depression and a lack of social support, particularly the family support, among African American cancer patients. The findings stress the importance of social support for mental well-being of these patients that have not received adequate research attention. RESEARCH IMPLICATIONS: Social relation between African American cancer patients and their social network can be complicated by a cancer diagnosis. The impact of social relation on these patients’ well-being needs to be further studied. CLINICAL IMPLICATIONS: Clinician’s support is important for many African American cancer patients. FUNDING: None. P1-32 Balancing the Scales: “Super Obese” Patients and the Oncology Experience Laura Kotler-Klein, Heather Sheaffer Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA PURPOSE: The case study presented focuses on the experiences of a “super obese” (Sturm, 2007) woman with gynecologic cancer seeking treatment and the implications for practice and research. Review of the literature indicates a limited research base evaluating the attitudes of health care providers towards the “super obese” (Puhl & Brownell, 2001). Working with this patient also illuminated an apparent lack of comfort by health care providers in treated the super obese. The goal of presenting this patient is to challenge current practice and attitudes. METHODS: Case study: 49 year old African American woman weighing more than 600lbs diagnosed with vulvar cancer in September of 2012 at a large urban teaching hospital. The abstract describes the institutional responses- from the refusal of the transportation provider to provide rides to treatment to the Cancer Centers challenges in assessment and treatment to providers’ response to the patient’s needs. RESULTS: Practice with this patient resulted in more questions than answers but opened the door to improved care and treatment through frank discussion among care providers. Ultimately, the outcome and options for our patient improved as a result of facilitated dialogue and advocacy by social work. CONCLUSIONS: The relevant questions which surfaced include: Are we prepared for morbidly obese patients in our clinics and © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Poster Abstracts of the APOS 11th Annual Conference

hospitals? Have the architects been consulted for improved access? Have we thought of entrances and exits, elevators, internal paths in our hospitals? In our roles providing psychosocial oncology care, are we prepared to be advocates for obese patients, with our teams, and in the broader medical arena? How can we ensure that the obese patient is treated with dignity, respect and privacy? How do we respond to the affective needs of the “super obese”? RESEARCH IMPLICATIONS: Suggest further research evaluating provider attitudes towards obese cancer patients and interventions to improve psychosocial care. CLINICAL IMPLICATIONS: Currently more than 1/3 of all adult Americans are obese (CDC, 2013). The likelihood of encountering more obese people with cancer is growing. We, as providers of psychosocial oncology care, must adapt to this reality and assist both institutions and fellow providers in responding to the needs of the obese oncology patient. FUNDING: None. P1-33 Cultural Values, Social Support and Cancer Screening for Underserved Latina Women Participating in an Educational Intervention Study Sunny Kim, Julie McNulty, Linda Larkey Arizona State University, Phoenix, AZ, USA PURPOSE: Inadequate adherence to cancer preventative care and low screening among Latinos puts them at risk for higher rates of cancer and lower survival rates. Several social factors are related to cancer screening behaviors including social support and cultural values. Previous research has focused on associations of acculturation with screening behaviors but not on the more specific factors of traditional family and rural cultural values. Further, it is not clear how level of social support differs in group vs. individual intervention and its association with cancer screening. Thus, we propose that Latino cultural values, such as family traditionalism and rural preferences contribute to cultural norms which have the potential to impact cancer screening rates. Also, level of social support in a group intervention differs from those receiving an individual intervention. METHODS: The current study is part of a large, group-randomized controlled intervention trial that randomized participants into classes conducted either individually or in a group and taught by promotoras. Participants are Latina women (aged ≥18) who were due for one or more of breast, cervical, or colorectal cancer (CRC) screening. The parent study yielded no significant differences between the two groups on cancer screening (published), thus, we explored other factors influencing screening behaviors. RQ: How are age, social support, and cultural values associated with screening behaviors? RESULTS: A total of 1,006 underserved Latina women participated (age M = 38.4, SD = 13.2); 57% with income $15,000; 65% without health insurance. Logistic regression Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Poster Abstracts of the APOS 11th Annual Conference

across both intervention groups for each type of screening showed that (a) Latina women who were younger, have lower family traditionalism, and higher rural preference were more likely to participate in cervical cancer screening, and (b) rural preference was significantly associated with breast cancer screening. No relationship was seen due to small sample size for CRC (7%, n = 75). An ad hoc analysis indicated that participants in the group intervention had higher emotional and instrumental social support than those receiving the individual intervention, however, there was no association between social support and screening. CONCLUSIONS: The present study suggests that traditional Latina family values and a rural preference are important cultural factors for Latina women in cervical and breast cancer screening. It appears that cultural values have an important impact on cancer screening, but in this context, not social support. More research and culturally sensitive prevention interventions are needed for Latina women to increase rates of screening for breast and colorectal cancer. RESEARCH IMPLICATIONS: The findings of this study suggest that both group and individual interventions implemented by promotoras de salud, achieved a meaningful degree of breast and cervical cancer screening adherence for Latina participants who were either never screened or past due for screening. Implications of these results call for more research and culturally sensitive prevention interventions for Latina women in increase rates of screening for colorectal cancer. The findings of this study also suggest that cultural values can extend to traditional family values and a rural preference as important factors on cancer screening for Latina women. Future study needs to further examine the relationship among traditional family cultural values (familismo), a rural preference, and social support for low income and underserved Latina women. Regardless of the results, participants in a group intervention had higher level of social support than those in an individual group intervention. Many of the studies do not use the unique talents and community base of promotera/es or take into account efforts to build social support in the group setting. It would be interesting to examine effectiveness of social support group interventions and factors to increase screening behaviors for Latina women. CLINICAL IMPLICATIONS: Understanding cultural factors associated with adherence to cancer screening will improve the clinician’s ability to facilitate adherence. A positive relationship with a healthcare provider and the perceived attitude of the healthcare provider contribute to the social support for Latina women and helps to reduce medical mistrust. These findings also point to the importance of assessing for adequate social support in Latina women, even during the screening and preventative stages of cancer care. FUNDING: The study was funded by the American Cancer Society, Juntos en la Salud: Cancer Prevention and Screening for Latinas TURSG-03-080-01-PBP. © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.


P1-34 Black Breast Cancer Survivors’ Health Information Preferences Teri Malo1, Tuya Pal1, Devon Bonner1, Jongphil Kim1, Susan Vadaparampil1,2 1 Moffitt Cancer Center, Tampa, FL, USA, 2University of South Florida, Tampa, FL, USA PURPOSE: An important goal of cancer survivorship care is the prevention or early detection of second primary cancers. In order to make informed decisions, patients must understand their future cancer risk, generally conveyed using statistical information. Yet, prior studies suggest that compared to White patients, Black patients are more likely to experience great difficulties in communicating with and understanding information presented by their healthcare providers. The purpose of this study is to characterize current comfort with and preferences for risk information among young Black female breast cancer survivors. METHODS: Black women diagnosed with invasive breast cancer ≤ age 50 in 2009–2012 were recruited through the Florida Cancer Registry utilizing statemandated recruitment methods. Participants completed a comprehensive baseline questionnaire which included sociodemographic, clinical, and psychosocial characteristics. In the current study, we specifically examined responses to 4 items related to numeracy (the ability to understand and work with numbers) that were based on items from the 2007 Health Information National Trends Survey. RESULTS: This report includes the first 111 women who completed the baseline questionnaire. The mean age at diagnosis was 42.59 years (SD = 6.5) and about 58% had at least some college education. About 59% somewhat/strongly agreed they feel uncomfortable with health information with a lot of numbers and statistics, yet 53% agreed that they depend on numbers and statistics to help make health decisions. Moreover, 68% reported they generally find medical statistics easy/very easy to understand. Regarding information presentation, more women preferred that the chance of something happening be described in words (39%) rather than numbers (23%), with 35% reporting no preference. CONCLUSIONS: Awareness of comfort with and preferences for the format of health information can help tailor educational materials to promote informed decision-making among Black breast cancer survivors. Findings from this study suggest these materials should include some numerical information, but use more words to describe the chance of something happening. Future research should aim to identify the optimal balance of risk information expressed as words and numbers to enhance comprehension. RESEARCH IMPLICATIONS: This research has important implications for researchers studying best methods for promoting informed medical management decisionmaking among breast cancer survivors. Researchers may Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


use this information to tailor and evaluate the effectiveness of educational materials designed to promote informed decision-making. CLINICAL IMPLICATIONS: Clinicians will find this information relevant for communicating risk information to their patients and helping patients to make informed decisions when presented with medical management options. FUNDING: This research was conducted with funding from the American Cancer Society [MRSG CPPB-111062] and the Miles for Moffitt Foundation. P1-35 Comparing Self-Reports of Health-Related Quality of Life Among Racial and Ethnic Minority Survivors of Young Adult Cancer: A Mixed Methods Approach Alexis Munoz1, Karen Kaiser2, David Victorson2, Betina Yanez2, Sofia Garcia2, Mallory Synder2, John Salsman2 1 University of Illinois Chicago, Chicago, IL, USA, 2 Northwestern University, Chicago, IL, USA PURPOSE: Young adult (YA) racial and ethnic minority survivors of cancer (diagnosed ages 18–39) experience a number of psychosocial challenges from time of diagnosis through survivorship. Medical, research and advocacy communities have yet to examine this important subgroup of survivors. The purpose of this study is to better understand the YA experience and health-related quality of life (HRQoL) among racial and ethnic minorities using a mixed method approach. METHODS: YA cancer survivors (N = 29) were recruited from a comprehensive cancer center. YAs participated in semi-structured telephone interviews and completed the FACT-G (physical, emotional, social HRQoL) and the FACIT-Sp (spiritual HRQoL). Interviews were audio-recorded, transcribed and coded by independent rater pairs using NVivo 10.0. RESULTS: YAs between 18 and 39 years old (M = 33) participated in interviews. The majority were female (66%), single (48%), and Black (N = 8), Asian (N = 8), Mixed/Other (N = 9) or Hispanic (N = 4) racial backgrounds. The most common cancers were thyroid (18%), breast (14%), Hodgkin lymphoma (14%), and leukemia (14%). During interviews, participants discussed common themes: emotional impacts from cancer (9%), the importance of received support (8%), changes in life perspectives (8%) and describing that cancer had “no change” in psychosocial or behaviors (e.g. physical health behaviors) (8%). Other frequently applied themes varied by race. Black YAs emphasized positive physical health behavioral changes (7%); Asian YAs focused on a newfound appreciation for life (5%); and Mixed/Other YAs discussed treatment side effects (6%). In a parallel series of ANCOVAs (controlling for gender and ECOG performance status), race was a significant main effect on emotional HRQoL (p = .038) and physical HRQoL (p = .025). No differences by race were reported for social or spiritual HRQoL (all p > .05). CONCLUSIONS: Minority survivors of YA cancer experience a variety of developments, changing © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Poster Abstracts of the APOS 11th Annual Conference

priorities and stressors as they enter survivorship. In general, interviews revealed numerous HRQoL impacts from cancer with patients likely to indicate “no changes” as well as specific “changes” after surviving the cancer experience. Qualitative responses demonstrated contrasting and varying results compared responses retrieved via questionnaires. This study reflects the need to incorporate mixed methods when evaluating HRQoL among YA minority cancer survivors. RESEARCH IMPLICATIONS: These findings contribute to a more focused understanding of the unique challenges of cancer survivorship in YAs who are racial and ethnic minorities. Future research should consider collecting mixed methods and longitudinal health-related quality of life and with an emphasis on emotional well-being to better understand changing self-reports. CLINICAL IMPLICATIONS: Survivorship care plans should incorporate multidimensional HRQoL assessments with an emphasis in emotional wellbeing to provide a broader perspective of post-treatment adaptation identify potential targets for future survivorship interventions. FUNDING: This work was supported by a Psychosocial and Behavioral Research Grant (PSB-08-15) funded by the American Cancer Society-Illinois Division. P1-36 Effects of the Stress Process on Psychological Well-Being Among Older Chinese- and Korean-American Breast Cancer Survivors: The Moderating Role of Perceived Social Support Min So Paek1, Jung-won Lim2 1 Wake Forest School of Medicine, Winston-Salem, NC, USA, 2 Kangnam University, Gyeonggi-do, Republic of Korea PURPOSE: Breast cancer survivors (BCS) often encounter multiple stress, thus it is critical to understand the stress process that can improve their psychological well-being (PWB). This study intended to examine the effects of primary (life stress) and secondary (perceived family communication strain) stress and internal coping (reframing) on PWB among older Chinese- and Korean-American BCS using the Stress Process Model; and to investigate the moderating effect of perceived socials support on the stress process. METHODS: A cross-sectional descriptive survey design was used. A total of 111 Chinese- (n = 58) and KoreanAmerican (n = 53) older BCS who were recruited from California Cancer Surveillance Program and local hospitals in Los Angeles County were included in this study. Life stress was measured using Urban Life Stress Scale and perceived communication strain which reflects avoidances in communication within the family was assessed with two family communication scales. Reframing was measured by Family Crisis Oriented Personal Reframing subscale. PWB was measured by three scales assessing psychological distress, emotional well-being, and vitality. Perceived social support was assessed using MOS Social Support and categorized into two groups (high vs. low). RESULTS: The CFA Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Poster Abstracts of the APOS 11th Annual Conference

demonstrated the adequacy of latent constructs. Structural equation modeling (SEM) was then performed to examine the direct and indirect relationships between variables of interest, which were derived from the stress process model. The hypothesized model provided an acceptable fit (χ2(40) = 66.48, CFI = .96, RMSEA = .07). Results revealed significant linkages among stress, perceived family communication, reframing, and PWB in older Chinese- and Korean-American BCS. Additionally, a multi-group SEM analysis was performed to examine whether the stress process differed across the level of perceived social support. Findings indicated significant differences in structural paths between low and high perceived social support groups, suggesting that they may have different psychosocial responses to cope with stress. CONCLUSIONS: Study results suggest the applicability of the stress process model in developing a better understanding of the psychological well-being of older Chinese- and Korean-American BCS. RESEARCH IMPLICATIONS: Findings provide greater insight into the impact of various factors in the stress process model on PWB. Further research of the stress process in BCS is critical in designing evidencebased interventions. CLINICAL IMPLICATIONS: Understanding the stress process will guide the development of evidence-based and culturally-sensitive interventions designed to enhance older Asian BCS’ psychological well-being. FUNDING: Dr. Paek is currently supported by the Comprehensive Cancer Center of Wake Forest University Cancer Survivorship Traineeship – NCI/NIH Grant# #R25CA122061. P1-37 Preliminary Results From the IS-ME Survey: Which Theoretical Mediators of Health Behavior Best Associate With Persistent and Sporadic Mammographic Screening Behaviors in One Bemidji Area Tribe? Wesley Petersen1, Ann Nicometo2, Robert Vierkant1 1 Mayo Clinic, Rochester, MN, USA, 2Empowering Communities, Rochester, MN, USA PURPOSE: Our tribal collaborator intends to develop interventions to increase women’s adherence with mammographic screening guidelines by employing theoretical health mediators that appear influential in the behaviors of women. To ascertain which, if any, of six theoretical mediators of health behavior are most likely to influence women’s screening behaviors, we are conducting a survey of 1400 women who are either Persistent Screeners (adhere to the tribes screening guidelines) or Sporadic Screeners (screen irregularly or not at all). METHODS: Using responses from an interview with 55 American Indian Persistent and Sporadic mammographic screeners, we designed an Influential Screening-Mediators Exploratory (IS-ME) Survey, currently being mailed to the tribe’s approximately 1,400 women who were at least 40-years of age. Surveys, each with a unique © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.


identifier, are completed and returned anonymously, with completers receiving a modest incentive. The identifier also is affixed to a tear-off page that a respondent can submit to her tribe for the incentive. All surveys and return mailers were sealed into envelopes before any address labels were affixed. This was done to prevent addressees from being linked to specific identifiers. Surveys are returned to Mayo Clinic. Upon confirmation of survey completion, a list of unique identifiers will be compiled and periodically sent to the tribe’s disbursement office. When a unique identifier is presented and matched to one on the list, a respondent can receive her incentive from the tribe. This process preserves women’s privacy and assures anonymity of responses. We are seeking responses from at least 600 women. RESULTS: We are currently mailing surveys. When we have obtained at least a 10% response (140 interviews), we will initiate preliminary analysis of women’s responses. Previous analyses of interview responses suggest that likely areas of differentiation will be associated with Health Beliefs and Social Norms. CONCLUSIONS: Theoretical mediators that differentially influence the behaviors of Sporadic Screeners and those of Persistent Screeners in an American Indian population may provide guidance for the development of interventions that improve women’s participation in mammographic screening and increase the likelihood of greater adherence with screening guidelines. RESEARCH IMPLICATIONS: Previous intervention research with tribes that has been guided by theoretical mediators of health behavior has typically relied on one or at most two theoretical mediators. However, there is no evidence that mediators influential in other populations function in the same manner in American Indian populations. This study will give researchers insight into the relative influence of six different theoretical mediators on American Indian women’s participation in their tribe’s annual mammography program. CLINICAL IMPLICATIONS: Specific mediators that distinguish Persistent Mammographic Screeners from Sporadic Screeners may be useful for the development of interventions in this tribal population to increase participation in, and adherence with, the tribe’s annual mammography program. FUNDING: This project is funded by a grant from the Midwest Division of the American Cancer Society and support from the Mayo Clinic Office of Health Disparities Research. P1-38 Multilevel Factors Influencing the Psychological Consequences of Breast Cancer Among Recently Diagnosed Ethnically Diverse Women Silvia Tejeda, Melinda Stolley, Garth Rauscher, Richard Campbell, Carol Ferrans, Richard Warnecke University of Illinois at Chicago, Chicago, IL, USA PURPOSE: Recent studies show that minority women may face greater adjustment issues to breast cancer Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


such as poorer quality of life and depression compared to White women, although little is known about the specific factors that contribute to this disparity. We adapted the contextual model of health related quality of life to examine multilevel predictors of psychological consequences of breast cancer in a diverse population of recently diagnosed cancer survivors. METHODS: The sample was from a cross-sectional study of 989 recently diagnosed breast cancer patients (397 non-Hispanic White, 411 non-Hispanic Black, and 181 Hispanic) living in Chicago, IL who completed an in-person interview between 2005 and 2008. Regression analyses were conducted to assess how predictors of interest including intrapersonal, interpersonal, institutional, and community level factors influenced the negative affective and behavioral consequences of breast cancer using the Psychological Consequences Questionnaire (PCQ). RESULTS: Factors associated with more negative consequences of breast cancer included intrapersonal factors such as higher levels of perceived stress (p = .004) and being diagnosed at a later stage (p = .02), and institutional factors such as having greater lack of trust with physicians (p < .001). Factors associated with fewer negative consequences of breast cancer included intrapersonal factors such as older age at diagnosis (p < .001), higher household income (p = .009), having private insurance (p = .04), having a longer time from diagnosis to interview (p = .05). CONCLUSIONS: These results indicate that in this small sample of children undergoing chemotherapy, IL-6 levels did not change in conjunction with reductions in self-reported and caregiverreported depressive symptomatology. This is contrary to animal models and has implications for the measurement and study of cytokines in pediatric oncology. RESEARCH IMPLICATIONS: These results indicate that in children undergoing chemotherapy, interleukin-6 (IL-6) may not be related to depressive symptomatology,contrary to results indicated by animal models. This warrants further investigation to replicate findings and determine whether proinflammatory cytokines are unrelated to depression or whether these results may apply to IL-6 alone. CLINICAL IMPLICATIONS: These results indicate that over the course of chemotherapy, both child and parent reported depression symptoms seem to decrease. Thus it is important to assess for depression earlier in chemotherapy treatment when these symptoms might be problematic. These findings also indicate that cancer patients show resiliency during the course of treatment. FUNDING: This study received funding from Hyundai Hope on Wheels. © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Poster Abstracts of the APOS 11th Annual Conference

P1-50 Bridging the Gap Between the Psychosocial and Educational Needs of Adolescents and Young Adults via a Toolkit for Adolescent and Young Adult Oncology Patients Lina Mayorga, Kayla Fulginiti, Jeanelle Folbrect, Marisol Trujillo, Natalie Kelly, Renee Ortiz, JoAnn Namm City of Hope National Medical Center, Duarte, CA, USA PURPOSE: One of the many challenges in providing AYAs with tools and resources is that little to no printed patient educational materials currently exists that are specifically tailored to the AYA population.The purpose of this study was to identify expressed educational needs of AYA patients and those of health professionals at various cancer centers and organizations to develop an educational toolkit to deliver patient education for the AYA population. METHODS: The following modalities were utilized in identifying the educational needs of AYA’s (1) literature review (2) query and telephone interviews of health care professionals at various cancer centers or cancer organizations; including the respondents’ role their within organization, geographic location, and current use and needs of AYA population in area of education and information gaps (n = 20) (3) AYA educational needs assessment. A needs assessment was developed and included questions designed to determine patient’s information needs to support the use an AYA toolkit. Responses were analyzed using descriptive statistics and thematic analysis. RESULTS: Data acknowledged the need of educational specific resources and tools for the AYA population from both the patients and healthcare provider’s perspective. However, many of the clinicians acknowledged lacking the knowledge and skills required to use these tools, or awareness of credible sources of information. AYA informational and educational gaps were identified in the following areas: communication, medical management, symptom management, sexuality & relationships, body image, coping, managing emotions and stress, managing life, school and work and resources for support. CONCLUSIONS: An AYA specific toolkit was developed by a multidisciplinary team to address all educational and information gaps and needs identified. There is a small but growing body of evidence available to address most of the specific topics mentioned, however this information needs to be available in print versus on the World Wide Web and needs to be tangible to both health care providers and patients/families. Creation of a tool, informed by the literature, could address these needs. This tool could be further enhanced by incorporating additional informational and psycho-social needs identified by cancer patients. RESEARCH IMPLICATIONS: Understanding individual patient preferences is critical to improve health behaviors. Implications of the results will be discussed in terms of enhancing patient-centered Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Poster Abstracts of the APOS 11th Annual Conference

tailoring of health information and communication for the AYA population. CLINICAL IMPLICATIONS: Little to no clinically relevant or tailored educational materials are available for the AYA population. Providing AYA’s with a tailored educational toolkit can empower patients to take more of an active role in their care and enhance communication and decision-making. FUNDING: None. P1-51 The Effect of Social Support on Child and Parent Reactions to Pediatric Cancer Treatment Procedures Amy M. Peterson1, David Merolla2, Felicity W. K. Harper1, Janet R. Hankin2, Jeffrey W. Taub3, Sean Phipps4, Louis A. Penner1 1 Wayne State University Department of Oncology, Detroit, MI, USA, 2Wayne State University Sociology Department, Detroit, MI, USA, 3Children’s Hospital of Michigan, Hematology/Oncology Department, Detroit, MI, USA, 4St. Jude Children’s Research Hospital, Memphis, TN, USA PURPOSE: Cancer is the leading cause of disease-related death in children (ACS, 2012) and children and their parents both report that cancer-related medical procedures are worse than the disease itself (Hedstrom et al., 2003). Social support may serve as a buffer against parent and child negative responses to treatment. The purpose of this study was to investigate the relationships between social support, parent–child communication during pediatric cancer treatment-related medical procedures, and parent and child reactions to these procedures. METHODS: One hundred and fifteen families were included in the analysis from two pediatric oncology treatment centers. Self-report questionnaire data and observational coding of videorecorded interactions in which a child experienced a cancer related medical procedure were utilized. OLS and logistic regression models were employed for hypothesis testing. Social support was measured at study entry and immediately before the treatment procedure and used to predict: parent anxiety, personal distress, and empathic concern before the procedure, parent positive and negative emotions after the procedure, parent distress, and child distress and cooperation during the procedure. Multiple raters rated child distress and cooperation. RESULTS: The more sources of social support parents reported at study entry the lower their own, and their child’s, distress during the procedures. Various types of social support measured on the day of a treatment procedure predicted parent and child reactions to treatment procedures. Parents who had more social support on that day had more empathic concern for their child before the procedure and more positive affect after the procedure. Parents who had more social support associated with the clinic visit had more positive affect and had children who were more cooperative and less distressed during the procedure. © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.


CONCLUSIONS: Parent social support is important in the pediatric cancer medical procedure context. Children with cancer, and their parents, would benefit from increased social support resources which could improve long-term psychosocial functioning for both children in treatment for cancer and their parents. RESEARCH IMPLICATIONS: Future research should examine by what mechanisms social support effects child and parent reactions to treatmentrelated medical procedures. Interventions should be developed to increase/improve parent social support resources. CLINICAL IMPLICATIONS: Increasing/improving parent social support may help children to be more manageable patients during pediatric cancer-related treatment procedures. FUNDING: National Cancer Institute (R01CA138981-05, Penner: PI); National Science Foundation Dissertation Improvement Award (#1068218, Hankin: PI); Blue Cross and Blue Shield of Michigan Foundation Student Award (#1801-SAP, Peterson: PI). P1-52 The Contribution of Intellectual Functioning to Academic Achievement in Pediatric Cancer Joseph Raiker, Cynthia Karlson, Patricia Graves, T. David Elkin, Maria Smith University of Mississippi Medical Center, Jackson, MS, USA PURPOSE: Despite well-documented declines in intellectual functioning and academic achievement following treatment of pediatric cancer, surprisingly little is known regarding the contribution of reductions in intellectual functioning to declines in academic achievement following treatment. Increased understanding of this relationship may have important implications for predicting academic difficulties after treatment and intervening prior to the onset of academic decline. The current study examines this relationship in a diverse pediatric cancer sample, using hierarchical regression. METHODS: Thirty-one children (51.6% African-American, 45.2% female, M time since diagnosis = 45.73 months, SD = 44.89) with cancer were administered a psychoeducational battery (M age = 10.10 years, SD = 3.07 years). Domains of intellectual functioning (verbal comprehension, perceptual reasoning, working memory, and processing speed) were examined as predictors of academic functioning domains (word reading, reading comprehension, pseudoword decoding, and numerical operations). Ethnicity and gender were entered into Step 1 of the model. The covariate age was excluded due to the use of standard scores in all analyses. Step 2 of each model included the intellectual domain of interest predicting the academic domain of interest. RESULTS: Analyses revealed that intellectual Processing Speed predicted both academic Word Reading (Beta = 0.60, p = .001, R-square change = 0.34) and Pseudoword decoding skills (Beta = 0.48, p = .01, R-square change = 0.22) accounting for approximately 34% and 22% of the variance in these skills beyond Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


basic demographic characteristics, respectively. Intellectual Verbal Comprehension (Beta = .66, p < .001, R-square change = .41), Perceptual Reasoning (Beta = .58, p = .006, R-square change = .25), and Working Memory (Beta = .51, p = .006, R-square change = .24) predicted academic Reading Comprehension accounting for 41%, 25%, and 24% of the variance in these skills beyond basic demographic characteristics, respectively. CONCLUSIONS: Collectively, these findings indicate that deficits in processing speed may contribute to deficits in basic reading skills, whereas, declines in multiple areas of intellectual functioning may contribute to deficits in more complex reading skills (i.e., reading comprehension). Post-treatment evaluation of these domains and interventions targeting these cognitive processes may be beneficial for children with cancer. RESEARCH IMPLICATIONS: The results of this study demonstrate that the impact of pediatric cancer treatment on intellectual functioning has important implications for understanding the declines in academic performance often observed following treatment. Future research examining the impact of pediatric cancer treatment on other cognitive processes may provide additional insight into the adverse academic outcomes these children experience. Furthermore, researchers may be interested in developing intervention programs targeted at improving cognitive deficits in children with pediatric cancer. CLINICAL IMPLICATIONS: The results of this study provide important information regarding the impact of pediatric cancer treatment on declines in intellectual functioning and how these declines are related to poor academic performance. Post-treatment evaluation of these domains and interventions targeting impaired cognitive processes and/or utilizing supplemental academic instruction (e.g., tutoring) may be beneficial for children with cancer. FUNDING: None. P1-53 Knowledge of Family Psychosocial Problems of Health Care Professionals Treating a Child With Cancer Maru Barrera1, Priyanga Yogalingam1, Kelly Hancock1, Alan Rokeach1, Donna Johnston2, Danielle Cataudella3, Marilyn Cassidy3, Shayna Zelcer3, Mariana Silva4, Patty Jansen4, Angela Punnett1, Ute Bartels1, Paul Nathan1, Wendy Shama1, Corin Greenberg5 1 Hospital for Sick Children, Toronto, ON, Canada, 2 Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada, 3Children’s Hospital, London, ON, Canada, 4 Kingston General Hospital, Kingston, ON, Canada, 5 Pediatric Oncology Group of Ontario, Toronto, ON, Canada PURPOSE: This pilot study aimed to: 1) assess the psychometric properties of the Psychosocial Care Checklist (PCCL); 2) conduct preliminary analysis of PCCL’s usefulness for assessing health care professionals’ (HCPs’) psychosocial knowledge of the family (child with cancer, © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Poster Abstracts of the APOS 11th Annual Conference

siblings, parents); and 3) examine if a summary of family psychosocial risk information (from parent-completed Psychosocial Assessment Tool (PATrev) [1]) improves HCPs’ psychosocial knowledge. METHODS: 72 HCPs (oncologists, nurses, social workers {SW}), caring for 43 families, completed the PCCL at T1 (2–4 weeks post-diagnosis), 29 at T2 (2–3 weeks after T1) and 28 at T3 (6 months later). 67 parents completed PATrev at T1. Reliability and construct validity were assessed using Intra-Class Correlation (ICC) and Pearson coefficients. Using a randomized controlled trial [2], 36 HCPs were in the Experimental Group (EG, received PATrev psychosocial risk information) and 36 HCPs in the Control Group (CG). ANOVA and Mann– Whitney U tests were used to test differences in HCP psychosocial knowledge and group status. RESULTS: The PCCL had strong test re-test reliability for all domains (> 0.60), strong internal consistency for the Total PCCL (alpha = 0.91), and moderate to strong reliability for the domains (range: alpha = 0.54 – 0.97). Inter-rater reliability was moderate for the oncologist-nurse dyad with regards to sibling knowledge (0.56, p < 0.05) and total knowledge (0.65, p < 0.01). Strong construct validity was indicated by comparing PCCL and PATrev for all knowledge domains at T1 (> 0.70, p < 0.001). At T1, there were significant differences for sibling knowledge between the SW and oncologist (F(2,53) = 3.98, p = 0.03, η-squared = 0.13) and total knowledge between SW and nurse (F(2,66) = 4.77, p = 0.01, η-squared = 0.13), where SWs were more knowledgeable of sibling’s and total psychosocial problems. There were several trends at T3: knowledge of sibling problems (U = 53.50, p = 0.08) and total psychosocial knowledge (U = 56.00, p = 0.08) were higher in the EG. CONCLUSIONS: This pilot study suggests that PCCL has adequate reliability (excluding inter-rater) and validity. Differences in psychosocial knowledge among HCPs suggest further investigation with a larger sample size is needed to determine the impact of sharing early psychosocial information systematically among the treating team. RESEARCH IMPLICATIONS: These results will facilitate further research on the assessment of HCPs’ knowledge of psychosocial problems in families of children with cancer. CLINICAL IMPLICATIONS: This information would help improve communication among HCPs caring for children who are treated for cancer and their families, which in turn would contribute to better care. FUNDING: This study was funded by POGO’s New Initiatives Research Unit. P1-54 Patterns of Adherence to Maintenance Treatment and Psychosocial Outcomes in Pediatric Cancer Jennifer Rohan1,2, Dennis Drotar1,2, Melissa Alderfer3, Crista Donewar4, Linda Ewing5, Ernest Katz6, Anna Muriel7 1 University of Cincinnati, Cincinnati, OH, USA, 2 Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA, Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Poster Abstracts of the APOS 11th Annual Conference


Children’s Hospital of Philadelphia, Philadelphia, PA, USA, 4Children’s Hospital Medical Center, Dallas, TX, USA, 5Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA, 6Children’s Hospital Los Angeles, Los Angeles, CA, USA, 7Dana-Farber/Children’s Hospital Cancer Center, Boston, MA, USA PURPOSE: Nonadherence to maintenance phase medications such as 6-mercaptopurine (6MP) is a common problem in pediatric cancer. This study describes 6MP adherence patterns based on electronic monitoring and metabolite concentration data for a sample of pediatric patients diagnosed with acute lymphoblastic leukemia (ALL) or lymphoblastic lymphoma (LBL) and describes the relationship between medication adherence and psychosocial outcomes such as quality of life and beliefs about medication. METHODS: Using two objective methods of oral medication adherence (electronic monitoring over one month and pharmacological measures at baseline), adherence was examined for 139 patients’ ages 7–19 diagnosed with ALL or LBL across six centers. Pharmacological measures (e.g., 6MP metabolite concentration levels) allow clinicians to determine if the drug was ingested prior to a blood draw by providing the level of drug metabolites found in the body. Behavioral measures (e.g., electronic monitoring of 6MP) reveal the pattern of drug taking behavior. Baseline patient-reported beliefs about medication and patient and parent-reported cancer-specific quality of life were examined. RESULTS: Adherence rates declined across the one month follow-up period. Three linear trajectories of 6MP behavioral adherence were identified: 1) optimal adherence (n = 99, 76%); 2) deteriorating adherence (n = 23, 18%); and, 3) chronically poor adherence (n = 9, 7%). Similar adherence patterns were observed at baseline with the 6MP metabolite clusters: one group demonstrated poor adherence as evidenced by low levels of both metabolites (n = 48, 35%), and two other groups demonstrated metabolite clusters consistent with adequate adherence (n = 91, 65%). Those patients identified as having deteriorating behavioral adherence reported significantly lower levels of cancer-specific quality of life (e.g., more pain, nausea, and physical symptoms) at baseline and indicated lower intentions to adhere to their prescribed treatment regimen relative to those who had optimal adherence levels. However, these differences were not observed with the pharmacological measure of medication adherence. CONCLUSIONS: This study advances science by providing objective data on the patterns of 6MP medication adherence using behavioral and pharmacological measures in a relatively large sample of pediatric patients with ALL and LBL during the maintenance phase of treatment. Psychosocial factors may serve as important targets at the onset of treatment to improve patterns of medication adherence over time. RESEARCH IMPLICATIONS: This study utilizes innovative research methods for describing medication adherence in pediatric © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.


cancer. CLINICAL IMPLICATIONS: Nonadherence to prescribed medication may not be readily detected by clinicians because patients and parents are unlikely to admit to missed doses. We anticipate that the eventual application of these objective methods will facilitate more effective clinical management of ALL and LBL by providing more targeted clinical management and adherence promotion interventions. FUNDING: This work was supported by the National Cancer Institute at the National Institutes of Health (grant numbers 1F31CA168307 to JMR, 1R01CA119162 to DD), the National Center for Research Resources (UL1RR024134 to MA), and the National Center for Advancing Translational Sciences ( UL1TR000003 to MA). P1-55 has been withdrawn. P1-56 A Study of Children and Adolescent Cancer Patient Referrals to a Psycho-oncology Service in a Tertiary Care Cancer Centre in a Developing Country: Types of Problems Faced and Interventions Used Jayita Deodhar, Lekhika Sonkusare, Savita Goswami, Rohini Hawaldar Tata Memorial Hospital, Mumbai, India PURPOSE: Literature is available on psychological problems faced by children and adolescents with cancer seen in psycho-oncology services in the developing countries. However, there is a paucity of similar data from India. The purpose of our paper is to study the referrals of children and adolescent cancer patients to the psycho-oncology service in a tertiary care oncology centre, examine their sociodemographic, disease and treatment related variables, types of problems faced and relationship (if any) with type of cancer, and interventions used. METHODS: A retrospective analysis, of prospectively maintained data, of all new referrals of children and adolescents with cancer to the psycho-oncology service over a period from 1 June 2010 to 31 May 2013 was carried out. A pro forma was designed to note socio-demographic variables, referral patterns, cancer diagnoses, treatment details, types of problems faced and psychological interventions used. Problems faced by patients are noted routinely during the assessment interviews and categorized in the pro forma. Relevant statistical analysis was done for descriptive statistics and to look for association between variables. RESULTS: 181 children and adolescents with cancer with 120 boys (66.3 %) and 61 girls (33.7%) were seen in the 3 year period. Age ranged from 1 to 156 months, mean age being 10.6 years. Most of the patients had completed their secondary education and belonged to lower and middle socioeconomic status (86%). Most of the patients were referred from Medical oncology unit (57. 5%). The majority had cancer diagnoses of hematolymphoid seen in 104 (57.5%) and brain tumor in 31 patients (17.1%). Treatment received was curative in Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


75% of patients. Primary problems faced by children and adolescents with cancer were mainly emotional in 41.4 %, followed by physical in 28.2% and scholastic in 18.2% of all patients. Psychological interventions used most commonly were child counseling (33.1%), cognitive behavior techniques (22.6%), play therapy (21.4%) and parental intervention (18.2%).There was an association between type of primary problems faced and type of cancer (p = 0.003). CONCLUSIONS: In our study, children and adolescent cancer patients faced more emotional than other problems. Psychological interventions used were child counseling, cognitive behavior therapy and play therapy to address their difficulties. RESEARCH IMPLICATIONS: This leads to new dimensions of understanding of various problems faced by children and adolescents. An appropriate psychological intervention can minimize the emotional distress and make them more cooperative during cancer treatment. FUNDING: None. P1-57 A Longitudinal Look at Basic Needs of Pediatric Oncology Patients, Their Families and Their Psychosocial Adjustment Heatherlun Uphold1, Felicity Harper1, Amy Peterson1, Jennifer Fox1, Tanina Foster1, Jeffery Taub2, Terrance Albrecht1, Louis Penner1 1 Wayne State University, Department of Oncology, Detroit, MI, USA, 2Children’s Hospital of Michigan, Hematology/Oncology Department, Detroit, MI, USA PURPOSE: Children are surviving cancer at increasing rates, but the challenges of pediatric cancer can create substantial needs for basic services among families of patients. This study examined (a) the extent of fiscal/ material/social needs in families of children in treatment, and (b) their relationship to parents’ psychosocial adjustment. METHODS: Participants included 113 pediatric cancer patients (ages 3–12), who were receiving outpatient cancer treatments at two large children’s hospitals, and their parents. Data were collected from parents at study entry, during three successive cancer treatment procedures and 3 and 9 months following the last procedure. At the 3-month follow-up, parents reported their fiscal/material/social needs and whether the hospital offered assistance for these needs. Parents also completed measures of psychosocial adjustment: satisfaction with life (Diener et al., 1985), perceived stress (Cohen, 1994), psychiatric symptoms (Derogatis, 1983), and post-traumatic stress symptoms (Weiss & Marmar, 1996) at 3- and 9-month follow ups. RESULTS: The top 5 needs identified by parents were: social work services, recreational/play activities during treatment, help with insurance to cover medical care, educational activities to help their child cope, and help obtaining cancer-related medical services. An analysis of demographic correlates showed the total number of reported needs was © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Poster Abstracts of the APOS 11th Annual Conference

significantly and negatively correlated with income, and Black families reported significantly more needs than White families. There were no other significant demographic correlates of need. Controlling for parent depression and trait anxiety at study entry, total number of needs was negatively associated with parent satisfaction with life at the 3-month follow up, and significantly and positively correlated with symptoms of post-traumatic stress at 9-month study follow up. The percent of unmet needs by the hospital was negatively and significantly correlated with psychiatric symptoms and post-traumatic stress at both 3- and 9-month study follow ups. CONCLUSIONS: Parents of pediatric cancer patients have substantial needs for basic services and the extent of these needs is associated with their psychosocial adjustment. Unmet needs may be a psychosocial risk factor for patients and their families. Programs that address these needs may benefit parents as well as their children. RESEARCH IMPLICATIONS: The need for basic services in the pediatric cancer context should be further examined. CLINICAL IMPLICATIONS: Programs that address basic needs may benefit parents as well as their children in the pediatric cancer context. FUNDING: This research was funded by National Cancer Institute RO1 CA138981-05 "Resources, Parent–child Communication and Adjustment to Pediatric Cancer" Penner, PI. P1-58 Healthy Living Educational Pilot Program for Children and Adolescent Survivors of Cancer Jennifer Welch1,2, June Bjerregaard1, Elissa Jelallian1,2, Michael Spoerri1, Cindy Schwartz3,4 1 Hasbro Children’s Hospital, Providence, RI, USA, 2 Brown University, Providence, RI, USA, 3MD Anderson Cancer Center, Houston, TX, USA, 4University of Texas, Houston, TX, USA PURPOSE: Pediatric oncology care results in cure for more than 80% of children and adolescents diagnosed with cancer. Young people who have been treated for cancer experience both short and long term toxicities of treatment. Effects may include physical deconditioning, fatigue, poor nutrition, and obesity. Children may be less likely to participate in gym class or organized sports experiences due to physical effects of therapy or sedentary habits developed during treatment. Even mild to moderate increases in physical activity may lead to improved health outcomes both immediately after therapy and in the long term. METHODS: Our pediatric oncology program offered, in collaboration with our local YMCA and Livestrong at the YMCA, a comprehensive educational program for children and adolescent survivors of childhood cancer including nutrition education, physical activity, and stress management. The educational program included 24 sessions over 12 weeks at a local YMCA. Parent use of YMCA facilities and sibling child care were included as inducement to Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Poster Abstracts of the APOS 11th Annual Conference

participate. Eighteen participants enrolled in this IRB approved research project. 60% were female with an average age of 11 years (range 8 to 18 years). Cancer diagnoses included leukemia (7), brain tumors (4), and other solid tumors (5). Subjects were assessed before and after participation in the program by physical therapy. RESULTS: Of the 18 participants, 12 (66%) attended the majority of sessions (more than 60%). Four (22%) attended no sessions after enrollment and withdrew from further participation. Eligible participants who chose not to enroll and those who withdrew cited inconvenience of location and time as the most important reason. Six of the 12 parent–child pairs who sustained participation completed post- intervention surveys and all of these participants felt the educational program was beneficial to them personally and would recommend the program to another survivor. CONCLUSIONS: Interest in this educational program for children and adolescent cancer survivors was strong but difficult to sustain over the entire program. Families who completed the intervention and responded to the questionnaire universally perceived personal benefit from the program. Further research on how to help families of pediatric cancer survivors engage in educational programming focused on healthy living is necessary. RESEARCH IMPLICATIONS: Researchers will be interested in gathering further evidence-based information on psychosocial care for pediatric oncology survivors including pre and post assessment of this education intervention. CLINICAL IMPLICATIONS: Survivors of pediatric cancer may benefit clinically from educational programs on nutrition, physical activity, and stress management. Clinicians will be interested in how to approach providing this education to their cancer survivors. FUNDING: Funding for this project was provided by Cure Kids Cancer Radiothon at Hasbro Children’s Hospital to the principal investigator, Jennifer Welch. YMCA of Greater Providence and Livestrong at the YMCA provided the educational content. P1-59 Psychology’s Role in Patient-Centered, Evidence-Based, Interdisciplinary Treatment: A Case Study of Phantom Limb Pain Shan Wong, Kaitlyn Powers, Shelley Heaton Department of Clinical & Health Psychology, University of Florida, Gainesville, FL, USA PURPOSE: Medical settings can lack individualized treatment plans that tailor the patient’s values and beliefs. This case illustrates the significance of Psychology’s role in teaching the importance of patient-centered care to an interdisciplinary pediatric hematology/oncology hospital setting. METHODS: We present a case of phantom limb pain (PLP) in a 23-year-old Caucasian male with highgrade osteosarcoma of the left femur. Medical treatment included chemotherapy, complete leg amputation, and physical therapy (PT) at an inpatient hospital and © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.


subsequent rehabilitation facility. Psychology was consulted regarding team concerns of sub-optimal social support, poor medical adherence (often refusing food, medications, and PT services), episodes of depressed mood and mild anxiety, and poor pain tolerance. During the clinical evaluation, patient revealed interests in Tai Chi, eastern ideologies, and the “mind-body” connection. Intellectual abilities (WASI) and personality characteristics (MMPI-2) were also assessed to inform the best psychological treatment approach. Literature review of evidencebased psychological interventions tailoring the patient’s interests and personality characteristics indicated Mindfulness-based psychotherapy (as opposed to CBT) to target mood and Mirror Box Therapy (as opposed to pharmacological adherence) to target PLP as the most appropriate treatments. Pain level was measured using a 0 (no pain) to 10 (most extreme pain imaginable) scale. Inpatient psychological services were provided bi-weekly targeting medical adherence and coping behaviors, and continuity of psychological services was maintained at the rehabilitation facility. In addition, Psychology provided consultation to medical and PT disciplines to improve the team’s rapport and communication with the patient. RESULTS: Results from the WASI showed above average intellectual abilities, with strong verbal skills. His MMPI-2 profile displayed tendencies to express high psychological distress as somatic complaints. Ongoing sessions of Mindfulness-based psychotherapy revealed improvements in mood and medical adherence, and after two sessions of Mirror Box Therapy, patient’s pain significantly decreased from a 10 (baseline) to a 2 (post-treatment). Additionally, previous negative outcomes of poor rapport and non-adherence with allied disciplines resolved following consultation with Psychology. CONCLUSIONS: This case demonstrates the importance of communication across disciplines, and Psychology’s vital role in teaching other health-care disciplines the value of tailoring clinical care and evidence-based practice to an individual’s needs for successful outcomes. RESEARCH IMPLICATIONS: This case demonstrates effective use of mindfulness-based therapy and graded motor imagery (including visual imagery and mirror box therapy) to reduce phantom limb pain of the lower limbs. The success of these techniques in a clinical setting supports the results from the current literature regarding phantom limb pain in a controlled setting, suggesting the potential application of these methods in future effectiveness and dissemination trials. CLINICAL IMPLICATIONS: This case highlights the need for clinicians to consider the current literature on evidence-based psychotherapy as well as the patient’s individual values and needs in an effort to create the best psychological intervention for the patient. Additionally, this case demonstrates successful outcomes when communication and collaboration with an interdisciplinary team are facilitated to provide comprehensive patient-centered care. FUNDING: None. Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


P1-60 Feasibility/Acceptability of Quality of Life Research Among Distressed Individuals Affected by Pancreatic Cancer Shan Wong1, Arlene Shi1, Thomas George2, Deidre Pereira1 1 Department of Clinical & Health Psychology, University of Florida, Gainesville, FL, USA, 2Department of Medicine, Division of Hematology/Oncology, University of Florida, Gainesville, FL, USA PURPOSE: Individuals affected by pancreatic cancer (PCa) often experience significant distress; however, few studies have examined quality of life (QOL) or coping interventions for these individuals. PhotoVoice (PV) is a qualitative, participant-based research technique that allows individuals to record and relay health experiences using photography. PV may be a powerful method of exploring/improving distress, mood, and QOL in individuals affected by PCa. This study (1) explored incidence of clinically significant distress and depressed mood in newly diagnosed individuals with PCa and (2) assessed feasibility/ accessibility of using PV to explore QOL in PCa newly diagnosed or currently/recently treated patients (+/ caregivers). METHODS: Aim 1 participants were 126 newly diagnosed PCa patients presenting for care at UF Health Cancer Center. Patients completed the NCCN Distress Screening tool and Patient Health Questionnaire (PHQ-9). For Aim 2, 38 newly diagnosed or currently/recently treated PCa patients and caregivers and 6 PCa patients without caregivers were assessed for their interest in participating in a PV QOL Study (1 = not interested, 10 = extremely interested). RESULTS: 48% of newly diagnosed PCa patients endorsed distress on the Distress Thermometer (score≥ > =4). Primary concerns related to emotional and physical well-being. Higher distress scores were significantly correlated with younger age (p < .05). Of those significantly distressed, 54% endorsed depressed mood. Currently/recently treated PCa patients reported significantly higher interest (M = 6.00, SD = .291.13) in PV participation than newly diagnosed patients (M = 3.48,SD = 2..04)38) (p < .001). PV interest was significantly higher in caregivers of currently/recently treated patients (M = 7.54,SD = 1.74) than caregivers of newly diagnosed patients (M = 3.54,SD = .482.42) (p < .001). Greater caregiver interest was significantly correlated with older age (p < .05). Qualitative responses indicated caregivers of newly diagnosed patients preferred focusing on patients’ medical treatment rather than research. Currently/ recently treated patients attributed PV interest to wanting to help others, while their caregivers attributed PV interest to desiring support. CONCLUSIONS: A significant proportion of patients with PCa endorse distress and clinically significant depressed mood. Screening newly diagnosed PCa patients for distress may allow early identification of patients who both desire and need psychosocial © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Poster Abstracts of the APOS 11th Annual Conference

intervention. Future studies should explore the benefits of PV among individuals with PCa and their caregivers, focusing on currently/recently treated patients who were significantly distressed at diagnosis. RESEARCH IMPLICATIONS: This study demonstrates the importance of conducting a feasibility/acceptability study prior to enrolling subjects for research participation. Conducting such a study allows researchers to create a time-efficient plan to maximize recruitment efforts in those individuals are desiring of and most in need of psychosocial interventions such as PV. CLINICAL IMPLICATIONS: This study highlights the presence of significant distress and mood disturbance among newly diagnosed PCa patients. In addition, it emphasizes that PCa patients and caregivers may be more interested in PV QOL research and interventions once active treatment has been initiated/completed. Therefore, PCa patients/caregivers who were significantly distressed at this point of diagnosis may be the most important individuals to target with PV research. FUNDING: None. P1-61 Role of Stressors and Psychosocial Resources in the Psychological Distress of Latinas With Breast Cancer Chris Segrin1,2, Terry Badger1,2 1 The University of Arizona Department of Communications, Tucson, AZ, USA, 2The University of Arizona College of Nursing, Tucson, AZ, USA PURPOSE: Psychological distress, highly prevalent in Latinas undergoing treatment for breast cancer, represents a serious threat to quality of life (QOL). Our purpose was to test components of the Stress Process Model with cancer stage treated as a primary stressor and family functioning as a secondary stressor, given the importance of familism in the Latino culture. Emotional support and social isolation were two indicators of psychosocial resources. METHODS: Our sample consisted of 48 Latinas with breast cancer (M age = 49.65) recruited from a larger intervention study. The majority of the participants had < high school and Stage III, or IV breast cancer. Hierarchical regression analyses were used to predict psychological distress (depression, anxiety, and perceived stress). All models were statistically significant at p < .01 - .001. RESULTS: Family functioning and social isolation significantly predicted depression and perceived stress. Social isolation and emotional support were both marginally associated (p = .05 -.06) with anxiety. Thus, good family functioning with minimal conflict and emotional support are beneficial to the psychological QOL of Latinas with breast cancer. Social isolation is detrimental to QOL. Stage, the primary stressor, was not a significant predictor of psychological distress. A post-hoc test was conducted to explore the association between family functioning and QOL through emotional support, with a bootstrapping procedure to estimate the standard error of the indirect effect. The results Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Poster Abstracts of the APOS 11th Annual Conference

indicated that family functioning had a significant direct effect on QOL (B = .30, p < .05). Family functioning also had a significant indirect effect on better QOL, through greater available emotional support (B = .06, p < .05, effect size κ2 = .10). It appears that social-relationship issues, particularly family functioning, play a more dominant role in predicting the QOL of Latinas than the stress posed by the stage of their disease. Our post-hoc test suggests that a vital provision of family functioning with salutary effects on QOL may be greater emotional support. CONCLUSIONS: These findings illustrate the importance of familism among Latinas and highlight the need to understand the social and family context in which the stress of cancer and its effective treatment are pursued. RESEARCH IMPLICATIONS: This model when tested in a larger sample (by presentation) will add empirical support to the theoretical linkages in the model and provide a valid model for research with Latinas with breast cancer. CLINICAL IMPLICATIONS: These findings illustrate the importance of familism among Latinas and highlight the need to understand the social and family context in which the stress of cancer and its effective treatment are pursued. The implications for clinical practice is to explore the family context and include family in treatment. FUNDING: American Cancer Society. P1-62 Cumulative Life Stress is Associated With Depressive Symptoms in Oncology Outpatients Undergoing Chemotherapy Dale Langford, Laura Dunn, Anand Dhruva, Steven Paul, Brad Aouizerat, Christine Miaskowski University of California, San Francisco, San Francisco, CA, USA PURPOSE: Oncology patients experience heterogeneity in levels of symptom severity in relation to their disease or treatment. Previous work by our group showed substantial heterogeneity in trajectories of depressive symptoms in patients with four cancer types. Although stressful life events (SLEs) are risk factors for depression, the impact of SLEs on depressive symptoms in oncology patients undergoing treatment has been minimally studied. The purpose of this study was to determine the prevalence and impact of SLEs using an in-depth instrument, the Life Stressor Checklist-Revised (LSC-R), among oncology outpatients receiving chemotherapy, and to examine the association between SLEs and depressive symptoms. METHODS: Patients (n = 534) with breast, gastrointestinal, gynecologic or lung cancer completed the LSC-R and the Center for Epidemiological Studies-Depression scale (CES-D). LSC-R scores (number of SLEs and impact on patient in the prior year) were evaluated in relation to demographic and clinical characteristics. Linear regression was used to evaluate the association between LSC-R and © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.


CES-D scores. RESULTS: Patients reported a mean of 6.2 SLEs (SD 4.1; range: 0–23 out of 30). The most frequently reported stressor was the death of someone close. Patients who were not married/partnered, lived alone, had incomes of < $30,000/year, or had lower functional status or higher comorbidity scores had significantly higher scores on the LSC-R. Controlling for relevant covariates, higher LSC-R scores were significantly associated with higher CES-D scores. CONCLUSIONS: SLEs were common in oncology patients. Certain demographic and clinical characteristics were associated with higher LSC-R scores. Cumulative life stress, including its impact on recent life, warrants further evaluation in oncology patients, as these data suggest that it is associated with more severe depressive symptoms at a time of already increased stress. RESEARCH IMPLICATIONS: While SLEs were associated with depressive symptoms in this cross-sectional study, inferences about causality warrant investigation in longitudinal studies. Further work is also needed to test interventions tailored to these high-risk individuals. CLINICAL IMPLICATIONS: In addition to assessing levels of distress, evaluation of oncology patients’ cumulative life stress may help identify individuals at higher risk for depressive symptoms, as well as to intervene more effectively with higher risk patients. FUNDING: This study was funded by the National Cancer Institute (CA134900). Dr. Langford is supported by a Department of Defense Breast Cancer Research Program Postdoctoral Fellowship. P1-63 The Relationship Between Neighborhood Crime Rates and Emotional Well-Being in Women With Gynecological Cancer Diego Esparza-Duran, Laura Telepak, Rachel Fox, Shan Wong, Deidre B. Pereira University of Florida, Gainesville, FL, USA PURPOSE: Factors at the neighborhood level may affect psychosocial functioning, such as emotional well-being, as well as health outcomes among individuals with cancer. Neighborhood crime rates, for instance, have been found to affect perceptions of safety, which may have an effect on negative mood. The present study examined the association between neighborhood crime rates and emotional well-being in women post-surgical intervention for gynecologic cancer. METHODS: Forty-four women with sleep difficulties were recruited prior to surgery for gynecologic cancer. Measures of violence in participants’ neighborhoods were obtained from the FBI US Crime Reports Local Area Rates (2011). Participants’ emotional well-being was assessed using the Emotional Well-Being subscale of the Functional Assessment of Cancer Therapy General (FACT-G), a measure of function across domains relevant to the cancer population. RESULTS: Hierarchical regression analysis was used to examine if neighborhood Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


crime rates (composite violent and property crime rates) significantly predicted poorer emotional well-being, while controlling for age and employment status (employed vs. other). Being employed was significantly associated with better emotional well-being (beta = 0.42, p < 0.05), while older age (beta = 0.34, p = 0.67) and lower total neighborhood crime rates (beta = 0.31, p = .067) were marginally associated with better emotional well-being. The overall model explained 27.8% of the variance in emotional wellbeing (R2 = .278, F(3,31) = 3.99, p < 0.05). CONCLUSIONS: This study suggests that unfavorable neighborhood characteristics may be associated with poorer emotional well-being among women post-cancer surgery. RESEARCH IMPLICATIONS: Given the modest sample size and marginally significant results, future research should examine these relationships in a larger sample. CLINICAL IMPLICATIONS: Psychosocial interventions for distressed women with cancer should take into account the potential impact of environmental factors on well-being. FUNDING: This study is sponsored by the National Institutes of Health (NIH) (R01 CA138808). P1-64 Pre-operative Inflammation (IL-6) and Sensory Pain Experience in Women With Suspected Gynecologic Cancers Rachel Fox1, Elizabeth Kacel1, Laura Telepak1, Diego Esparza-Duran1, Shan Wong1, Linda Morgan2, Deidre Pereira1 1 Department of Clinical and Health Psychology University of Florida, Gainesville, FL, USA, 2Department of Obstetrics and Gynecology University of Florida, Gainesville, FL, USA PURPOSE: Pain is an important symptom in the cancer experience and is related to systemic inflammation, the latter of which may be related to upregulation of proinflammatory cytokines including interleukin-6 (IL-6). Animal models have demonstrated a link between higher IL-6 and greater hyperalgesia. However, few studies have examined this relationship in humans particularly prior to invasive interventions, such as surgery. The current study examined the relationship between inflammation and pain experience in women with suspected gynecologic cancers. METHODS: Participants were 19 women (M age [yrs] = 56, SD = 12) who were undergoing surgery for suspected gynecologic cancers. Pain experience was assessed via the McGill-Melzack Pain Questionnaire (MPQ); serum IL-6 concentrations were evaluated from pre-operative blood draw. RESULTS: Controlling for demographic variables associated with pain experience (e.g., education), women with greater IL-6 used a greater number of words to describe their pain (beta = .36, p = .04). In addition, higher IL-6 was marginally associated with higher sensory pain scores (beta = .32, p = .06). CONCLUSIONS: These findings suggest higher IL-6 levels are associated with (a) more poorly © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Poster Abstracts of the APOS 11th Annual Conference

differentiated qualitative pain experiences, and (b) marginally greater sensory pain among women undergoing cancer surgery. RESEARCH IMPLICATIONS: Future research should attempt to replicate these relationships in a larger sample and explore the relationship between changes in peri-operative IL-6 levels and changes in peri-operative pain experiences in cancer. CLINICAL IMPLICATIONS: Interventions that target reducing inflammation-associated pain experiences may improve perioperative quality of life and health outcomes in women undergoing cancer surgery. FUNDING: National Institutes of Health (NIH) R01 CA13808. P1-65 Comparison of Depressive Symptoms and Distress in Patients Preparing for Allogeneic and Autologous Stem Cell Transplant Jessica Hamilton, Meagan Dwyer, Michele Tsai University of Kansas Medical Center, Kansas City, KS, USA PURPOSE: There is limited research examining psychological differences of the experience when preparing for autologous versus allogeneic stem cell transplant. When comparing autologous and allogeneic transplants, autologous stem cell transplants have been found to have lower morbidity and mortality rates, such as lack of risk for graft versus host disease (GVHD). Psychosocial factors including patients’ levels of distress, depressive symptoms, and quality of life have been highlighted as important factors influencing treatment and recovery. However, there is a lack of literature related to levels of distress and depression between these patient groups preceding transplant. This study looks to better understand psychosocial factors affecting distress and depression in patients preparing for allogeneic versus autologous stem cell transplant. METHODS: Study participants were adult patients with hematological malignancies who have undergone evaluation at the University of Kansas Cancer Center for bone marrow or peripheral blood stem cell transplant (BMT). Our sample consists of 225 patients evaluated prior to stem cell transplant at an NCI designated cancer center. During the evaluation, patients completed the NCCN Distress Thermometer, CES-D, and SF-12. Demographic data regarding the patient population is also examined and reported. RESULTS: There was a total of 225 participants (M = 54.67, SD = 13.86). There were no significant differences found on the Distress Thermometer or the CES-D based off of type of stem cell transplant. Level of distress measured by Distress Thermometer was on average 3.25 (SD = 2.79), which is below the clinical level of distress. The mean score on the CES-D was 10.09 (SD =8.65) and both the subscales of the SF-12 were within normal limits (Physical M = 36.95, SD = 10.90; Mental M = 52.28, SD = 9.35). Further analyses will be completed examining specific differences between groups Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Poster Abstracts of the APOS 11th Annual Conference

in the future. CONCLUSIONS: Patients preparing for allogeneic and autologous stem cell transplant do not differ significantly on self-reported measures of distress or depressive symptoms. Prior to transplant, patients’ average reported scores on distress and depressive symptoms were below clinical significance. The screeners were utilized in identifying those patients who endorsed significant symptoms and/ or problems and aided in providing them with the appropriate psychosocial services. RESEARCH IMPLICATIONS: Results suggest a limited amount of psychosocial differences between patients preparing for autologous compared to allogeneic stem cell transplant. Future research should examine longitudinal data assessing the stability of these self-reports both during and after stem cell transplant. CLINICAL IMPLICATIONS: On average, patients did not endorse clinical levels of distress or depression prior to stem cell transplantation. Those reporting significant levels of distress were referred to psychosocial services at that time. Continued screening during the treatment and recovery process will assist in further identification of support need in addition to clinical staff referrals for patients. FUNDING: None. P1-66 Implications of Household Size on Quality of Life in Low-Income Ethnic Minority Cancer Patients Migda Hunter, Rosario Costas, Francesca Gany Memorial Sloan-Kettering Cancer Center, New York, NY, USA PURPOSE: Household size has great implications for health and overall QOL. The purpose of this study is to determine the impact of household size on QOL in ethnic minority cancer patients. It will provide insight into how the number of people living in a household and satisfaction with living situation may affect social well-being (SWB), emotional well-being (EWB), QOL, and depression in cancer patients. This has implications for policies around housing for cancer patients. METHODS: A sample of 1,030 cancer patients was recruited through the Portal Cancer Project, which addresses socioeconomic determinants of cancer treatment access and adherence in NYC. Participants completed a sociodemographic survey (with questions about household size, perceptions of crowding, and overall satisfaction with living situation), FACT-G, and the PHQ-9. An objective measure of overcrowding was computed using the Census formula of more than 2 people per bedroom. RESULTS: Participants’ mean age was 55, 65% were female. 62% were Latino and 43% African American. 20% of the participants were living alone, 71% in a household comprised of 2 to 5 people, and 9% six or more. Those who perceived their household as crowded had lower EWB, less overall QOL, and higher levels of depression. Using the objective measure, overcrowding was not associated with the psychosocial outcomes. Patients living with 6 © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.


or more people reported lower EWB and higher depression levels; patients who live alone reported lower SWB. Participants who reported not being satisfied with their living situation had less SWB, less EWB, higher depression levels, and less overall QOL. CONCLUSIONS: Household size among cancer patients is an important determinant of QOL. More than 6 people in a household affects the EWB and overall QOL of cancer patients. Also, cancer patients living alone experience a great deal of distress as they receive less social and family support. Results suggest that it is the patient’s perception of overcrowding and their satisfaction with their living situation, rather than objective definitions, that impact the psychosocial outcomes. RESEARCH IMPLICATIONS: This information provides researchers with insight of the degree and implications that overcrowding and overall living satisfaction has on psychosocial outcomes among cancer patients. Household size is an important determinant of QOL among this population and taking into consideration its impact can provide researchers with core information to broaden research in this particular matter as well as implications for policies regarding housing for cancer patients. CLINICAL IMPLICATIONS: The information provided will give insight to clinicians of the psychosocial outcomes among cancer patients and the impact that household size has among this population. Obtaining knowledge regarding this area may increase awareness on how the household size and the patients’ living satisfaction has on QOL. Furthermore, this will provide information on areas to be addressed in clinical interventions as well as its implications for improving health and overall QOL. FUNDING: New York Community Trust; NCI Support: U54-13778804-S2 & T32CA00946. P1-67 Group Psychotherapy for Patients With Advanced or Recurrent Cancer: Preliminary Study on Their Participative Condition Mayumi Ishida, Hiroaki Toyama, Satoshi Kawada, Hideki Onishi Saitama International Medical Center, Saitama Medical University, Saitama, Japan PURPOSE: There is strong evidence that group psychotherapy interventions for cancer patients are effective in improving the quality of life and reducing psychological distress. However, few interventions have been reported for advanced or recurrent cancer. With the aim of alleviating psychological distress, our hospital provides group psychotherapy for patients with advanced or recurrent cancer (regardless of cancer site) once a month with a psychiatrist and a clinical psychologist. The purpose of this study was to examine their backgrounds and participative condition until they developed difficulty in attending, with the aim of improving group psychotherapy program among the patients who attended them. METHODS: In Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


this retrospective study, all patients who participated in this group psychotherapy between May 2007 and April 2013 were reviewed, with a focus on their backgrounds, participative condition and reason for absence or discontinuation. This study was approved by the Institutional Review Board of Saitama Medical University International Medical Center. RESULTS: During the study period, 25 patients participated in our group therapy, and 5 patients are continuing to participate after the end of the study period. For this analysis, we excluded 2 patients whose reasons for discontinuation were unknown. The main reason for discontinuation was poor physical condition (65%), followed by treatment-related scheduling conflicts (25%). Eight patients (44%) participated in this group only once. During three months before they became unable to participate, 12 patients participated in this group. However, only 7 patients (58.3%) could attend all sessions for three months. During the six months before they became unable to participate, 10 patients participate in this group. However, only 2 patients (20.0%) could attend all sessions for six months. CONCLUSIONS: This study examined participation in programmed series sessions for several months. Because of their physical condition and treatment-related scheduling conflicts, continued participation in this monthly group psychotherapy appears too difficult for the advanced or recurrent cancer patients. RESEARCH IMPLICATIONS: Because of the poor physical condition of advanced or recurrent cancer patients, continued participation in programmed series sessions for several months may be difficult. CLINICAL IMPLICATIONS: None. FUNDING: This study was supported by a Grant-in-Aid for Research Activity Start-up < KAKENHI > . P1-68 Sleep Disturbances and Cytokines in Breast Cancer: A Review of the Literature Carly Paterson, Cecile Lengacher University of South Florida College of Nursing, Tampa, FL, USA PURPOSE: The purpose of this review is to synthesize the available research regarding the association between sleep disturbances and cytokines in the breast cancer population. METHODS: The PubMed, Science Direct, Web of Knowledge®, PsycInfo and CINAHL databases were searched using a combination of the terms “cytokines,” “TNF-α,” “IL-10,” “IL-1,” “IL-6,” “sleep,” “sleep disturbance,” and “breast cancer.” Inclusion criteria included 1) original research; 2) sample that includes breast cancer patients; 3) assessment of sleep disturbance; 4) assessment of inflammatory cytokines; and 5) publication in a peerreviewed journal. Exclusion criteria included 1) dissertations and theses, and 2) studies not published in English. RESULTS: Twelve relevant studies, that met all outlined inclusion/exclusion criteria, were included in this review. Five © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Poster Abstracts of the APOS 11th Annual Conference

were randomized controlled trials, were longitudinal studies, and were cross sectional studies. The findings were difficult to synthesize due to a large variability in cytokines and subjective sleep measures utilized in each study as well as a limited number of significant findings in those studies included. CONCLUSIONS: Due to the limitations of the studies included in this review, it is recommended that larger randomized controlled trials with consistent measurement parameters examining the association between sleep disturbance and cytokines be implemented in order to further clarify the nature of the association between these variables. RESEARCH IMPLICATIONS: In order to further investigate the relationship between sleep disturbances and inflammation, it is likely necessary that large-scale randomized controlled trials, perhaps implementing an exercise intervention, which this review has shown promising preliminary results for in reducing inflammation and sleep disturbance in breast cancer patients, may help to strengthen the evidence of the association between sleep disturbance and inflammation along with the potential interventions that may help to improve these symptoms in breast cancer patients. CLINICAL IMPLICATIONS: The evidence that sleep disturbances and inflammation are linked is strong in the general scientific literature, and it is important to continue investigating this distressing symptom in cancer survivors in order to insure an improved quality of life and to reduce morbidity and mortality in this population. FUNDING: None. P1-69 Obesity in Survivorship: Healthy Behaviors Associated With Improved Quality of Life Among Obese Cancer Survivors Errol Philip1, Amir Goren2 1 Memorial Sloan-Kettering Cancer Center, New York, NY, USA, 2Kantar Health, New York, NY, USA PURPOSE: Approximately 9 of the 14.5 million cancer survivors in the US are overweight or obese, possessing a ‘dual-risk’ profile (cancer history, excess weight) and increased risk of secondary cancers, cardiovascular disease and impaired quality of life (QOL). The current study examined exercise, smoking behavior and psychosocial outcomes among obese cancer survivors in a US population-based survey. METHODS: Participants were 2745 respondents from the 2012 US National Health and Wellness Survey who self-reported a cancer diagnosis and were obese (BMI ≥ 30). The majority were male (54%), Caucasian (84%), had some college education (80%), with mean age of 62 years. Three healthy behavior groups were formed based on self-reported exercise and smoking behavior: (1) non-exercising smokers (reference group), (2) respondents who either exercised regularly or did not smoke, and (3) non-smoking exercisers. Demographics and psychosocial outcomes (SF-12v2-based QOL scores, Work Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Poster Abstracts of the APOS 11th Annual Conference

Productivity and Activity Impairment) were examined across groups, adjusting for covariates in regression models. RESULTS: Respondents comprised 285 (10%) nonexercising smokers, 1889 (69%) who either exercised or did not smoke, and 571 (21%) non-smoking regular exercisers. Those who engaged in at least one healthy behavior (vs. both unhealthy behaviors) were more likely to be Caucasian and have a higher education and income. Adjusting for covariates, obese cancer survivors who were non-smoking regular exercisers had significantly better quality of life and lower activity impairment than those who smoked and did not exercise. Smaller impairments emerged for those engaging in just one negative health behavior. CONCLUSIONS: Despite evidence suggesting that a cancer diagnosis can prompt positive behavior change, only one-fifth of those surveyed reported regular exercise and non-smoker status. Engagement in both healthy behaviors was associated with better psychosocial outcomes, even after adjusting for the socioeconomic advantage seen among those undertaking healthy behaviors. These findings can help promote engagement in healthy behaviors as part of comprehensive cancer care. RESEARCH IMPLICATIONS: The current study provides insight into the health behaviors of a large population-based sample of obese cancer survivors, a group at risk of poorer long-term outcomes. Further analysis provides researchers information regarding the relationship between health behaviors and quality of life. CLINICAL IMPLICATIONS: Obese cancer survivors are at-risk of poorer long-term outcomes. Clinicians play a critical role in promoting engagement in healthy behaviors. The current study provides insight into the rate of health behavior engagement and its relationship with quality of life, and further emphasizes the need for increased awareness of health promotion in the context of obesity and cancer survivorship. FUNDING: NIH-NCI: T32CA009461. P1-70 Implementation of a Systematic Approach to Increase Occurrence and Documentation of Fertility Discussions in Newly Diagnosed Acute Leukemia Patients Prior to Induction Chemotherapy Dawn Speckhart, Scott Solomon, Asad Bashey, H. Kent Holland, Lawrence Morris The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, USA PURPOSE: The American Society of Clinical Oncology established guidelines on fertility preservation in cancer patients in 2006. However, recent data suggests that the guidelines are not followed in many oncology cases. Several studies have begun to examine the rate in which fertility discussions occurred, appearing as low as 34% in some reviews. A recent study published by Gwede, et al., suggests that less than 50% of adult patients with cancer who are of childbearing receive adequate education about the options before cancer treatment. New acute leukemia © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.


patients are in a particularly difficult situation as they typically need to start chemotherapy within days of being diagnosed. The urgency to begin chemotherapy, coupled with a potentially life threatening illness, leaves many medical professionals to focus on the leukemia therapy versus discussions regarding other potential long term side effects of treatment. However, medical professionals agree that it is still essential that patients be educated on the potential impact of chemotherapy on fertility and any possible options for patients protect their fertility. In order to assess programmatic performance in this area, 27 newly diagnosed leukemia patient charts were audited for the documentation of a fertility discussion. This chart review revealed that 12 of 27 (44%) patients had documentation indicating that a fertility discussion took place prior to the start of chemotherapy. In an effort to improve the occurrence and documentation of fertility discussions in newly diagnosed acute leukemia patients, a process improvement plan was put into place. METHODS: A task force, lead by the program’s Psychologist educated the team on the need for fertility discussions and what documentation needed to occur. Barriers identified as impeding fertility discussions included fear of increasing emotional distress, lack of knowledge of what fertility options existed for patients, and a reminder to bring up fertility and/or document discussions. Due to the underlying emotions related to both a new cancer diagnosis and potential fertility issues, critical team members were identified and educated to discuss fertility issues with patients. The entire treatment team was encouraged to remind those critical team members to have and document the fertility discussion with patients. RESULTS: After implementing a systematic, multi-disciplinary plan and staff education, a new set of 27 newly diagnosed leukemia patient charts were reviewed for documentation of a fertility discussion. After the intervention, 27 of 27 patient charts had documentation that a fertility discussion took place prior to the patient starting induction chemotherapy. As found in a previous review by Reinecke, et al., the inclusion of an internal champion and education of staff worked well to ensure that these discussions occurred. CONCLUSIONS: This trend reinforces the use of a multidisciplinary team, process improvement and education as ways to ensure all aspects of patient care are covered. RESEARCH IMPLICATIONS: For researchers interested in assessing the effectiveness of Onoclogists following the ASCO guidelines and methods to improve communication with patients this abstract highlights one successful intervention. It also allows for other programs to come up with ways to utilize team members to improve patient care. CLINICAL IMPLICATIONS: Helps programs discover ways to ensure that fertility issues are being discussed and ways to utilize and identify appropriate team members to help with this process. FUNDING: None. Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


P1-71 Effects of Depressive Symptoms and Distress on Psychosocial and Physical Factors in Pre-bone Marrow Transplant Patients Michele Tsai1, Meagan Dwyer2, Jessica Hamilton2 1 University of Kansas, Lawrence, KS, USA, 2University of Kansas Medical Center, Kansas City, KS, USA PURPOSE: Psychosocial aspects of cancer– including patient distress and identified problems, depressive symptoms, and health-related quality of life (HRQOL) – are important influences on treatment and recovery. Patients with hematological malignancies experiencing difficulties with distress, depression, and HRQOL before bone marrow and peripheral blood transplant (BMT) are likely to experience sustained difficulties in these same areas. The purposes of the current study are to: 1) confirm psychooncological findings that psychosocial problems, patient age, and female gender are positively related to depression severity and HRQOL in a sample of patients evaluated for BMT; and to 2) test depression and distress scores as potential mediators of the relationships between psychosocial and physical problems, and physical and mental health aspects of HRQOL in this population. METHODS: The medical charts of 218 adult patients (46.8% female, mean age of 54.7 years) with hematological malignancies, who had undergone evaluation at an NCI designated cancer center for BMT, were reviewed for this study. Demographics and scores from the NCCN Distress Thermometer, CES-D, and SF-12, completed as part of the clinical pre-transplant evaluation, were analyzed. RESULTS: Relationships among psychosocial problems, age, gender, depression, distress, physical HRQOL, and mental HRQOL were tested through bivariate correlations. The number of problems identified was positively correlated with depression (r = 0.72, p < 0.001), and female gender was related to lower mental HRQOL (r = 0.22, p = 0.001). Sobel tests supported the two models in which depression (z = 6.84, p < 0.01) or distress (z = 5.79, p < 0.01) mediated the relationship between identified problems and mental HRQOL. Though identified problems, distress, and depression were each directly related to physical HRQOL, distress and depression did not mediate the relationship between such problems and physical HRQOL. CONCLUSIONS: Patients with hematological malignancies at greater risk for lower mental HRQOL include females, those identifying more psychosocial and physical problems, those experiencing greater distress, and those suffering from more severe depressive symptoms. The results of this study’s mediation analyses suggest that preventative efforts assisting patients with management of distress and depression pre-BMT would improve patients’ mental HRQOL. RESEARCH IMPLICATIONS: The results of this study provide preliminary support for the mediation of the effect of psychosocial and physical problems on patients’ mental © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Poster Abstracts of the APOS 11th Annual Conference

health quality of life by depression severity and distress. Future studies of longitudinal design would be needed to test whether depression and distress mediated the effect of problems identified before transplant on longterm (post-BMT) mental health quality of life. This study also indicates the need to test additional models of how patient-identified problems, depression, and distress affect physical quality of life. CLINICAL IMPLICATIONS: This study’s results suggest that the relationship between more psychosocial and physical problems identified by patients with hematological malignancies before transplant and lower mental health-related quality of life may be, at least partially, attributed to patients’ experience of depression or psychological distress. In addition to assisting patients in addressing identified problems, reducing depression and distress should be prioritized in psychosocial preventative efforts early in patients’ treatment. Early screening, support, and intervention to address such concerns are an important component of oncology care. FUNDING: None. P1-72 Psychosocial Factors Predicting Quality of Life in Allogeneic Stem Cell Transplant Patients Prior to Transplant Brindha Pillay1, Stuart Lee2, Lynda Katona3, Sue Burney4, Sharon Avery5 1 School of Psychology and Psychiatry, Monash University, Melbourne, Australia, 2Monash Alfred Psychiatry Research Centre, Monash University and Alfred Health, Melbourne, Australia, 3Department of Psychology and Consultation Liaison Psychiatry, Alfred Health, Melbourne, Australia, 4 Cabrini Monash Psycho-oncology Unit, Cabrini Health, Melbourne, Australia, 5Malignant Haematology & Stem Cell Transplantation, Alfred Health, Melbourne, Australia PURPOSE: Allogeneic haematopoietic stem cell transplant (HSCT) has been offered as a potentially curative treatment for a range of haematological cancers. Given the complications that may arise post-transplant, a significant body of research has developed about the factors that predict survival and quality of life (QoL) post-transplant. As quality of life impairments often begin prior to HSCT because of disease progression or the effects of previous treatment, it is important to also examine the pre-transplant phase. Thus, one of the key aims of the present study was to ascertain the levels of psychological distress and QoL pretransplant. In addition, a primary aim was to examine the demographic, medical, and psychosocial factors that predicted various domains of QoL at this stage of treatment. The relationships between coping responses and psychological distress were also explored. METHODS: 147 allograft patients completed a series of measures as part of routine psychological assessment at the treating hospital prior to undergoing the transplant. These included the Mental Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Poster Abstracts of the APOS 11th Annual Conference

Adjustment to Cancer Scale, Brief Symptom Inventory-18 and World Health Organisation Quality of Life-BREF. Demographic and medical data were also extracted. RESULTS: Twelve and fourteen percent of the sample experienced significant levels of depressive and anxiety symptoms respectively. Half of the sample reported impaired physical QoL, while approximately 40% reported poor psychological and social QoL. Apart from relationship status, demographic and medical factors did not contribute significantly to QoL domains. Fighting spirit was significantly negatively associated with depression but not with anxiety. Anxious-preoccupation, helpless-hopelessness and fatalism coping responses were significantly positively correlated with both depression and anxiety symptoms. After controlling for medical and demographic factors, higher levels of depression and weaker fighting spirit emerged as the only predictors of poorer physical, psychological and social QoL. CONCLUSIONS: Given the association between psychological distress, coping responses and QoL, psychosocial screening pre-transplant is an important part of the treatment protocol for patients who have decided to undergo allogeneic HSCT. Interventions that treat depressive symptoms and encourage fighting spirit prior to transplant may serve to improve QoL of patients during this period. This is likely to lead to better post-transplant outcomes. RESEARCH IMPLICATIONS: The results of the current study add to the body of literature by examining the levels of psychosocial distress, four domains of QoL and coping responses prior to allogeneic transplantation. This phase of treatment has received considerably less attention compared to the post-transplant period. There is, however, a distinct need for repeated studies investigating QoL due to significant medical advances in the field during the last decade. Given the limitations of the present study (i.e. retrospective, cross-sectional, conducted in a single centre), recommendations are made for future research. Future research should employ longitudinal designs comparing the types of psychosocial factors that influence various QoL domains at key points prior to and following transplantation. Other factors such as social support or personality-related factors that may contribute to increased risk or resilience should be explored using measures such as the Multidimensional Scale of Perceived Social Support and Sense of Coherence Scale. Furthermore, the use of standardised disease/transplantspecific instruments (e.g. Functional Assessment of Cancer Therapy – Bone Marrow Transplantation) would be helpful in ensuring that the patient’s experience is adequately captured and would allow comparison with studies conducted in other institutions. CLINICAL IMPLICATIONS: The findings suggest that psychosocial screening pre-transplant is an important part of the service that is provided to patients who have decided to undergo allogeneic HSCT. Despite the low levels of distress on anxiety and depression measures, it is important that clinicians conduct a clinical interview to ascertain an individual’s psychological functioning, and to © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.


be cognizant of defense mechanisms that may be employed at this stage of treatment. In particular, individuals who exhibit significant depressive symptoms and have a weak fighting spirit towards their disease are particularly vulnerable to experiencing poorer QoL. The transplant procedure may then exacerbate levels of physical and mental distress experienced. Thus, assessment and intervention that commences pre-transplant is beneficial as patients are not as physically compromised at this point of the treatment process compared to when transplantation procedures have begun. Tailored interventions that aim to treat depression and foster fighting spirit can then be delivered in a timely manner to individuals who are at high risk of experiencing deteriorating QoL outcomes. FUNDING: None. P1-73 Decisional Conflict and Depression Within the Family Context in Survivorship Care Jung-won Lim1, En-jung Shon2, Ji-Eun Lee3 1 Kangnam University, Yongin, Gyeonggido, Republic of Korea, 2Case Western Reserve University, Cleveland, OH, USA, 3Ewha Womans University, Seoul, Republic of Korea PURPOSE: Coping with stress in survivorship care as well as the quality of family and social networks may influence decisional conflict, and ultimately promote positive adaptation for cancer survivors. The purpose of this study is to examine how stress is associated with decisional conflict and depression within the family context among multiethnic breast, colorectal, and prostate cancer survivors, and to investigate whether such relationships differ by according to the extent to which individuals rely on formal social ties relative to informal social ties. METHODS: A total of 248 White (n = 74), AfricanAmerican (n = 16), Chinese-American (n = 83), and KoreanAmerican (n = 70) breast, colorectal, and prostate cancer survivors were included in this study. Participants were recruited from California Cancer Surveillance Program and local hospitals in Ohio and California. Stress was assessed by familial, functional, and neighborhood-related stresses. Family adaptability and coping were included to consider the family context as mediators. Decisional conflict and depression were measured by the Decisional Conflict Scale and the BSI-18 depression subscale, respectively. RESULTS: The adequacy of latent constructs of stress, family adaptability, family coping, and decisional conflict was confirmed by the CFA. Based on the Conflict Model of Decision Making, the structural equation modeling (SEM) tested the direct and indirect relationships of variables of interest. The hypothesized model provided an acceptable fit (X2(312) = 773.75, CFI = 0.9, RMSEA = 0.07) . Findings demonstrated that stress is directly associated with family adaptability, decisional conflict, and depression. Family Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


coping mediated the relationship between family adaptability and depression. The multiple group SEM found that pathways significantly differed according to the extent to which individuals rely on formal social ties relative to informal social ties. For example, for survivors who indicate the importance of formal social ties, family coping was not associated with decisional conflict. On the contrary (informal social ties), family coping influenced both decisional conflict and depression. CONCLUSIONS: Our findings provide insight into decisional conflict and depression within the family context for cancer survivors, allowing a better understating of the quality of family and social networks. The role of social networks to manage decisional conflicts and attain consensus under the family contexts are essential to reduce depression for cancer survivors. RESEARCH IMPLICATIONS: This investigation provided valuable evidence for identifying factors which are associated with decisional conflict and depression in multiethnic cancer survivors, considering the quality of social networks. CLINICAL IMPLICATIONS: Findings have implications for psychosocial interventions that enhance coping skills within the family context and improve the quality of social networks, which may reduce decisional conflict and depression for cancer survivors. FUNDING: Grants from the NIH/NCI R03 CA139941 and the NIH/NINR P30NR011907. P1-74 was withdrawn P1-75 Attitudes of Medical Students Regarding End of Life Issues in Oncology Kate Lieb1, Keren Zaltsman2, Aaron Allen1,2 1 Sackler School of Medicine, Tel Aviv, Israel, 2Rabin Medical Center, Petach Tikvah, Israel PURPOSE: Patient choices regarding end of life issue are always complex. One aspect in which there is great variability among oncologists is the extent of disclosure and at what time course to the patient and their family. Additionally, although many patient request spiritual or pastoral counseling during palliative care this referral is rarely initiated by the physician. We hypothesized that this discomfort and lack of attention to these topics arise from inadequate training of medical students and residents in discussing these issues. We therefore sought to explore the attitudes of medical students regarding the physician patient interaction with end of life issues. METHODS: A standardized 31 question survey was sent out to all 238 medical students at the Sackler School of Medicine in January of 2013. The questionnaire asked the students to imagine they were an oncology patient with an oncological illness. The questions then focused on four main areas: honesty regarding prognosis, level of involvement of immediate family in decision making, desire for © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Poster Abstracts of the APOS 11th Annual Conference

spiritual/pastoral counseling and advanced directives. Each question was graded on a 1–4 scale and the results were tabulated and separated based on class year. RESULTS: The questionnaire return rate was 26%. Of the 62 students who responded to the questionnaire the breakdown was 16(MED 1), 24(MED II), 16 (MED III) and 8 (MED IV). Overall students responded that it was most important to them for their doctor to be honest with them even about bad news (Mean score 1.08) and to know the exact name and stage of their disease (Mean 1.22). However, the highest score was the hope that their doctor would be optimistic about the prognosis. (Mean 1.62) The students did not think that their doctor should discuss spiritual issues or prayer with them (mean 3.4 and 3.7) but were more in favor of these discussions with family and clergy (mean 2.67 and 2.65). CONCLUSIONS: Medical students are an important test case for this end of life questionnaire. The results suggest the need for further education and exploration in this area in medical education. RESEARCH IMPLICATIONS: This information is novel and relevant on its own and the next stage of research will be to compare this data to patient data and resident and fellow data from the same questionnaire. CLINICAL IMPLICATIONS: These findings will help to guide oncologists with interests in End of Life issues to educate students and residents regarding decisions their patients will have to make. FUNDING: None. P1-76 Treatment Interruptions and Associated Factors Gwen Wyatt, Alla Sikorskii Michigan State University, East Lansing, MI, USA PURPOSE: Changes in chemotherapy protocol such as dose delays, reductions or stoppages in chemotherapy can lead to suboptimal treatment of cancer. The symptom burden associated with cancer and its treatment may be reasons for chemotherapy interruptions, yet little is known whether symptom severity and interference with daily life are associated with alterations in the course of chemotherapy. Clinicians need a clear understanding of which patient symptoms may hinder dose completion, so they can target these patients with symptom management interventions. METHODS: A secondary analysis of data collected in a randomized clinical trial (RCT) of reflexology for symptom management was performed. The trial enrolled women with advanced breast cancer undergoing treatment (N = 385). Outcome data were collected at baseline, weeks 5 and 11 using a valid and reliable inventory of 25 symptoms. Medical records provided data on treatment interruptions and metastasis. The hypotheses testing the association between dose delays, reductions or stoppages in chemotherapy during the study period with symptom severity, symptom Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Poster Abstracts of the APOS 11th Annual Conference


interference with daily activities and metastatic status were tested using generalized estimating equations (GEE) models. RESULTS: The relationship between dose delays and dose reductions of chemotherapy and symptom severity was differential according to metastatic status, with the higher strength of association among women with distant metastasis compared to those with loco-regional disease (p = 0.02). The interaction of symptom interference and metastatic status was also significantly related to dose delays and reductions (p = 0.04). Severity of pain was a stronger predictor of dose delays or reductions among patients with distant metastasis compared to those with loco-regional disease (p < .01). CONCLUSIONS: This analysis points out the importance of understanding symptom outcomes that impact research, clinical practice, and medical treatment decisions. RESEARCH IMPLICATIONS: These results point to the need for data analysis, of not only which symptoms are affected by treatment, but also symptom severity and symptom interference with daily life. CLINICAL IMPLICATIONS: These findings underscored the importance of clinical symptom management during cancer treatment with special attention to those with metastasis. FUNDING: NIH, Grant #1R01 CA 157459–01.

of Knowledge, and Embase). There was no date restriction and both quantitative and qualitative studies were included. RESULTS: Of the 1,134 articles retrieved in the search, 20 studies met inclusion criteria. Of these, only one specifically examined burden among caregivers of outpatient HSCT patients, although studies of caregivers of inpatient HSCT patients highlighted potential risk factors for this population. Across studies, correlates of caregiver burden included loss of control, a disruption in the predictability of daily life, and avoidant coping strategies. CONCLUSIONS: This review highlighted the potential significant emotional costs of conducting HSCT on caregivers and the critical need to identify caregivers at high risk for burden early in, and perhaps prior to, the transplant process. RESEARCH IMPLICATIONS: Studies that focus on the unique experience of caregivers of HSCT patients and in particular, outpatient and homebound transplant patients, are needed to identify time points along the transplant trajectory at which caregivers are at particular risk for burnout and burden. CLINICAL IMPLICATIONS: Psychotherapeutic interventions tailored to caregivers of outpatient and homebound HSCT patients are needed. Such interventions should incorporate elements of already established empirically supported treatments for caregiver burden and capitalize on telehealth modalities. FUNDING: None.

P1-77 has been withdrawn.

P2-2 was withdrawn

P2-1 The Experience of Caregivers of Outpatient Hematopoietic Stem Cell Transplant Patients: Lessons Learned From the Inpatient Hematopoietic Stem Cell Transplant Literature Allison Applebaum1, Tammy Son1, Margaret Bevans2, Marisol Hernandez1, Katherine DuHamel1 1 Memorial Sloan-Kettering Cancer Center, New York, NY, USA, 2National Institutes of Health Clinical Center, Bethesda, MD, USA

P2-3 A Prospective Study of Patient and Care-Partner Coping in Allogeneic Bone Marrow Transplantation Larry Foster1, Linda McLellan2, Lisa Rybicki3, Brian Bolwell2 1 Cleveland State University School of Social Work, Cleveland, OH, USA, 2Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA, 3Cleveland Clinic Department of Quantitative Health Sciences, Cleveland, OH, USA

PURPOSE: While a large body of literature has examined burden among cancer caregivers, few studies attend specifically to the experience of providing care to a patient undergoing a hematopoietic stem cell transplant (HSCT), and fewer still examine the unique burden experienced by caregivers of patients receiving outpatient transplants. This is a critical gap in the literature, as outpatient transplants are becoming a more widely used modality and such caregivers are at particularly high risk for burden. This systematic review synthesized the literature on burden experienced by HSCT caregivers, with an emphasis on the unique burden associated with the outpatient transplant process. METHODS: A systematic review was conducted of studies relating to burden among caregivers of adult HSCT patients. Studies were identified by searching online databases (Pubmed, Psychinfo, Cochrane, CINAHL, Web © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

PURPOSE: This study explores similarities/differences between patient and care-partner (CP) coping in relation to duration and frequency of CP in-hospital visitation and patient survival in allogeneic bone marrow transplantation (BMT). METHODS: A larger prospective CP study contains data on 164 allogeneic patients transplanted November 2003 through November 2008. This analysis utilizes data from a sub-group of 88 patients with a CP. Coping data was obtained by administering the BRIEF COPE inventory to both patient and CP at baseline, post-discharge, and day 100. Spearman correlation ® assessed strength and direction of association between patient and CP COPE and between CP duration and frequency and patient and CP COPE. Cox proportional hazards analysis was used to identify prognostic factors for survival. RESULTS: At baseline, there were significant but modest correlations between patient and CP on self-distraction (r = 0.38), use of emotional support (r = 0.24), humor (r = 0.26), religion (r = 0.43), and Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


self-blame (r = 0.24). Significant correlations were found for venting (r = 0.28), and acceptance post-discharge (r = 0.34) and for use of emotional (r = 0.32) and instrumental support (r = 0.30) at day 100. Associations were found between CP duration and frequency and COPE; noteworthy is a negative relationship between duration of CP visitation and CP use of emotional support (r = 0.29) and a positive relationship between CP frequency and patient use of emotional support at day 100 (r = 0.29). None of the variables are prognostic for survival; however, >3 hours CP duration (P = 0.07) and >75% CP frequency (P = 0.06) are nearly significant. CONCLUSIONS: Apparent is a shift in range and nature of patient and CP COPE from baseline to day 100 posttransplant; findings suggests coping is a process that may become more relational and enhanced for the patient having a partnered relationship that allows time for emotional processing of the transplant experience. RESEARCH IMPLICATIONS: Instead of exploring similarities/differences between individual patient and CP COPE scores in relation to survival, recommended is empirical research investigating prognostic value of relational coping or specific coping processes within partnered relationships. CLINICAL IMPLICATIONS: Findings indicate the need for increased emotional support for CPs in allogeneic BMT. FUNDING: None. P2-4 Post-traumatic Stress Disorder Classification in Parents of Children With Cancer Stephanie Hullmann1, David Fedele2, Elizabeth Molzon3, Larry Mullins3 1 Indiana University, Indianapolis, IN, USA, 2University of Florida, Gainesville, FL, USA, 3Oklahoma State University, Stillwater, OK, USA PURPOSE: To examine differences between methods for classifying posttraumatic stress disorder (PTSD) in parents of children with cancer and to assess a method for examining the new DSM-V PTSD criteria using the currently available symptom inventories. METHODS: Participants were parents (N = 125, 84% female) of children (55% female; 1–18 years) with cancer. Parents completed a demographic questionnaire, the Impact of Events Scale – Revised (IES-R), and the Brief Symptom Inventory (BSI). Three previously published methods for classifying DSMIV PTSD in pediatric oncology samples were applied to this sample (Creamer et al., 2003; Jurbergs et al., 2009; Stuber et al., 2011). In addition, the authors developed a method for examining the new DSM-V PTSD criteria by using items from the BSI to assess for negative alterations in cognitions and mood. RESULTS: Using previously established clinical cutoff scores for the IES-R (Creamer et al., 2003), 35.2% of parents were experiencing clinically significant levels of PTSD symptomatology. Following methodology utilized by Stuber and colleagues (2011), © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Poster Abstracts of the APOS 11th Annual Conference

32% of the sample met DSM-IV criteria for PTSD. Applying Jurbergs’ et al. (2009) methods, 9.6% met DSM-IV criteria. Stuber and Jurbergs’ methods yielded statistically different proportions for DSM-IV criteria (z = 4.363, p < .001). For DSM-V criteria, the Stuber method indicated that 32.8% of the sample met criteria for PTSD. Using the Jurbergs method, 0% of parents met criteria for PTSD as classified by DSM-V. The methods yielded statistically different proportions for DSM-V criteria (z = 5.876, p < .001). Neither methodology differed significantly when DSM-IV and V criteria were compared (p > .05). CONCLUSIONS: Researchers and clinicians can obtain discrepant rates of PTSD in parents of children with cancer by altering the methodology by which they are classified. These results also indicate that rates of PTSD in parents of children with cancer using the new DSM-V criteria are similar to the rates using DSM-IV criteria. RESEARCH IMPLICATIONS: Researchers should continue to compare self-report inventories with gold standard assessments for PTSD in order to determine which criteria are most clinically useful in diagnosing PTSD this population. CLINICAL IMPLICATIONS: Clinicians should assess for all aspects of the DSM-V criteria for PTSD, including severity and duration of symptoms and impairment, before diagnosing parents of children with cancer. FUNDING: Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under Award Number R25CA117865. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. P2-5 Looking at Support for Caregivers in a New Way: The GUIDES Program Tara Perloff Lung Cancer Alliance, Washington, DC, USA PURPOSE: Lung cancer has been the leading cause of cancer death in the United States for decades. Caregivers whose loved one has died from the disease have unmet needs and require specialized support due to lung cancer stigma. Research studies have identified a lack of support for caregivers who have lost a loved one, but few programs exist to address the need. This study explores the unique and lasting benefits of a peer-to-peer telephone support program for caregivers. METHODS: The Grief and Understanding Into Death and End-of life Support (GUIDES) Program is a peer-to-peer telephone support program for caregivers whose loved one is at the end of life. Caregivers are matched with others who have shared a similar experience for information, hope and support. All volunteers are at least 12 months past the death of their loved one. A survey of 10 questions was distributed to 20 participants of the GUIDES Program by e-mail and mail. Out of those 20 participants, 10–15 participants were Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Poster Abstracts of the APOS 11th Annual Conference

interviewed via telephone about the substance and nature of the program in relation to their journey with loss. RESULTS: Caregivers who were matched with a GUIDE reported a decrease in anxiety and feelings of empowerment. Many caregivers reported that after talking with a GUIDE, they reached a state of acceptance and were able to cope with loss because they knew what to expect and gained a new sense of “normal”. Many reported that a GUIDE was able to prepare and support them in a way that their health care professional did not provide. CONCLUSIONS: Telephone-based support is much lessresource intensive than live support groups and other professionally-led forms of support. While there are inherent challenges to managing end of life telephone-based peerto-peer support, the benefits to participants outweigh those challenges. The focus of this study is on caregivers who have lost a loved one to lung cancer, but the results extend far beyond and can inform oncology and mental health professionals about the psychosocial needs of caregivers. RESEARCH IMPLICATIONS: Researchers will be interested in learning why caregivers found the program empowering in ways different than other forms of support. Further research to understand the needs of caregivers whose loved one is at the end of life is needed and to explore peer-to-peer companionship as a missing component in end of life support. CLINICAL IMPLICATIONS: Clinicians will gain a better understanding of the psychosocial needs of caregivers when their patient is at the end of life. Clinicians will also be apprised of the benefits in peer-to-peer support with the goal of creating additional programs which can then be analyzed to strengthen the validity of this study. FUNDING: None. P2-6 “Outside The Ring of Fire”: Distress Screening for Cancer Caregivers During Survivorship Patricia Prince, Margaret Bevans The National Institutes of Health, Clinical Center, Bethesda, MD, USA PURPOSE: Distress screening for cancer patients has become a hallmark of cancer care. Screening identifies patients at risk for ongoing psychological problems and unmet supportive care needs. Research demonstrates that in addition to increased levels of stress for the patients, the caregivers experience significant distress. The purpose of this review is to identify established measures for distress screening in caregivers during survivorship and to exam barriers to translating these measures into practice. METHODS: A systematic review of the literature was conducted. Relevant studies were identified by searching online databases (PubMed, APA PsycNET and Web of Knowledge). Inclusion criteria were studies that evaluated distress screening of adult outpatients and caregivers. There was no date or language restriction and both © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.


quantitative and qualitative studies were included. RESULTS: Of the 238 articles retrieved in the search, 33 studies met inclusion criteria and were reviewed in their entirety. Of these, only 12 specifically examined distress screening of caregivers. Most commonly used measure for caregivers is the distress thermometer. Multiple barriers were discussed to include resources, systems issues and language. CONCLUSIONS: Caregivers are vulnerable for unmet psychosocial needs and methods of outpatient screening are not standardized. Providers must have a model of care that incorporates evidence-based practice that endorses distress screening and a clear referral pathway to address the unmet needs creating distress. Barriers to screening are present and must be addressed. RESEARCH IMPLICATIONS: This information highlights the importance of continuing to build the evidence focused on translation into practice for screening of cancer caregivers during survivorship. There remains a need for further studies evaluating how to best to screen in the outpatient setting and to identify effective intervention for caregivers’ significant distress. CLINICAL IMPLICATIONS: Psycho-oncology providers must partner with clinicians to implement outpatient screening into practice. A better understanding of the barriers to screening of caregivers will provide guidance to facilitate the transition of established measures into ambulatory centers and community providers. FUNDING: None. P2-7 What Do Children Wish for From a Dying Parent? A Qualitative Exploration Anna Muriel1, Cynthia Moore2, Elyse Park2, Paula Rauch2 1 Dana-Farber Cancer Institute, Boston, MA, USA, 2 Massachusetts General Hospital, Boston, MA, USA PURPOSE: An estimated 55,000 US children under the age of 18 yrs lose of a parent to cancer each year. Experiencing the death of a parent during childhood correlates with a range of emotional and health outcomes in adulthood. This study sought to qualitatively explore the experience of early parental death and the experience or wish for specific legacies from the deceased parent. METHODS: A community-based sample of young adults, who experienced the anticipated death of a parent from a medical illness before the age of 12 participated in a 90min semi-structured interview. The interview asked about memories and knowledge about the deceased parent, ways that they keep the memory alive, and what they wish they knew about or had from their parent. Transcriptions of interviews were coded in an iterative process of content analysis by 3 independent coders to achieve thematic saturation. RESULTS: 16 adults, ages 23–32 yrs, participated in individual interviews. Subjects expressed a uniform desire for some kind of communication left for them by the deceased parent, including information Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


about the parent, what they were like, what they valued, as well as for information related to them as children. They wished for their parent’s thoughts and observations about them, and expectations for their future, conveying hopes, encouragement, and pride. Other themes included the importance of information about the illness around the time of death, and ongoing family relationships and a sense of normalcy into bereavement. CONCLUSIONS: Although early parental loss has significant impact on the surviving children, there is little data about what might be done to help provide meaningful legacies of the deceased parent. This exploratory study suggests that parentally bereaved young adults have wishes for specific communication from their parent. Further study might provide guidance for clinicians caring for families at parental end-of-life, to help families provide legacies that may be important to bereaved children over time. RESEARCH IMPLICATIONS: Although prior studies have explored mental health outcomes in parentally bereaved children, there is no data about the role of legacies, or the more subtle aspects of bereavement. Prospective bereavement research has a role in identifying meaningful legacies that parents with cancer may leave for their young children. CLINICAL IMPLICATIONS: Clinicians caring for dying parents may be asked about legacy leaving for the surviving children. This exploratory study provides broad guidelines about what parentally bereaved young adults may wish for in retrospect. FUNDING: None. P2-8 He Loves Me, She Loves Me Not: Self-Reports of Parental Marital Stress and Closeness During Pediatric Cancer Caitlyn Loucas1, Anna Muriel1, Sima Zadeh2, Wendy Pelletier3, Haven Battles2, Elaina Vasserman-Stokes2, Lori Wiener2 1 Dana-Farber Cancer Institute, Boston, MA, USA, 2 National Institutes of Health, Bethesda, MD, USA, 3 Alberta Children’s Hospital, Calgary, Canada PURPOSE: In the midst of adapting to a child’s cancer diagnosis, the impact on the parental relationship is often overlooked. The ability of parents to appropriately handle these stressors can strengthen or weaken the relationship and influence the child’s own coping process. The purpose of this study was to examine qualitative responses of selfreported situations when the parental relationship was particularly positively or negatively affected, and what factors should be addressed in order to support the partnership. METHODS: Self-administered questionnaires containing both quantitative and qualitative questions were completed by married/partnered caregivers of children diagnosed with cancer. Descriptive analyses were performed on open-ended qualitative questions regarding: 1) Situations when individuals felt most close to their © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Poster Abstracts of the APOS 11th Annual Conference

partner, 2) Situations when individuals felt most distant from their partner, 3) Recommendations to other couples or clinicians to support and strengthen the relationship. All responses were coded using an iterative coding strategy for thematic saturation. RESULTS: Preliminary analyses on all completed responses (N = 100; M(age) = 44 years; female = 68, male = 32) identified 1) the combined impact of partnership-oriented behaviors (emotional expression, teamwork, joint advocacy for child) and positive emotional traits (composure, support, optimism) during situations when they felt most connected to their partner and 2) events (sibling issues, physical separation, hurtful dialogue) and negative emotional traits (selfishness, emotional distance) during times when they felt most distant. 3) Recommendations to other couples or clinicians included the need for honest communication, respect for differing emotional styles, mutual and social support, joint decision-making, prioritizing time for physical and emotional closeness, and setting aside personal and couple time. CONCLUSIONS: The experience of pediatric cancer can stress the parents’ relationship throughout the disease trajectory, but includes identifiable situations and behaviors that can influence the parental relationship. Correlations with quantitative survey data are appropriate to provide a more balanced assessment of couples’ functioning in this population. RESEARCH IMPLICATIONS: Future psychosocial research in childhood cancer should include measures of couples’ functioning to better understand the impact of pediatric cancer. CLINICAL IMPLICATIONS: The present findings can be used to guide psychosocial interventions to better support couples’ functioning in the context of their child’s illness. FUNDING: This work was supported (in part) by the intramural program of the National Cancer Institute, Center for Cancer Research. P2-9 Interventions Targeting Psychosocial and ProcessRelated Outcomes Following an Abnormal Breast Cancer Screening Test: A Systematic Review Rina Fox1,2, Sarah Mills1,2, Tonya Pan1,2, Erin Merz1, Vanessa Malcarne2,3 1 SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA, 2UCSD Moores Cancer Center, San Diego, CA, USA, 3San Diego State University, San Diego, CA, USA PURPOSE: The period immediately following an abnormal screening test is integral to the timely treatment of breast cancer. Unfortunately, many women do not receive appropriate follow-up care after being notified of an abnormal result. While research has identified interventions to improve outcomes during this period, no synthesized review of the literature has been conducted to date. The present systematic review, which followed PRISMA guidelines, was conducted to meet this need. METHODS: Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Poster Abstracts of the APOS 11th Annual Conference


PsycINFO, CINAHL, PubMed/Medline and EBSCO/Medline were systematically searched; backward and forward searches of identified studies were conducted. Included studies were required to: 1) evaluate an intervention designed to impact psychosocial or process-related outcomes following an abnormal breast cancer screening test, 2) use a randomized controlled trial design, and 3) include a comparison group. Only studies published after 1976 were included, as that was when the American Cancer Society first recommended mammography as a breast cancer early detection screening device. RESULTS: Eight studies met inclusion criteria. The majority of studies (n = 6) utilized some form of patient navigation as the primary intervention. The remaining two studies included an educational component in their intervention. One of these also had a condition in which a radiologist was on site to read films immediately following mammography. Across studies, psychosocial outcomes included anxiety and patient satisfaction; process-related outcomes included adherence to recommended follow-up, diagnostic interval, and diagnostic resolution. Anxiety was decreased by patient navigation and immediate reading of films, but not education. Adherence to follow-up was improved by patient navigation. Interventions targeting patient satisfaction, diagnostic interval, and diagnostic resolution had mixed results. CONCLUSIONS: Radiology and patient navigation interventions were highly effective at improving psychosocial and process-related outcomes, while educational interventions were less effective. However, given the small number of studies in this review, additional research exploring the impact of education is needed before definitive conclusions can be drawn. The ability of patient navigation to improve outcomes following an abnormal breast cancer screening test, as observed in this review, is already well established. Research is now needed to further examine other interventions (e.g., having films read immediately after mammography), and to compare them to patient navigation. RESEARCH IMPLICATIONS: These results identify specific areas of need for future research by synthesizing the current literature and identifying topics that need further study. CLINICAL IMPLICATIONS: The present results synthesize the literature regarding currently identified evidence-based techniques clinicians can use to improve psychosocial and process-related outcomes following an abnormal breast cancer screening test. FUNDING: None.

IOM report of 2007 set the standard that all stages of cancer care include psychosocial care, Billings and Block recently found that only 3 of 11 palliative care programs surveyed had psychiatrists on their teams.3 The objective of our study is to learn about the availability and manner of integration of psychiatrists or other mental health professionals with palliative care teams at NCCN centers. METHODS: An online survey will be distributed to Palliative Care departments at National Comprehensive Cancer Network centers. The main queries are “Do you have a psychiatrist on your palliative care team?” and “What is your model of working with the psychiatrist?” We will also ask if other mental health professionals are involved on the teams. Information will be collected on common reasons for including psychiatric services and barriers to this collaboration. RESULTS: Project is underway; results will be reported at the APOS meeting. CONCLUSIONS: This survey will advance the understanding of integrating psychiatry services into mental health staffing of palliative care teams. We will also explore possible barriers to this collaboration, and hope to further discussion of how obstacles can be overcome. More detailed conclusions will be possible when the survey is completed. RESEARCH IMPLICATIONS: Researchers might use this information when studying the impact of psychiatric services on patient distress levels and success of referrals for mental health care in palliative care services. CLINICAL IMPLICATIONS: This information may aid clinicians and program directors to explore models and reasons for collaboration between palliative care teams and psychiatrists. It can help palliative teams evaluate how to include mental health professionals to respond to patient distress. FUNDING: None.

P2-10 Integration of Psychiatry With Palliative Care at NCCN Cancer Centers Rosanne Fox, Jimmie Holland Memorial Sloan-Kettering Cancer Center, New York, NY, USA

PURPOSE: In this exploratory analysis we examined differential treatment effects of a nurse navigator intervention among patients with depressive symptoms in order to better understand who may benefit most from nurse navigation interventions. METHODS: We recently conducted a randomized controlled trial of a nurse navigation intervention for patients newly diagnosed with lung, breast or colorectal cancer (N = 251; Wagner et al., 2013). The 16- week intervention was designed to address delays and poor coordination in the early phases of cancer

PURPOSE: Over the last two decades the importance of collaboration between Psychiatry and Palliative Care services has been increasingly recognized.1,2 Even though the © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

P2-11 Newly Diagnosed Cancer Patients With and Without Depressive Symptoms Benefit From Nurse Navigation Evette Ludman1, Erin Bowles1, Carolyn Rutter1, Jessica Chubak1, Robert Penfold1, Robert Reid1, Ruth McCorkle2, Edward Wagner1 1 Group Health Research Institute, Seattle, WA, USA, 2 Yale University School of Public Health and Nursing, New Haven, CT, USA

Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


care; lack of information and decision-making help regarding treatment options, and lack of emotional and social support for patients. While the intervention did not impact quality of life, it had a positive impact on reported problems in care and on quality of patient care, most notably on perception of psychosocial care. Patients were stratified by baseline scores on the 9-item Patient Health Questionnaire (PHQ); 76 patients in the trial had mild symptoms of depression (PHQ = 5-9); 34 had moderately severe symptoms (PHQ = 10 or greater). We examined the interaction between depressive symptoms and intervention arm on subscales of the Patient Assessment of Chronic Illness Care (PACIC) and selected subscales from a cancer adaptation of the Picker Institute’s patient experience survey at 4-month follow-up. RESULTS: With the exception of the PACIC subscale of delivery system/ practice design (example item: “I was shown how what I did to take care of myself influenced my condition,”) we did not find that patients with depressive symptoms differentially benefitted from the intervention in analyses that adjusted for age and education (which differed by randomization group). CONCLUSIONS: Because of the modest percentage of patients in our study with significant depressive symptoms we cannot conclude with certainty that patients with and without depressive symptoms benefit equally from a nurse navigation intervention. However it appears the intervention was broadly useful, i.e., beneficial for depressed and for the majority of patients who are not significantly depressed in the first few weeks post-diagnosis. RESEARCH IMPLICATIONS: In our study, patients with depressive symptoms did not differentially benefit from the nurse navigator intervention compared to non-depressed patients. Researchers may want to identify other potential sub-populations for targeting of nurse navigation interventions. CLINICAL IMPLICATIONS: Nurse navigation has been shown to improve the patient experience for newly diagnosed patients. Patients with depressive symptoms and patients without equally benefitted from participation. Patients with and without significant depressive symptoms should be invited into nurse navigation programs soon after diagnosis. FUNDING: Financial Support for the study was by grant P20CA137219 from the National Cancer Institute of the National Institutes of Health.

Poster Abstracts of the APOS 11th Annual Conference

adult patients in acute care centers, community hospitals, and well-resourced multidisciplinary oncology centers. CONCLUSIONS: Implications identified in later section. RESEARCH IMPLICATIONS: A standardized process for implementing distress screening allows for a consistent aggregate database to be developed for the system. The standardized format will allow researchers the capability of analyzing distress and its management throughout a large healthcare system. CLINICAL IMPLICATIONS: Distress management and the integration of psychosocial care in existing healthcare delivery models have been established as the standard of care within oncology. The National Comprehensive Cancer Network (NCCN) provides clinical guidelines for distress management to assist healthcare organizations in the identification of distress and subsequent management in their patients. Most recently, the Commission on Cancer - American College of Surgeons included distress screening and management as an accreditation standard to be implemented by 2015. As different healthcare systems move toward implementation of distress screening in accordance with the Commission on Cancer (CoC) and NCCN standards of care, a review of existing models of implementation for distress screening is essential. Carolinas Healthcare System is one of the nation’s largest and most comprehensive systems, with more than 60,000 employees and more than 7,460 licensed beds. Implementation of distress screenings and management processes in a standardized way throughout a large system of 12 hospitals, 1 pediatric hospital, and multiple private infusion clinics has inevitable challenges. Reviewing the process of implementation in various clinical settings within CHS will assist clinicians from all types of oncology facilities in their own standardized distress screening plans. FUNDING: None.

P2-12 Distress Screening and Management Strategies Throughout a Large Healthcare System Patrick Meadors1,2, Amii Steele1,3 1 Carolinas Healthcare System, Charlotte, NC, USA, 2 Levine Cancer Institute, Charlotte, NC, USA, 3Levine Children’s Hospital, Charlotte, NC, USA

P2-13 Linking Psychosocial Care to the Disease Continuum in Patients With Multiple Myeloma and Their Family Caregivers James Zabora1, Joanne Buzaglo2, Vicki Kennedy2, Tiffany Richards3, Tara Schapmire4, Brad Zebrack5, Irene Ghobrial6 1 Life with Cancer, Inova Health System, Fairfax, VA, USA, 2Cancer Support Community, Washington, DC, USA, 3MD Anderson Cancer Center, Houston, TX, USA, 4 University of Louisville School of Medicine, Louisville, KY, USA, 5University of Michigan School of Social Work, Ann Arbor, MI, USA, 6Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA

PURPOSE: The primary aim of this presentation is to review models of systematic and standardized implementation across a large healthcare system which serves pediatric and

PURPOSE: Research has demonstrated that the diagnosis of cancer generates more fear than any other medical diagnosis. For most patients with the diagnosis of multiple

© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Poster Abstracts of the APOS 11th Annual Conference

myeloma, it takes time to fully understand how the disease may impact their lives. Given that multiple myeloma is a chronic disease characterized by re-occurring phases of cancer remission and relapse, this diagnosis presents an initial challenge for these patients and their families to grasp what lies ahead with treatment, side effects, and long-term physical, emotional, and social consequences. Although it is a relatively rare disease, patients with multiple myeloma face an unusually complex course of treatment that could include proteasome inhibitors, chemotherapy agents, immunomodulatory agents, radiation therapy, and stem cell transplantation (SCT) and will likely persist for the remainder of their lives. However a model of psychosocial care specific for patients with multiple myeloma and their caregivers has not yet been proposed. We sought to develop a model of care that considered the specific profile of this disease. METHODS: The authors, representing the multidisciplinary care team, met in December 2012 to identify a model of psychosocial care for patients with multiple myeloma and their caregivers. The model was determined by consensus during the meeting and final agreement following the meeting. The meeting was sponsored by Onyx Pharmaceuticals. RESULTS: The need for targeted psychosocial care for the multiple myeloma patient and caregiver throughout the disease process is essential to ensure quality of life and optimal treatment outcomes. We propose herein the first known model of care for the treatment of multiple myeloma that engages both the patient and their caregivers. CONCLUSIONS: Innovative partnerships between psychosocial providers and other entities such as pharmaceutical companies can maximize resources for comprehensive program development. This presentation proposes a model of care that promotes active engagement in therapies for multiple myeloma while engaging the individual patient and their family caregivers. This treatment approach must be evidence-based in terms of distress screening tools, comprehensive psychosocial assessments, and most importantly, in the interventions and measurements of response that clinicians apply to this population. RESEARCH IMPLICATIONS: This evidence-based model of care provides salient opportunities for investigators to test appropriate interventions to reduce distress among this population. Interventions such as "problem-solving education" could be applied to establish benefit for these patients as well as their family caregivers. Finally, since this tends to be an older population, investigators could contribute to the sparse psychosocial literature related to cancer patients who are 65 and older. CLINICAL IMPLICATIONS: This is a comprehensive model that identifies theory and evidence to support a psychosocial continuum of care that could provide significant benefit. FUNDING: Onyx pharmaceuticals supported a multidisciplinary meeting and related conference calls to develop this model of care. © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.


P2-14 Establishing the Reliability and Validity of the Chronic Illness Distress Scale-Short Form James Zabora1, Karlynn BrintzenhofeSzoc2, Sage Bolte1, Paul Clark1 1 Inova Health System, Life with Cancer, Fairfax, VA, USA, 2 Catholic University of America, School of Social Service, Washington, DC, USA PURPOSE: An integrated model of distress screening and early intervention such as problem-solving education at the time of the initial cancer diagnosis could produce benefit to significant numbers of cancer patients and their families. In addition, if symptoms and problems are managed more effectively with active patient and family participation, health care costs could be reduced. The purpose of this study is to establish the reliability and validity of the Chronic Illness Distress Scale-Short Form (CIDS-SF) in order to establish the initial component of this model, i.e., an appropriate tool for Distress Screening. METHODS: The reliability and validity of the CISD-SF will be established in a Radiation Oncology Department in a sample of 300 new patients. Potential patients will be approached by a research assistant during the patient’s “Consultation Visit” who will explain the purpose of the study, complete informed consent, and provide the standardized instruments to the patient for completion. Upon return for ‘Simulation”, the RA will have the patient complete the CIDS-SF for a second time in order to establish test-retest reliability. RESULTS: In addition to test-retest reliability Cronbach’s alpha and inter-item correlations, will also be calculated. Convergent validity will be established based on correlations between the BSI-18 and the CIDSSF. Further evidence of validity will be developed through correlations between the CIDS-SF and the Condensed Memorial Sloan-Kettering Symptom Assessment Scale. CONCLUSIONS: If the CIDS-SF proves to be reliable and valid, all patients diagnosed with cancer or coming to 5 adult cancer programs within a health system will be automatically screened for distress through the use of the CIDS-SF. This screening process meets the new standard of care as mandated by the American College of Surgeons’ whose Commission on Cancer accredits the delivery of cancer therapies in the United States. Screening for distress will occur automatically via the EPIC Medical Record System. RESEARCH IMPLICATIONS: If the CIDS-SF proves to be reliable and valid, a new and brief measure with higher levels of reliability and validity than the Distress Thermometer (DT) could be available for use by investigators in screening studies. CLINICAL IMPLICATIONS: This new tool could also provide an alternative to the DT for clinicians and the BSI-18 which has been quite costly for psychosocial programs to manage. FUNDING: Funding for this study is being generated internally from the Life with Cancer program of the Inova Health System. Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


P2-15 Integrating Cancer-Related Employment Assessments Into Psychosocial Care Monica Bryant1, Rebecca Nellis2, Joanna Morales1 1 Triage Cancer, Culver City, CA, USA, 2Cancer and Careers, New York, NY, USA PURPOSE: This purpose of this symposium is to provide psychosocial oncology healthcare professionals with information and tools to help navigate their patients through the employment-related legal and practical issues that arise when someone is diagnosed with cancer. These issues include the laws and practical strategies for working though treatment and/or taking time off work for treatment and recovery, deciding whether or not to disclose their diagnosis, returning to the workplace, managing side effects on-the-job, and maintaining income. METHODS: This symposium is appropriate for any psychosocial oncology health care professional. Attendees will be given information about the state and federal laws that may apply to patients and caregivers in the workplace, including protections against discrimination, access to reasonable accommodations and disability insurance options. Attendees will also learn about the different needs of individuals who are newly diagnosed, those who work through treatment, those who take time off, and those who are returning to the same job or looking for a new one. RESULTS: Health care professionals surveyed after a comparable event responded that 99.5% would recommend a similar event to others who are interested in knowing more about working with cancer; 98% said the information received can be applied to their daily patient interactions; and 97.1% rated the overall usefulness of information as good or excellent. Similar responses can be expected from attendees of this symposium. CONCLUSIONS: It is critical for psychosocial oncology healthcare professionals to receive education in this area, because they are uniquely positioned to help patients navigate balancing cancer and work, provided they receive appropriate training and resources. Psychosocial oncology healthcare professionals who attend will obtain a better understanding of the unique employment issues faced by those coping with cancer, the legal rights and benefits to which patients and caregivers may be entitled and practical tips for navigating those issues. RESEARCH IMPLICATIONS: Researchers should be aware of additional issues (e.g., employment) that people coping with cancer are facing in order to further study how healthcare professionals integrate cancer-related employment assessments into cancer care. CLINICAL IMPLICATIONS: Healthcare professionals are in a unique position to conduct employment related clinical assessments. This presentation will raise awareness about these issues and provide concrete information on how to conduct these assessments as well as resources for their patients. Specifically, this symposium is appropriate for any oncology © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Poster Abstracts of the APOS 11th Annual Conference

healthcare professional or provider of cancer education. Attendees will be given information about the state and federal laws that may apply to patients and caregivers in the workplace, including protections against discrimination, access to reasonable accommodations and disability insurance options. Attendees will also learn about the different needs of individuals who are newly diagnosed, those who work through treatment, those who take time off, and those who are returning to the same job or looking for a new one. FUNDING: None. P2-16 Meaning Sources Identified in Life History Interviews of Patients With Metastatic Breast Cancer Stefana Borovska1,2, Donna Tran1, Laura B. Dunn3,4, Judith T. Moskowitz1 1 University of California San Francisco, Osher Center for Integrative Medicine, San Francisco, CA, USA, 2University of Michigan Medical School, Ann Arbor, MI, USA, 3 University of California San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA, 4University of California San Francisco, Department of Psychiatry, San Francisco, CA, USA PURPOSE: Clinicians caring for patients with advanced cancer are increasingly called upon to address patients’ needs for spirituality and meaning. Meaning-Centered Group Psychotherapy, or MCGP targets four sources of meaning based on Frankl’s logotherapy: attitude, experience, legacy and creativity. However, minimal in-depth qualitative research examines: (1) which sources of meaning are apparent when patients share life story narratives and (2) how cancer diagnosis affects reports of meaning sources. The purpose of this qualitative study was to identify sources of meaning highlighted by advanced cancer patients during interviews exploring their self-reported life stories based on open-ended prompts. METHODS: Data sources were audio-recorded, semi-structured interviews with 12 women with stage IV breast cancer, randomized to the control arm of a positive affect intervention study. Participants were asked to tell their life story, highlighting significant material and developmental milestones. For the qualitative analysis, two coders, guided by directed content framework, independently reviewed transcripts to ensure confirmability and transferability. RESULTS: Mean age was 49.4 (+12.5) (range 32–69). Seven of the women were in chemotherapy at the time of the interview and two were receiving radiation. Two were receiving psychological counseling. Qualitative analysis revealed that each participant described and emphasized at least one of the four sources of meaning delineated in MCGP. Additionally, patients discussed three sources of meaning not in MCGP. Self-transcendence is the sense of belonging to or acting on behalf a universal cause, or group beyond one’s self, immediate surroundings, or kin. Autonomy derives purpose Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Poster Abstracts of the APOS 11th Annual Conference

from desiring or achieving independence for one’s self or life. Spirituality or Meaning-Making is drawing on spirituality, religion, or metaphysical to provide meaning or significance to life events. Quotes illustrating meaning sources will be included in the presentation. Per patients’ self-reports, the significance of at least one source of meaning changed after cancer diagnosis. CONCLUSIONS: These novel findings suggest that women with metastatic breast cancer incorporate various sources of meaning in their life narrative. Additional meaning sources identified through this qualitative approach expand our understanding of the role of meaning and its sources for cancer patients and may inform future directions for meaningcentered therapies. RESEARCH IMPLICATIONS: Further qualitative research is needed to address the rising call for understanding how meaning making and the search for meaning affects patient outcomes for cancer patients. Meaning-centered approaches and other interventions targeting spiritual wellbeing may benefit from the inductive derivation of new definitions that can help address a wider range of needs for advanced cancer patients dealing with loss of meaning, loss of quality of life, hopelessness or demoralization. CLINICAL IMPLICATIONS: Using an enriched set of meaning sources, clinicians can better understand patients’ spirituality and meaning and can more successfully incorporate meaning-based approaches to improve cancer patients’ lives. Helping patients identify their own sources of meaning and supporting them to engage in meaningful activities may help improve quality of life. FUNDING: Ms. Borovska was supported by the Osher Center Training in Research in Integrative Medicine (TRIM) T32 pre-doctoral program. The positive affect intervention was funded by a grant to Dr. Moskowitz from the Mt. Zion Health Fund/UCSF. P2-17 Growing Up Without Growing Old: Meaning Sources Identified by Older vs. Younger Women With Metastatic Breast Cancer Stefana Borovska1,2, Donna Tran1, Laura B. Dunn3,4, Judith T. Moskowitz1 1 University of California San Francisco, Osher Center for Integrative Medicine, San Francisco, CA, USA, 2University of Michigan Medical School, Ann Arbor, MI, USA, 3 University of California San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA, 4University of California San Francisco, Department of Psychiatry, San Francisco, CA, USA PURPOSE: Patients with advanced cancer and their families can benefit from clinician guidance around their concerns for spiritual wellbeing and sense of meaning. Meaning-Centered Group Psychotherapy (MCGP) is informed by Frankl’s logotherapy and has been making strides in targeting four sources of meaning: attitude, experience, © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.


legacy and creativity. However, minimal in-depth inductive qualitative research has examined meaning sources in the geriatric population. The goals of this qualitative study were to (1) compare sources of meaning between older vs. younger patients with advanced cancer; and (2) explore how a cancer diagnosis affects these meaning sources. METHODS: We examined 12 audiorecorded, semi-structured interviews with women with stage IV breast cancer, who were control arm participants in a randomized study of a positive affect intervention. The women were asked to tell their life story, focusing their narrative on significant events and milestones. Two coders, guided by directed content framework, independently reviewed transcripts to ensure transferability and confirmability of qualitative analyses. Sources of meaning identified by younger vs. older patients were compared. RESULTS: Eight patients were < 60 years old (mean age 42.1 SD + 7.6). Four were sixty or older (mean age 64 SD + 3.9). Each participant described and highlighted at least one of the four sources of meaning delineated in MCGP. Additionally, three novel sources of meaning—not emphasized in MCGP—were identified through the qualitative analysis: self-transcendence, autonomy and spirituality. Quotations illustrating meaning sources will be presented. Per patients’ self-reports, the significance of at least one source of meaning changed after their cancer diagnosis. Older patients were more likely to highlight legacy and self-transcendence as sources of meaning after diagnosis, while younger patients were more likely to discuss meaning sources based on autonomy and experience. CONCLUSIONS: These novel findings suggest that women with metastatic breast cancer incorporate various sources of meaning in their life narrative and that the importance of each meaning source changes with age. Additional meaning sources identified using qualitative methods expand our understanding of the sources and roles of meaning for older cancer patients, in turn informing future directions for therapies aimed at enhancing meaning in older patients. RESEARCH IMPLICATIONS: Clinicians can better identify sources of meaning using these elaborated definitions and can use the examples from this qualitative research to better target their approach when addressing meaning-based needs for older patients. Addressing loss of meaning and hopelessness by encouraging elderly patients to rediscover and engage in meaningful activities may help improve their quality of life. CLINICAL IMPLICATIONS: Further research can help enhance our understanding of meaning-making and spiritual wellbeing in older cancer patients. Meaning-centered and other therapies focused on spiritual wellbeing may benefit from better personalization of the approaches for elderly cancer patients dealing with loss of meaning, hopelessness, or demoralization. Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


FUNDING: Ms. Borovska was supported by the Osher Center Training in Research in Integrative Medicine (TRIM) T32 pre-doctoral program. The positive affect intervention was funded by a grant to Dr. Moskowitz from the Mt. Zion Health Fund/UCSF. P2-18 Spirituality and Psychosocial Distress in Head and Neck Cancer Survivors Kellie Martens, Jean Quispe, Jessica Geller, Shannon Madore, Kristin Kilbourn University of Colorado Denver, Denver, CO, USA PURPOSE: As a group, head and neck cancer survivors (HNCS) report higher levels of distress during treatment than survivors of other types of cancers. HNCS continue to face physical and psychological challenges as they embark on the re-entry phase of survivorship. Thus, it is important to understand the psychosocial factors that may mitigate or buffer HNCS’ distress. This study sought to understand the association between spirituality and psychosocial adjustment in HNCS who recently completed cancer treatment. METHODS: HNCS (N = 114) recruited from three local radiation oncology clinics, completed a self-report questionnaire assessing emotional and physical symptoms, health locus of control, spirituality and use of/interest in support services. Physical and psychosocial variables were assessed on a scale ranging from 0 (“not at all”) to 4 (“very much”). “Distress” was composed of two items assessing depression and anxiety. “Physical problems” was a composite of 16items (e.g., pain, fatigue, difficulty swallowing). Spirituality was assessed with 7-items from the FACIT–Sp. Data analyses included multivariate hierarchical regression. RESULTS: Participants’ mean age is 58.75 years (SD = 11.1), 77% male, 79% Caucasian, and 65% married/ partnered. Participants reported symptoms of pain (69%), fatigue (77%), anxiety (60%) and depression (51%). Physical problems predicted distress scores, Beta = .50, p .001. Moreover, higher levels of self-reported spirituality significantly predicted distress above and beyond physical problems, Beta = .28, p < .01 (R2 change = .08). The final model explained 33% of the variance in distress (R2 = .33, F(2, 103) = 26.6, p < .001). CONCLUSIONS: Spirituality may be a protective factor for HNCS because people with higher levels of spirituality predicted lower levels of depression and anxiety, even after controlling for physical problems. RESEARCH IMPLICATIONS: Further research should explore the specific elements of spirituality that have the greatest impact on buffering distress (e.g., a sense of meaning in life, prayer, attending a place of worship). CLINICAL IMPLICATIONS: Psychosocial interventions that explore and foster coping strategies that integrate spiritual activities and beliefs may reduce or buffer distress in cancer survivors who recently completed treatment. FUNDING: NCI, R-21; CA115354-01. © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Poster Abstracts of the APOS 11th Annual Conference

P2-19 Trajectory of Distress in Bone Marrow Transplant Inpatients and Validation of Jewish Hospital Distress Screening Measure Lyn Sontag1, Ashley Barraquillo2 1 Jewish Hospital, Cincinnati, OH, USA, 2 Xavier University, Cincinnati, OH, USA PURPOSE: Bone marrow transplantation (BMT), with the requirement of long weeks of inpatient hospital stays and arduous treatment protocols, is inherently distressing to almost all patients. A BMT distress screening measure was developed to be specific to the experience of inpatient transplant. The JHDSM is a brief self-report measure that screens for distress around Practical, Family, Emotional, Spiritual and Physical Issues. Studies have identified points along the trajectory of transplant that cause patients to have heightened distress: Fife et al. (2000), Molassiotis et al. (1996), and Meyers et al. (1994) Our interest was in identifying points when patients report the most distress and variables contributing to distress, particularly the contribution of religious coping style and attributed meaning to distress. METHODS: To gain information about the trajectory of distress in BMT, the most prevalent sources of distress and potential protective factors in coping in inpatient BMT patients. Data was collected on 85 transplant patients at specific data points in the trajectory of transplant: at or shortly after the pre-transplant psychological evaluation, T-1, weekly thereafter until and at discharge. Measures were the JHDSM, the DT, Mastery Scale, Brief RCOPE, HADS, and MiLS. Aim is to see if positive religious coping and/or positive meaning of life/illness are mediating factors in reporting distress. RESULTS: The JHDSM proved to be a valid screening for distress in BMT. Patients endorsed increased levels of distress at 2 points in the trajectory of their transplants: at T 3, which is about a week post-transplant, and at T5, which is about 2–4 weeks post-transplant. Both MiLS and RCOPE were able to predict patient distress at Time 1. Only meaning in life/illness was able to predict distress at Time 2. At discharge, both variables are able to predict distress when the dependent variable is patient’s current level of distress but when the dependent variable is patient’s level of distress over the past week only meaning in life/illness is able to predict distress at discharge. CONCLUSIONS: We were able to identify two points in the transplant process that patients endorsed increased distress: the week following transplant and 2–4 weeks post-transplant when patients expected to have been discharged but remained due to complications. Both meaning and religious coping appear to be predictive of distress at some points along the transplant process. RESEARCH IMPLICATIONS: Contrary to expectation, the day before transplant did not represent a peak in distress as was reported by previous authors, so further study is needed to understand the conflicting results. Meaning in life /illness and religious coping appear to be predictive of distress at some points along Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Poster Abstracts of the APOS 11th Annual Conference

the transplant process and there is very little in the literature on this connection. CLINICAL IMPLICATIONS: Increased levels of distress in BMT patients are associated with poorer treatment adherence, poor patient satisfaction, high psychosocial morbidity, and poor survivorship QoL. Identification of qualities and coping styles which predispose patients to improved distress tolerance may lead the way towards developing strategies to foster improved experiences and more successful outcomes in BMT patients. FUNDING: None. P2-20 Breast Cancer: Maladaptive Personality Functioning as a Mediator of Depression and Affective Pain Sarah K. Galloway1, Megan Baker Ruppel1, Frank Brescia1, Jennifer Correll1, Sharlene Wedin1, Wendy Balliet1, Eva Serber1, Alok Madan2, Jeffrey Borckardt1 1 Medical University of South Carolina, Charleston, SC, USA, 2Baylor College of Medicine, Houston, TX, USA PURPOSE: Pain experienced during the course of breast cancer often relates to cancer treatment as well as the disease itself. Pain is a complex experience with sensory, affective, and cognitive dimensions. Although depression is common among cancer patients, little is known about the relationship between depression, maladaptive personality functioning, and different components of the pain experience among breast cancer patients. METHODS: In the present study, 60 pre-treatment females presenting to an NCI-designated Cancer Center with newly diagnosed breast cancer completed the Center for Epidemiological Studies 10-item Depression Scale, the Standardized Assessment of PersonalityAbbreviated Scale, and the McGill Pain Questionnaire Short Form. RESULTS: Forty-eight percent exceeded the cut-off for clinically significant depression (M = 10.25 ± 5.83). Participants reported moderate sensory (44%) and affective (45%) pain. Personality functioning mediated the relationship between depression and affective pain. The four criteria for mediation were present: (1) The standardized regression coefficient between depression and affective pain was non-significant when controlling for personality functioning (beta = .20, p = .132); (2) depression was a significant predictor of affective pain (beta = .36, p = .005) and (3) personality functioning (beta = .38, p = .002); lastly, (4) personality functioning was a significant predictor of affective pain while controlling for depression (beta = .37, p = .006). Interestingly, depression (r = .36, p = .005) but not personality functioning (r = .14, p = .288) is related to sensory pain. CONCLUSIONS: Findings suggest that depression is common among newly diagnosed breast cancer patients; furthermore, patients experience an appreciable amount of pain prior to the initiation of oncologic treatment. Depression is directly related to the sensory component of pain. However, depression is not directly related to the affective component of pain as this relationship is mediated by maladaptive personality functioning. © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.


RESEARCH IMPLICATIONS: This study serves as a platform for future research focused on identifying optimal and efficient pharmacologic and behavioral interventions targeting the reduction of cancer patients’ pain experience. CLINICAL IMPLICATIONS: Results imply that clinicians treating pain within the context of breast cancer should be attuned to psychological and psychiatric factors such as depression and longstanding maladaptive personality functioning. Interventions targeting and structuring maladaptive personality functioning will help to decrease patients’ overall pain experience. Results further emphasize the need for interdisciplinary multimodal approaches to treat pain within the breast cancer population. FUNDING: None. P2-21 Mindfulness Based Stress Reduction for Breast Cancer Survivors and Telomerase Activity Cecile Lengacher1,2, Richard Reich2,3, Kevin Kip1, Sophia Ramesar1, Carly Paterson1, Jerrica Farias1, Irina Carranza1, Melissa Shelton1, Pinky Budhrani1, Janice Post-White4, Jong Park2 1 University of South Florida, Tampa, FL, USA, 2Moffitt Cancer Center, Tampa, FL, USA, 3University of South Florida, Sarasota-Manatee, Sarasota, FL, USA, 4University of Minnesota, Minneapolis, MN, USA PURPOSE: The purpose of this study was to determine if participation in a six week Mindfulness Based Stress Reduction for Breast Cancer Survivors (MBSR(BC)) program would cause significant changes in telomere length (TL) and telomerase activity (TA) in post-treatment breast cancer survivors. METHODS: Participants (n = 142) were assessed at baseline and randomized into either the MBSR (BC) program (n = 74) or a Usual Care (UC) control group (n = 68). Individuals in the MBSR(BC) group attended six weekly two-hour classes which provided instruction, discussion, and practice of mindfulness and meditative techniques. MBSR(BC) participants were expected to practice formally and informally for 30 to 90 minutes each day. Five mL of blood was collected at baseline, 6 weeks, and 12 weeks. TA was quantified using TRAPezeRT and TL was measured through a quantitative real-time PCR assay. Linear mixed models were used to determine whether TL or TA were affected by group assignment. RESULTS: Complete data were collected and analyzed from 138 participants. The majority, 72%, were White Non-Hispanic, with 78% recovering from Stage I or II breast cancer, and 36% who had undergone radiation and chemotherapy. There were no significant differences between groups in TL at 6 or 12 weeks; however, even after correcting for baseline between group differences in TA, the MBSR(BC) group had significantly greater increases in telomerase activity at 12 weeks (F (2, 392) = 5.48, p < .01). TA increased approximately 17% over time in the MBSR(BC) group compared to approximately 3% in the UC group. CONCLUSIONS: These results indicate no Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


change in TL related to MBSR(BC) participation; however, there was a sustained increase in TA at least six weeks after the conclusion of the intervention. RESEARCH IMPLICATIONS: Further investigation of clinical benefits related to increased TA would significantly enhance the application of these findings. CLINICAL IMPLICATIONS: Telomerase repairs DNA and thus increased telomerase may reduce the likelihood of cancer recurrence; however, the clinical implications of increased TA have not been thoroughly investigated at this time. FUNDING: This work was supported by the USF Established Researcher Grant Award and in part by the National Cancer Institute, Grant Number 1R01CA131080-01A2. P2-22 Improvements in Subjective and Objective Sleep Quality Due to Mindfulness-Based Stress Reduction for Breast Cancer Survivors Cecile Lengacher1,2, Richard Reich2,3, Sophia Ramesar1, Heather Jim2, Carly Paterson1, Pinky Budhrani1, Jerrica Farias1, Jong Park2, Irina Carranza1, Kevin Kip1 1 University of South Florida, Tampa, FL, USA, 2Moffitt Cancer Center, Tampa, FL, USA, 3University of South Florida, Sarasota-Manatee, Sarasota, FL, USA PURPOSE: The purpose of this study was to determine if participation in a six-week MBSR(BC) program would improve subjective and objective sleep quality in posttreatment breast cancer survivors (BCS). METHODS: A R01 trial subset of 79 BCS participants (Stages 0-III) were assessed at baseline and randomized into the MBSR(BC) program (n = 38) or a Usual Care (UC) control group (n = 41). MBSR(BC) participants attended six weekly two-hour classes involving mindfulness and meditation techniques. Sleep quality was measured subjectively using the Pittsburg Sleep Quality Index (PSQI) and objectively with actigraphy using the Actiwatch®-Score (MiniMitter, Bend, OR). Data were collected at baseline, 6, and 12 weeks. ANCOVA was used to analyze changes between groups; Spearman correlations coefficients examined associations between type of practice and sleep quality. RESULTS: The mean age was 57 years. The majority (73.4%) were White Non-Hispanic and had Stage I or II breast cancer (68.4%). BCS had undergone a variety of treatment options: mastectomy (57%), radiation (28%), chemotherapy (12.7%), and combination radiation and chemotherapy (29.1%). ANCOVA results trended toward improved subjective sleep quality at six weeks, with lower average PSQI scores in the MBSR(BC) group ( 0.18 MBSR(BC) vs. 0.05 UC, p = 0.09). For MBSR(BC) participants, objective sleep quality measurements significantly improved for 1) “time to fall asleep” from baseline to 12 weeks (27.9 minutes MBSR(BC) vs. 43.2 minutes UC, p = 0.04); and 2) from 6–12 weeks sleep efficiency significantly improved for the MBSR(BC) group (78.2% MBSR(BC) vs. 74.6 UC, © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Poster Abstracts of the APOS 11th Annual Conference

p = 0.04) along with “fewer wake times” (93.5 MBSR (BC) vs. 118.6 UC, p = 0.01) and “less activity during rest periods” (40.4 MBSR(BC) vs. 60.4 UC, p = 0.01). Spearman correlation coefficients showed no relationship between minutes practiced and sleep quality measures. CONCLUSIONS: MBSR(BC) effectively improved objective measures of sleep quality and trended towards improved subjective sleep quality among BCS. RESEARCH IMPLICATIONS: Future research may confirm these findings in a larger study or investigate whether sleep improvements mitigate post-chemotherapy cognitive impairment frequently seen in BCS. CLINICAL IMPLICATIONS: MBSR(BC) may be an effective non-pharmacological intervention for the treatment of insomnia and sleep disturbances among BCS. FUNDING: This work was supported by the National Cancer Institute, Grant Number: 3R01CA131080-02S1. P2-23 Design and Delivery of a Home-Based MindfulnessBased Stress Reduction for Breast Cancer Program for Breast Cancer Survivors via an Innovative iPad Approach Cecile Lengacher, Sophia Ramesar, Carly Paterson, Irina Carranza, Manolete Moscoso University of South Florida, Tampa, FL, USA PURPOSE: The purpose of this study was to pilot the delivery of the Home Based Mindfulness-Based Stress Reduction for Breast Cancer (MBSR(BC)) program via a new technological method using an iPad. METHODS: The Home Based MBSR(BC) was designed to deliver the weekly 2-hour sessions for a period of 6 weeks and formatted for use on the iPad allowing participants to complete the 6-week intervention at home. MBSR(BC) is a standardized stress-reducing intervention that combines sitting and walking meditation, body scan, and yoga adapted for BC survivors. This study uses a single group pre-post design delivered among female BC patients (stages 0-III) who completed treatment. Data were collected on self-report measures of psychological, physical symptoms, and quality of life at baseline and 6-weeks after program participation. Daily practice was monitored by diaries completed on the iPad. Using Apple’s iBooks Author for iMac, the iPad study was designed and customized with embedded audio and video presentations for each class. Final data analyses and evaluation is in process. RESULTS: Preliminary results show 15 participants were enrolled, 13 completed with 2 lost to follow up, one related medical reasons and other a family emergency. The mean age was 58 years. Of the total 15 enrolled, 1 or 6.7% reported Black Non-Hispanic and, 14 or 93.3% reported White Non-Hispanic. Sixty percent reported having a Mastectomy and 53.3% reported having radiation and chemotherapy as treatment, with 13.3% reported no chemotherapy or radiation. CONCLUSIONS: This study Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Poster Abstracts of the APOS 11th Annual Conference

was designed to meet the unmet needs of survivors, and decrease subject burden for those who could not participate in a traditional weekly intervention. The few patients lost to follow-up, indicates it may be a viable mode of delivery. Evaluation is continuing on analyses of outcomes and ease of use. RESEARCH IMPLICATIONS: This study is of high importance for delivering effective interventions to cancer survivors through technology thus decreasing the stress, cost and time burden for traveling to class. Although patients want to enroll in an intervention, they declined study participation due to scheduling or other commitments, such as work. CLINICAL IMPLICATIONS: This method of delivery offers participants flexibility to receive the benefits of Home Based MBSR(BC) without requiring attendance to regularly scheduled intervention sessions. FUNDING: This work was supported by the University of South Florida (USF) Research Incentive Award. P2-24 Genetic Variations Moderate Mindfulness-Based Stress Reduction for Breast Cancer-Based Reduction in Post-Chemotherapy Cognitive Impairment Jong Park1, Cecile Lengacher1,2, Richard Reich1,3, Sophia Ramesar2, Carly Paterson2, Irina Carranza2, Jerrica Farias2, Heather Jim1, Kevin Kip2 1 Moffitt Cancer Center, Tampa, FL, USA, 2University of South Florida, Tampa, FL, USA, 3University of South Florida, Sarasota-Manatee, Sarasota, FL, USA PURPOSE: Many breast cancer survivors suffer cognitive impairment (CI) during and after chemotherapy, which may persist up to 10 years. The purpose of this study was to investigate whether genotype may moderate the level of benefit received by Mindfulness Based Stress Reduction for Breast Cancer (MBSR(BC)) treatment. METHODS: Cognitive function of 33 MBSR(BC) participants with stages 0-III BC were assessed at baseline and after the MBSR(BC) program using the Measurement of Everyday Cognition (ECog). MBSR(BC) involved six weekly twohour classes of mindfulness and meditation techniques. Data were collected at baseline, 6 weeks, and 12 weeks. DNA samples from participants were screened for the presence of 10 SNPs in genes involved with cognitive function: ANKK1 (rs1800497), APOE (rs429358), BDNF (rs6265), COMT (rs4680), DRD2 (rs6277), HTR2A (rs6313,rs 6314, and rs4941573), MTHFR (rs1801133) and SLC6A4 (rs16965628) by TaqMan assay using the ABI Prism 7900HT sequence detection system (Applied Biosystems), according to the manufacturer’s instructions. Wilcoxon rank-sum tests were used to compare increased cognitive function following MBSR(BC) between different genotypes. RESULTS: The mean age was 61 years. The majority (73%) was White Non-Hispanic, 69% had Stage I or II BC. Forty-six percent of participants had undergone a mastectomy; other treatments included radiation (69%), © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.


chemotherapy (33%), with some participants having received both radiation and chemotherapy (30%). Significant improvement on five out of eight ECog scales were observed in recessive model (GG vs. AA or AG) of both SNPs in the ANKK1 (rs1800497) and SLC6A4 (rs16965628) (p < 0.05). These differences also were clinically meaningful, with three out of eight mean differences greater than 0.5 SD for the ANKK1 SNP and seven out of eight differences greater than 0.5 SD for the SLC6A4 SNP. CONCLUSIONS: Benefit by MBSR(BC) on cognitive function may be contingent on individual’s genetic background. RESEARCH IMPLICATIONS: These results could be used to determine the impact of genetic profile on CI after chemotherapy and may be applied in determining the efficacy of cognitive improvement interventions for the individual patient. CLINICAL IMPLICATIONS: Integration of genotype analysis as a predictor of intervention efficacy may help tailor individualized treatment plans for patients. FUNDING: This work was supported by the University of South Florida (USF) Research Incentive Award and the USF Established Researcher Grant Award. P2-25 Examining Common Process Themes in Advanced Cancer Patient Counseling Groups Julia Kulikowski1, Hayley Pessin1, Rebecca James2, Barry Rosenfeld2, William Breitbart1 1 Memorial Sloan-Kettering Cancer Center, New York, NY, USA, 2Fordham University, Bronx, NY, USA PURPOSE: Past research has highlighted the unique content of terminally ill cancer patients in psychotherapy groups. Identifying common themes and eliciting feedback from patients regarding their experience will allows clinicians to gain a deeper understanding of the needs of advanced cancer patients participating in group programs. METHODS: As part of a randomized controlled trial, patients with advanced cancer (Stage III/IV; n = 253) received 8 group sessions (1.5 hour weekly sessions) of either Supportive (SGP, n = 121) or Meaning-Centered Psychotherapy (MCGP, n = 132). Patients completed the Post-Intervention Questionnaire (PIQ) in the assessment after the final session (n = 125). Developed by the investigators, this faced-valid questionnaire assessed for a patient’s group preferences, adherence, and highlighted qualitative data on aspects of the group patients found to be most and least helpful. A content analysis conducted of the qualitative questions on the PIQ revealed common themes in the responses. RESULTS: Patients in both groups reported the group was most helpful in making them feel less alone and giving them a place to share experiences and express feelings. Interestingly, additional themes varied slightly between the two arms, with MCGP patients identifying existential program specific content to be helpful, and SGP patients citing coping with their Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


illness was most helpful. Overall, both sets of patients found their group had helped them the least with addressing practical concerns, how to involve friends and family, and speaking about death. Patients also indicated difficulty with groups not being matched by diagnosis and/or staging and issues related to member absences. CONCLUSIONS: The valuable common themes that emerged from the perspective of the advanced cancer patients’ experience in groups provide novel data that clinicians can integrate into counseling programs for advanced cancer patients. These findings demonstrate that despite the differing group content there are fundamental themes essential to address in order to have a successful group in this population. Given the sensitive nature of these groups, attending to these needs may improve clinical practice, reduce attrition, and contribute to increased group counseling utilization, treatment adherence, and member satisfaction. RESEARCH IMPLICATIONS: The analysis of the qualitative data provided offers researchers important thematic content that should be considered when examining group psychotherapy interventions for advanced cancer patients. CLINICAL IMPLICATIONS: This research provides clinicians with key themes terminally ill cancer patients identified as central to their experience in group psychotherapy programs. This data is useful for clinicians working with advanced cancer patients to facilitate group programs and allows for the exploration of these applicable topics. FUNDING: This study was funded by NCI Grant 1RO1AT00184201. P2-26 Assessing Quality Outcomes in an Integrated PsychoOncology Program Elizabeth Archer-Nanda, Sarah Parsons, Marisa Crenshaw, Rebecca Reichert, Holley Stallings, Rebecca Lilly Norton Cancer Institute, Louisville, KY, USA PURPOSE: The purpose of this paper is to describe initiatives and outcomes associated with sequential monitoring of depression for patients seen within an integrated psycho-oncology program at the Norton Cancer Institute. This paper will provide an illustration of an integrated psychiatric program’s process for evaluation of programmatic outcomes and integration of evidence-based guidelines. Preliminary data will be presented on sequential assessment with the PHQ-9, including demographic data, compliance with assessment, and disease specific observations. METHODS: Study data from this 6 month retrospective chart review will be presented. Data was collected on all newly referred patients to the Behavioral program from January 1, 2013 through March 31, 2013. Data points include: Distress score prior to referral, PHQ-9 scores from each visit, psychiatric diagnosis, presence of treatment plan and rationale, goals of care and follow up. RESULTS: © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Poster Abstracts of the APOS 11th Annual Conference

Results will describe A) Percentage of PHQ-9 completed at provider visits B) Presence of Psychiatric Diagnosis based on PHQ-9 data C) Description of interventions in accordance with the National Quality Forum D) Description of changes in depression scores. E) Distress Scores associated with referral. CONCLUSIONS: Broad variability exists among measurements used in psychiatry and psychooncology departments. The IOM report (2006) describes that as few as 27% of studies reviewed showed adherence to clinical guidelines and as few as 10.5% of individuals were found to receive evidence-based interventions. A better understanding of a patient’s baseline presentation allows for ongoing assessment of interventions and identifies opportunities to focus on targeted areas for clinical improvement (Oldham et al., 2008). This paper will overview one approach to implementing evidence based practice guidelines and illustrate tracking of psycho-oncology department outcomes as identified through sequential monitoring with PHQ-9. Preliminary analysis suggests distress scores are not congruent with PHQ-9 scores. RESEARCH IMPLICATIONS: A gap remains between clinical care and evidence based practice guidelines. Sequential monitoring of patient PHQ-9 scores provides data for ongoing assessment to better understand patient outcomes. Aggregation of patient specific responses allows for trending of data to better understand disease specific challenges and outcomes. CLINICAL IMPLICATIONS: Currently broad variability exists among measurements used in psychiatry and psycho-oncology departments. The IOM report (2006) describes that as few as 27% of studies reviewed showed adherence to clinical guidelines and as few as 10.5% of individuals were found to receive evidence-based interventions. A recommendation exists for patient centered decision-making and engagement in care, including information related to options and effectiveness of treatments (IOM, 2006). FUNDING: This project was funded in part with federal funds: NCI, NIH Contract No. HHSN261200800001E. P2-27 Intervention Fidelity: Promoting Health-Related Quality of Life in a Reflexology Randomized Control Trial Using Lay-Providers Dawn Frambes Michigan State University College of Nursing, East Lansing, MI, USA PURPOSE: The purpose of this presentation is to demonstrate how the elements of intervention fidelity, put forth by the National Institutes for Health Behavior Change Consortium Treatment Fidelity Workgroup (HBCCTFW), were incorporated into a reflexology randomized controlled trial (RCT). These elements are: 1) dose (number, frequency, and duration of sessions); 2) provider training; 3) treatment delivery; 4) treatment receipt; and 5) enactment of treatment skills. METHODS: Study participants Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Poster Abstracts of the APOS 11th Annual Conference

were enrolled as dyads consisting of women receiving treatment for advanced breast cancer and a friend/family caregiver (n = 122 dyads). Dyads were randomized to a reflexology or standard care group. To contrast the ongoing RCT to other studies using the HBCCTFW framework, a literature review was conducted using CINAHL, Pub Med, and the Cochrane Library to identify all reflexology studies that incorporated a lay provider to deliver a reflexology intervention to cancer patients. The aims for this work were to determine: 1) challenges and benefits related to dose; 2) how consistency in provider training is achieved; 3) how delivery fidelity is maintained; 4) how consistency in receipt and skill enactment are achieved. RESULTS: Four completed studies were identified that used lay providers to deliver reflexology to cancer patients. Two studies identified the number of sessions, one specified the interval of time between sessions, and all four identified the duration of reflexology sessions. None of the studies, however, addressed all components of dose. Training was described to a greater or lesser extent in all four. Only one study included treatment delivery. None of the studies included intervention receipt or enactment of skills. The ongoing RCT is the first to address all of the elements of intervention fidelity utilizing lay providers to deliver reflexology to cancer patients. CONCLUSIONS: In contrast to the ongoing RCT, most previous reflexology studies using lay providers have not fully addressed the elements of intervention fidelity. RESEARCH IMPLICATIONS: Research protocols that address intervention fidelity provide results that support internal and external validity, which can lead to future replication. CLINICAL IMPLICATIONS: When choosing supportive care options, drawing upon studies that included intervention fidelity provides a basis for making informed decisions. FUNDING: Funded by: National Institutes of Health, National Cancer Institute Grant # RO1 CA 257459–01. P2-28 A Review of Suicide Prevention Training Within Hematology-Oncology Fellowship Programs Laurel Ralston, Isabel Schuermeyer Cleveland Clinic, Cleveland, OH, USA PURPOSE: The purpose of this study was to better understand how hematology-oncology fellowship programs increase their trainees’ awareness of suicide risk management. Cancer patients are twice as likely to commit suicide as compared with the general population. In response to growing evidence that distress negatively affects cancer patient outcomes, The Commission on Cancer has mandated that providers evaluate for patient distress as a standard of care. We believe that effective distress management should also include suicide screening in patients with suicidal ideation or known suicide risk factors. In this study, we review if and how training oncology training programs are integrating © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.


risk assessment screening into their curriculum. METHODS: Program directors at each of the 136 ACGME accredited hematology and oncology fellowship programs were emailed a survey link along with a brief disclosure of our research purpose. Responses were voluntary and anonymous. Survey topics addressed depression screening, suicide risk assessment and lethal means counseling. Information about the evolution and implementation of these clinical skills was also collected. RESULTS: We are still collecting data for this project. From what we currently know, we hypothesize that the majority of programs have not yet implemented a formalized tool or process for training fellows about screening and management of suicide risk factors. CONCLUSIONS: The recent requirement that all cancer patients be screened for distress may potentially lead to a natural evolution of improved suicide screening by oncology staff. Our data suggests that most oncology fellowships do not formally include this within their training curriculum. One possible solution is to amend current ACGME accreditation guidelines to include suicide prevention management as a component within the current competency of “managing pain, anxiety and depression in patients with cancer.” The increased incidence of suicide in the cancer population necessitates an adequate suicide risk assessment as a component of emotional distress screening. RESEARCH IMPLICATIONS: Growing evidence suggests that patient distress has a negative effect on patient outcomes. Suicidal thoughts can be a component of patient distress. Physicians who ask about and acknowledge those thoughts and create a suicide prevention plan would most likely have better patient outcomes than those who did not. This could be easily tested. If the hypothesis is true, the next step would be to decide the most effective way to incorporate suicide screening (during the interview, patient questionnaire, etc.). CLINICAL IMPLICATIONS: Many physicians are aware of the increased risk of suicide in the cancer population but do not ask about suicidal ideation during oncology visits. Hopefully as physicians begin more consistently screening for "psychological or emotional distress," they will also incorporate questions about suicidal thoughts and formulate a suicide prevention plan if necessary. FUNDING: None. P2-29 Measuring Positive Change in Patients With Advanced Cancer: An Examination of the Benefit Finding Scale and the Post-traumatic Growth Inventory Emma Stein1, Allison Marziliano2, Allison Applebaum2, Barry Rosenfeld3, William Breitbart2 1 Ferkauf Graduate School of Psychology, Bronx, NY, USA, 2 Memorial Sloan-Kettering Cancer Center, New York, NY, USA, 3Fordham University, New York, NY, USA PURPOSE: While there are a number of extant measures of positive change following a cancer diagnosis, there is limited research on the structure of these measures, particularly in Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


patients with advanced cancer, and on whether these measures are assessing overlapping constructs. The study purpose was to conduct a factor analysis of the Benefit Finding Scale (BFS) in advanced cancer patients and examine the utility of using this measure with the Post-traumatic Growth Inventory (PTGI). METHODS: Participants were ambulatory patients with advanced cancer in an outpatient setting at Memorial Sloan-Kettering Cancer Center (n = 196). Participants completed measures of psychological functioning, including the BFS and PTGI. An exploratory factor analysis (using principal components analysis) with varimax rotation was conducted to examine the structure of the BFS and the findings were compared to the PTGI subscales. RESULTS: Two factors emerged with eigenvalues greater than 1, accounting for 61% of the variance in benefit finding. The first rotated factor (eigenvalue = 9.13) had high loadings (>0.5) on items involving coping and mindset and was conceptualized as internal/personal benefits. The second rotated factor (eigenvalue = 1.34) had high loadings (>0.5) on items related to family and relationships and was conceptualized as external/social benefits. The internal/personal subscale of the BFS seemed to be a broader measure of the PTGI subscales appreciation of life and personal strength. The external/social scale of the BFS focused more exclusively on relationships with family and friends, whereas the PTGI relating to others subscale seemed to measure general interpersonal relationships. CONCLUSIONS: Despite differences in how the BFS and the PTGI approach the question of positive change, the conceptual commonalities between the two extracted subscales of the BFS and the already established subscales of the PTGI suggest overlap in constructs measured by both. RESEARCH IMPLICATIONS: Research is needed to examine the relationships between individual items on these scales with the possible aim of creating a hybrid measure. This will streamline the measurement of positive change in cancer patients, reducing patient burden. CLINICAL IMPLICATIONS: A clearer understanding of positive change throughout the cancer trajectory will allow clinicians to identify and facilitate patients’ ability to find benefit, which can serve as a protective factor against psychopathology and distress. FUNDING: This study was funded by NCI grant 1RO1CA128187 to Dr. William Breitbart. P2-30 Advance Directives: Innovative Approaches to Using Online Media to Provide Education, Support and Outreach to Patients, Families and Healthcare Professionals Kayla Fulginiti, Lina Mayorga, Finly Zachariah, Rupinder Sidhu, Priscilla Avanessian City of Hope, Duarte, CA, USA PURPOSE: City of Hope launched a new, Advance Directives website, which aims to improve education, support © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Poster Abstracts of the APOS 11th Annual Conference

and outreach to patients, families and community. An interdisciplinary task force composed of social workers, physicians, nurses, and educators was formed to develop an advance directives website that would be innovative, informative, and sensitive to the needs of patients and families given the complexities of advance care planning in order to increase the rate of AD completion amongst patients. METHODS: A multidisciplinary team was formed to create an AD website to provide clear and concise information on advance care planning. The team focused on creating an educational and supportive environment online for patients, families, and providers to get their questions answered, seek guidance, and access resources and support. Focus was placed on educating not only patients and families, but also healthcare providers on the benefits of completing an advance directive early during the treatment process. A patient-centered approach was taken and the Patient Family Advisory Council was consulted for input. RESULTS: The AD website, portrays an interactive approach and includes patient, family and medical staff testimonials, information on ADs and supportive services, FAQ’s and an educational video on the importance of completing an AD. Based on patient feedback, it was decided to develop a series of educational videos to promote the use of AD completion and destigmatize negativity associated with ADs. CONCLUSIONS: ADs are often considered a taboo topic and one that is difficult for patients, families and providers to discuss. By creating an AD website, patients/ families are given the opportunity to access a crucial component of their healthcare planning in a non-threatening, user friendly environment. Further research and evaluation into the utilization of the AD website will provide future directions for improvement and enhancement. Using different information technologies may offer practical alternatives to engage patients, families and healthcare professionals in health education, promotion of ADs and ultimately give them more control over their lives and healthcare. Hopes are that the website would encourage not only patients and families but also healthcare providers to bring up the topic of ADs. RESEARCH IMPLICATIONS: Advance directives can often be a sensitive topic and one that is difficult to initiate by patients and providers. Research has shown that internet and web-based interventions can empower patients to take a more active role in their care. Implications of research on whether online access to AD information increases the number of ADs completed would be crucial to further development of online interventions geared towards patients/healthcare providers to assist in patient empowerment. CLINICAL IMPLICATIONS: Advance directives continue to be a topic that is difficult to discuss, not only for patients and families, but healthcare professionals as well. By developing an AD website that provides education and support in a non-threatening and safe environment, patients and healthcare clinicians Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Poster Abstracts of the APOS 11th Annual Conference

can feel better prepared to initiate and continue conversations related to advance care planning. FUNDING: None. P2-31 What Happens After Initial Distress Screening? Uptake of Supportive Care Services Among Cancer Patients Rachel K. Funk, Heidi A. Hamann, Cassidy A. Cisneros, Rush Ciarán Williams, Jeffrey Kendall University of Texas Southwestern Medical Center, Dallas, TX, USA PURPOSE: Distress screening is a widely accepted tool for monitoring psychosocial health among cancer patients; however little is known about the uptake of supportive care services following outpatient screening. METHODS: The current study tracked the psychosocial follow-up of patients who completed distress screens at an NCI-designated cancer center during a two-week period in April 2013. Patients who rated their distress in any category (e.g. depression, anxiety, appetite) as an 8 or higher and/or requested to speak with a member of the supportive care team (psychologist, social worker, dietician) met criteria for follow-up assessment by a member of supportive care. Follow up assessment occurred within two weeks of initial screening through inperson appointment, telephone call, or secure Electronic Health Record (EHR) email and was documented in the EHR. Demographic, illness, and triage information was then collected through EHR review. RESULTS: During the study time period, 364 cancer patients returned a completed distress screen. The majority of patients were female (n = 221, 61%), non-Hispanic White (n = 244, 67%) with an average age of 60 years (SD = 12.99). Hematologic cancers were the most frequent diagnosis (n = 131, 36%) followed by breast (n = 102, 28%) and lung (n = 38, 10.4%) cancers. Of the 364 who completed screens, 68 (18.7%) fulfilled criteria for supportive care contact. This includes 39 referrals for psychology, 31 for social work, and 39 for nutrition (patients could receive multiple referrals). Of those 68 patients meeting criteria for contact, the supportive care team attempted follow-up with a total of 58 (85%) patients and completed an actual assessment with 49 (72%) patients. Only 13 (27%) of the 49 assessed patients requested additional follow-up, and 10 (77%) of these follow-up appointments were completed within the 60-day study period. CONCLUSIONS: Overall, data indicate that a substantial minority of cancer patients report supportive care needs and suggest that most patients are responsive to an initial contact by supportive care staff. However, most of these patients do not request additional follow-up despite initial reports of high distress and support needs. More research is needed to understand optimal delivery of supportive care services for this population. RESEARCH IMPLICATIONS: This study provides additional information about the utility and outcomes of distress screening among an © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.


outpatient cancer population. Future research could build upon these findings by investigating why a percentage of this sample does not require additional assistance beyond the follow-up assessment. For instance, it would be useful to identify whether patients needs are indeed met through successful supportive care intervention or are an artifact of the screening tool or other reasons. CLINICAL IMPLICATIONS: This study is useful in understanding the role of distress screening in supportive care programming as well as its impact on supportive care resources. Since many patients did not request additional assistance beyond an initial follow-up assessment, it may be important to develop clinical interventions that can be implemented within the context of the follow-up assessment. FUNDING: None. P2-32 “What about us?” Understanding the Supportive Care Needs of Latino Male Cancer Survivors Dinorah Martinez Tyson, Claudia Aguado Loi, Patricia Medina Ramirez, Coralia Vasquez Otero University of South Florida, Tampa, FL, USA PURPOSE: Cancer survivors encounter many challenges that deeply affect quality of life such as cancer recurrence, diminished sexual desire/intimacy and functional impairments and other treatment side effects. There is a paucity of research on the survivorship experience of Latino men who have been diagnosed with cancer. This presentation contributes to our limited understanding by describing the supportive care needs of Latino men diagnosed with cancer. METHODS: A multi-perspective, exploratory qualitative study was employed. Latino male cancer survivors completed in-depth interviews (n = 10) and three focus groups (n = 20). Provider in-depth interviews (n = 7) and one focus group (n = 6) were also conducted to gather additional perspective of the supportive care needs of Latino men. Data were analyzed using thematic analysis techniques. RESULTS: Collectively, four major themes emerged. First, men’s experiences were often associated with beliefs related to masculinity and sexuality; commonly discussed interdependently. Second, communication issues, especially within the patient-provider context, and disclosure emerged as important concerns precluding further discussion and support from others. A multitude of underlying causes (e.g., lack of trust, embarrassment, stigma, physician’s communication style) were described to lead to these concerns. Third, spouses played a vital role in how men dealt with cancer and were instrumental sources of support and advocacy. Fourth, stress and anxiety related to treatment side effects were also discussed. In addition, participants provided suggestions for the best ways to reach Latino men. CONCLUSIONS: A strong commitment to culturally mediated gender roles may influence how Latino men express their needs and cope with cancer. Before valid strategies and interventions can be developed to address the psychosocial needs Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


of this understudied population, development of explanatory models and conduct of further research is necessary to strengthen our understanding of the sociocultural contexts of cancer survivorship. RESEARCH IMPLICATIONS: This proposal is framed in the context of recommendations set forth by the Institute of Medicine’s seminal report titled “Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs” and the “National Action Plan for Cancer Survivorship: Advancing Public Health Strategies.” Findings contribute to the existing science of cancer-related health disparities by providing an in-depth understanding of the psychosocial needs of Latino male cancer survivors and the influence of sociocultural contexts on cancer survivorship among this understudied population. Findings set a foundation to continue a further investigation on how sociocultural context influence cancer survivorship among Latino male cancer survivors. CLINICAL IMPLICATIONS: Several clinical implications are suggested based on findings. First, there is a need for additional provider cultural sensitivity training to improve communication with Latino male cancer survivors. Second, Latino male cancer survivors, and possibly other population groups, that tend to embrace or a stronger inclination to ”Machismo roles” may have a harder time coping and communicating needs to providers and family. Finally, additional efforts to reduce shame and stigma through education are needed to ensure survivors that it is okay to have cancer and seek support from others. FUNDING: This study was in part funded by the National Institute on Minority Health and Health Disparities, National Institutes of Health, Department of Health and Human Services (Dr. Richard Roetzheim & Dr. B. Lee Green, PI, 5P20MD003375-05 and the National Cancer Institute, National Institute of Health, Department of Health and Human Services (Dr. Dina Martinez Tyson, PI, 1R03CA168403-02). P2-33 Cancer Stress, Negative Emotions, Physical Health and Needs for Assistance Among Individuals With Lung Cancer Michelle McDonnell1, Desiree Azizoddin1, Jason Owen1, Holly Morrell1, Andrea Thornton2, Annette Stanton3 1 Loma Linda University, Loma Linda, CA, USA, 2UCLA Resnick Neuropsychiatric Hospital, Los Angeles, CA, USA, 3 Psychology and Psychiatry & Biobehavioral Sciences, UCLA, Los Angeles, CA, USA PURPOSE: Given the physical, emotional, and economic impact of caregiving, understanding patients’ needs for assistance is important. Relatively little is known about the need for caregiving assistance in those living with lung cancer, despite the fact that lung cancer patients are more likely to experience significant threats to health status and emotional well-being relative to other cancer types. The purpose of this study was to evaluate the relationship between cancer stress, emotional well-being, physical well© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Poster Abstracts of the APOS 11th Annual Conference

being, and need for assistance in those living with lung cancer. METHODS: Lung cancer patients (n = 230; 57% female, 43% male) were recruited from two large treatment facilities in Southern California and were asked to complete self-report questionnaires measuring physical and psychological health and needs. Structural equation modeling was used to evaluate a model predicting need for assistance (SF-36) using health status (single item), emotional well-being (POMS), and cancer stress (IOES-R). RESULTS: A path analysis indicated that the hypothesized model predicting need for assistance provided a good fit to the data, χ2 (2) = 4.298, p > .1; CFI = .986; SRMR = .033; RMSEA = .079; RMSEA 90% CI = [0.000, 0.184]. As expected, lower health status was associated with greater need for assistance, and worse emotional well-being predicted need for assistance only indirectly through health status. However, cancer stress (.015, p < .05) directly influenced need for assistance, and this relationship was only partially mediated by emotional well-being and health status. CONCLUSIONS: These results suggest that efforts to attend to factors that influence health status, such as symptom management/palliative care, may be particularly helpful in reducing need for assistance. Additionally, psychosocial interventions designed to target stress symptoms are likely to further reduce need for assistance and the resulting caregiver burden associated with these needs. RESEARCH IMPLICATIONS: Patients diagnosed with lung cancer may require alternative or additional forms of caregiving assistance than those suffering from other cancer types. Evaluating the mediating effects of emotional well-being and physical health status on cancer stress may reveal how they uniquely influence the well-being of lung cancer patients. CLINICAL IMPLICATIONS: Further investigation of cancer stress, negative emotion, and physical health status may reveal a clearer picture for improving the patients quality of life, the caregiving process, as well as the perceived burden associated with caregiving. FUNDING: The Lance Armstrong Foundation P2-34 Psychosocial Care Needs Among Women Undergoing Breast Cancer Treatment: Desired Form of Intervention Karin Stinesen-Kollberg1, Ulrica Wilderäng1, Gunnar Steineck1,2 1 University of Gothenburg, Gothenburg, Sweden, 2 Karolinska Institute, Stockholm, Sweden PURPOSE: In order to help clinicians more effectively direct psychosocial support of women diagnosed with breast cancer, we wanted to gain a better understanding of the desired form of intervention for twelve types of common psychosocial problems. METHODS: In an observational population-based study, we analyzed data from 313 women treated for breast cancer at Sahlgrenska Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Poster Abstracts of the APOS 11th Annual Conference

University Hospital in Gothenburg, Sweden. RESULTS: Worry about one’s own children, chemotherapy-related hair loss and nausea, and fear of dying were the types of problems breast cancer-treated women desired to receive psychosocial support about together with their partner. In general, however, women primarily desired individual intervention. CONCLUSIONS: When women are diagnosed with breast cancer and express a need for psychosocial support regarding the worry about their own children, health care professionals may consider inquiring whether they are also concerned about their partner relationship, if they have any chemotherapy treatment-related questions, and if so, whether they wish to include their partner in the intervention. RESEARCH IMPLICATIONS: Results from this study indicate the need to further investigate the form of intervention that is most desired for different types of questions in order to provide more effective psychosocial support. CLINICAL IMPLICATIONS: When women are diagnosed with breast cancer and express a need for psychosocial support regarding the worry about their own children, health care professionals may consider inquiring whether they are also concerned about their partner relationship, if they have any chemotherapy treatment-related questions, and if so, whether they wish to include their partner in the intervention. FUNDING: None.


oncology team. The referrals that are made are considered to be appropriate and require the intervention by professionals with additional psychosocial expertise. Staff members report it took time to gain confidence and comfort in using the standardized screening tool in routine practice and they continue to experience difficulties in responding to all patients. CONCLUSIONS: Successful implementation of distress screening requires a programmatic approach. Screening must be followed by appropriate assessment and intervention at the primary team level and referral if additional expertise is required. Staff members require education to perform successfully and relevant clinical tools and supports must be available to assist the members of the inter-professional team. RESEARCH IMPLICATIONS: Creating and testing tools to measure patient experience is necessary as a next step to determine the impact of programmatic screening for distress. CLINICAL IMPLICATIONS: Implementation of programmatic screening for distress requires practice change by members of the interprofessional team. Education and collaboration are essential. FUNDING: None.

P2-35 Implementing a Programmatic Approach for Responding to Screening for Distress Margaret Fitch, Jeff Myers, Stephanie Burlein-Hall Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada

P2-36 Implementing Survivorship Care Plans in the Canadian Cancer Setting Margaret Fitch1, Holly Bradley2, Geoff Eaton3, Janine Giese-Davis4, Jeff Sisler5, Jill Taylor-Brown5 1 Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada, 2Wellspring, Toronto, Canada, 3 Young Adults Cancer Association, St. John’s, Canada, 4 Alberta Health Services, Calgary, Canada, 5Cancer Care Manitoba, Winnipeg, Canada

PURPOSE: Distress is commonly experienced as patients cope with the consequences of cancer. Identifying those individuals who would benefit from supportive care intervention and ensuring there is an appropriate clinical response remains a challenge in busy ambulatory settings. We designed a concrete approach for early identification of patient distress related to both physical and psychosocial issues and clinical response by the inter-professional team. METHODS: We implemented a programmatic approach that includes a standardized tool to screening for distress, a brief assessment conversation with the patients, a subsequent dialogue for deeper assessment as required, and intervention or referral based on the assessment. Education, quality improvement cycles, evidenced-based practice guidelines and inter-professional team algorithms were introduced. Evaluation included pre- and postmeasures. RESULTS: Staff report that conversations with patients unfold differently than before the implementation and more psychosocial issues are being identified. The assessments provide a basis for tailoring the care plan with the patient. Psychosocial-oncology referrals have not increased as most of the issues are handled by the primary

PURPOSE: The number of individuals living after a diagnosis of cancer is growing steadily. Cancer survivorship does not come without cost as it is increasingly evident there are late and long-term effects that survivors experience. Physical and psychosocial effects can compromise quality of life and increase the burden of suffering. The Institute of Medicine has recommended that patients who are finishing treatment receive a survivorship care plan to assist in coping with the after effect of treatment and moving on with their lives. To date, few cancer programs utilize survivorship care plans in Canada. The aim of this work was to identify sustainable survivorship care plan approaches. The objective of this project was to learn about the barriers to implementing survivorship care plans in our Canadian health care environment. METHODS: Four jurisdictions were selected through a competitive process to mount survivorship care plan projects. The jurisdictions were selected to reflect a broad range of settings for the delivery of care plans and included a community-based agency, cancer centre, cancer-centre/ community-based consortium (urban/rural), and a national volunteer based organization (on-line). Each designed a

© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


Poster Abstracts of the APOS 11th Annual Conference

P2-38 Where Can Cancer Survivors Find Post-treatment Information? An Inventory and Gap Analysis Rachel S. Cannady1, Tenbroeck Smith1, Rebecca CowensAlvarado1, Michael Diefenbach2, Annette L. Stanton3, Linda Fleisher4, Anne Willis5 1 American Cancer Society, Atlanta, GA, USA, 2Icahn School of Medicine at Mount Sinai School, New York, NY, USA, 3University of California, Los Angeles, Los Angeles, CA, USA, 4Fox Chase Cancer Center, Philadelphia, PA, USA, 5George Washington University Cancer Institute, Washington, DC, USA

In 2011, under the aegis of the National Cancer Survivorship Resource Center, an expert panel developed informational domains relevant to post-treatment survivorship and identified 30 credible, national health organizations that provide information about cancer, including non-profits, federal agencies, professional organizations, prominent cancer centers, and cancer consortiums. First, the websites of these organizations were searched. Second, the Internet was searched using the following terms singly or in conjunction with the term cancer: post-treatment survivor, after treatment, long-term or late effects, psychosocial issues, emotional support, long-term support, nutrition, physical activity, hereditary, genetic testing, post-treatment surveillance, and second cancer screening. The authors combined results of these two search approaches for the current analysis. RESULTS: Overall, 401 post-treatment information resources were identified (259 multimedia, 79 print, 63 both). Among multimedia resources, information on healthy habits (36%) was most prevalent, followed by information on psychosocial issues (29%), physical side effects (24%), screening/surveillance (8%), and genetic counseling (3%). With regard to print resources, post-treatment information on physical side effects (30%) was most common, followed by healthy habits (25%), psychosocial issues (20%), screening/surveillance (18%), and genetic counseling (6%). The number of available information resources varied significantly by delivery channel (Chi-Square (12) = 292.001, p < .001). CONCLUSIONS: Technology-based health information has become a popular mode of information delivery, particularly web-based resources. However, a number of printed resources are also available. The type of resources available varied by mode of delivery; multimedia resources were most likely to cover healthy habits, whereas print resources were most likely to address physical side effects. The multimedia channel lacked resources on screening/surveillance. A gap exists in the availability of information about genetic counseling for posttreatment cancer survivors, regardless of delivery channel. RESEARCH IMPLICATIONS: Future research should examine gaps in the availability of cancer site-specific information. CLINICAL IMPLICATIONS: Evidence-based resources should be developed to fill the gaps related to information on genetic testing for post-treatment cancer survivors and their families. FUNDING: This study is supported by Cooperative Agreement #1U55DP003054 from the Centers for Disease Control and Prevention.

PURPOSE: As cancer survivors complete treatment they see health care professionals less often, decreasing their access to important cancer information. Often, survivors face challenges in finding information and resources to help manage their post-treatment experience. This study conducted a web scan of current post-treatment information available to cancer survivors and identified gaps in information content and delivery channels. METHODS:

P2-39 Body Image in Women Following Primary Treatment for Anal and Rectal Cancer Catherine Benedict1, Errol Philip1, Raymond Baser1, Tammy Schuler1, Lina Jandorf2, Roxanne Unger1, Christian Nelson1, Katherine DuHamel1 1 Memorial Sloan-Kettering Cancer Center, New York, NY, USA, 2Mount Sinai School of Medicine, New York, NY, USA

unique approach for using a care plan based on the template draft provided in the proposal call. Evaluations included patient/staff satisfaction as well as program utilization. RESULTS: The project illustrated that use of survivorship care plans in Canada was feasible. Survivors reported the plans helped them understand the next steps in their cancer journey. Jurisdictions reported the following elements were important for successful implementation of care plans: leadership, teamwork/collaboration, tailored care plan, education/training, communication/ dissemination, and conceptualization of survivorship. Barriers identified included infrastructure support (information technology), process for developing actual care plan, access to services, and engaging in robust evaluation. CONCLUSIONS: All projects served to streamline the transition from treatment to survivorship, and to significantly increase the capacities of patients and health care providers to address this gap in care provision. It is possible that the community, cancer centre, and on-line modalities could all work as complementary systems to bridge the gap for survivors, offering care plan services at a variety of times/places to suit the range of patients’ needs along the survivorship trajectory. RESEARCH IMPLICATIONS: Further research is needed to identify salient outcome measures for survivorship care plans; systematic evaluation using these variables is needed across various settings. CLINICAL IMPLICATIONS: It is possible that the community, cancer centre, and on-line modalities could all work as complementary systems to bridge the gap for survivors, offering care plan services at a variety of times/places to suit the range of patients’ needs along the survivorship trajectory. FUNDING: None. P2-37 was withdrawn

© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Poster Abstracts of the APOS 11th Annual Conference

PURPOSE: Treatment for anal and rectal cancer (ARCa) typically includes radiation, chemotherapy, and surgery, alone or in combination, and can require a stoma. Survivors often experience unwanted changes to their body that directly impact sexual functioning, psychosocial wellbeing, and quality of life (QOL). Body image (BI) may be an important predictor of the sexual sequelae for women post-treatment, particularly among sexually active women. Greater BI concerns have been associated with worse sexual and QOL outcomes in other cancers, yet ARCa survivors remain a largely understudied group. This preliminary study sought to (1) describe the nature and prevalence of BI problems, including sociodemographic and disease/treatment correlates; and (2) examine relations between BI and sexual/psychological functioning and QOL. METHODS: For the baseline assessment of a larger study, 70 women completed the EORTC QLQ-C30 and CR38 BI subscale, the Female Sexual Function Index, the Impact of Events—Revised scal), and the Brief Symptom Inventory. Bivariate correlation and independent t-tests assessed relations among sociodemographic, disease/treatment variables, and BI. Relations between BI and sexual/psychological functioning, cancer-specific distress, and QOL were evaluated using partial correlations controlling for relevant covariates. RESULTS: Women averaged 55 years old, 4-years post-treatment, were mostly White (76%), and married (57%). 86% reported BI problems; dissatisfaction was most common (72%). Almost half experienced 2 or more BI problems at least “a little,” and 35% experienced at least one problem “very much”. Younger age and stoma-related problems were related to poorer BI (p’s < .05). Married women reported marginally better BI (p = .07). BI was not related to education, ethnicity, cancer type or stage, or time since treatment. Women who reported poorer BI, also reported greater depression and anxiety, and worse cancerrelated distress and global QOL (p’s < .01). Among sexually active women, poorer BI was related to worse outcomes in all sexual domains (p’s < .05). CONCLUSIONS: BI concerns remain a significant problem for female ARCa survivors. Younger, sexually active, single women may have higher risk for BI problems, which may have important implications for sexual and psychosocial recovery. Interventions to improve post-treatment adjustment should consider targeting BI concerns. Given that analyses were correlational, future research should evaluate longitudinal relations. RESEARCH IMPLICATIONS: Findings have important implications for post-treatment intervention efforts targeting this patient population. Interventions to improve post-treatment adjustment should consider targeting BI concerns. Furthermore, given that analyses were correlational, future research should evaluate longitudinal relations in a more diverse sample. CLINICAL IMPLICATIONS: Younger, sexually active, single women may have higher risk for BI problems, which may have important implications for sexual and psychosocial recovery. FUNDING: © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.


Support for this research was provided by grants from the National Cancer Institute (R21 CA129195-01: K. DuHamel (PI) and T32CA009461-28: E.J. Philip). P2-40 Depression and Perceived Financial Burden Among Long-Term Rectal Cancer Survivors Yuda Chongpison1, Mark C. Hornbrook2, Robin B. Harris1, Marcia Grant3, Joanna E. Bulkley2, Christopher Wendel4, Lisa Herrinton5, Robert S. Krouse4,6 1 University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, AZ, USA, 2The Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA, 3City of Hope National Medical Center, Duarte, CA, USA, 4Southern Arizona Veterans Affairs Health Care System, Tucson, AZ, USA, 5Kaiser Foundation Health Plan, Inc. Division of Research, Oakland, CA, USA, 6University of Arizona College of Medicine, Tucson, AZ, USA PURPOSE: Consequences of surgery for rectal cancer (permanent ostomy (PO), anastomosis (AN), or temporary ostomy (TO) followed by anastomosis) can affect survivors’ psychological and financial well-being. Previous studies suggested that depression and perceived financial burden were present and might be associated among cancer survivors; however, the evidence was limited among long-term survivors. We investigated depression and its association with perceived financial burden resulting from their illness/treatment among long-term (≥5 years post-diagnosis) survivors. METHODS: A mail survey of 574 long-term rectal cancer survivors from Kaiser Permanente Northern California and Northwest was conducted in 2010–2011. The survey included questions on current depression and perceived financial burden from the City of Hope Quality of Life questionnaire. Responses were indicated on a scale where 0 = ‘none’ and 10 = ‘severe.’ Scores ≥4 were classified as depressed and ≥5 as high financial burden. ANOVA was used to contrast mean scores among surgery types. Regression models evaluated depression and financial burden scores with covariates. RESULTS: Mean current depression level was 2.09 (SD = 2.40), with 23% classified as depressed. PO survivors (N = 182) had the highest current depression levels (M = 2.46, SD = 2.61), compared to AN (N = 326, M = 1.96, SD = 2.37) and TO (N = 66, M = 1.68, SD = 1.81) (p = 0.02). These differences in depression by surgery type were significant even after adjusting for age, sex, and race (p = 0.015). Survivors reported average perceived financial burden of 1.94 (SD = 2.72), with 18% perceiving high financial burdens. PO survivors perceived highest burden (M = 2.5, SD = 2.92), compared to AN (M = 1.60, SD = 2.57) and TO (M = 2.12, SD = 2.65) (p = 0.001). After confounding adjustment, level of perceived financial burden was positively associated with higher current depression levels (p < 0.0001). Surgery type did not modify this relationship, although history of depression after surgery did; the association was stronger among Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


those also reporting depression after surgery (p = 0.04). CONCLUSIONS: Current depression was frequent among long-term rectal cancer survivors and was highest among those with permanent ostomy. While current depression and perceived financial burden due to their illness/treatment were statistically associated, there were no differences by surgery type. Psychosocial services for survivors should include concurrent discussion of depression and financial burden. RESEARCH IMPLICATIONS: Research is needed to identify factors influencing high depression and financial pressures among long-term rectal cancer survivors. CLINICAL IMPLICATIONS: Clinicians should be aware that long-term survivors, particularly those with permanent ostomy, can have depression and financial burdens resulting from their illness or treatment. Encouraging patients to receive psychosocial services may improve their well-being. FUNDING: National Cancer Institute Grant No. R01-CA106912, HR-QOL in Colorectal Cancer Survivors with Stomas (Renewal), PI: Robert S. Krouse, MD, Co-PI: Lisa Herrinton, PhD. P2-41 Behavioral Intervention Targets for Exercise Among Hematopoietic Stem Cell Transplant Survivors Shawna Ehlers, Eleshia Morrison, Christi Patten, Matthew Clark, Karen Grothe, Randi Hoffman, William Hogan, Tabetha Brockman, Chris Hughes, Dennis Gastineau Mayo Clinic College of Medicine, Rochester, MN, USA PURPOSE: Physical activity interventions for hematopoietic stem cell transplant (HSCT) patients demonstrate consistent positive effects on distress, fatigue, and independent functioning. We utilized a prospective cohort of HSCT patients to cross-sectionally document behavioral theory constructs potentially associated with exercise that may be useful targets in the iterative process of behavioral intervention development and improvement. METHODS: HSCT survivors completed a survey of lifestyle behaviors and associated constructs at 1-year post-HSCT. Theory constructs included exercise stage of change, exercise selfefficacy, and motivators and barriers to exercise among 406 1 year survivors of HSCT; 391 analyzed who responded to query of intent to exercise. Survivors were predominantly partnered (80.6%), Caucasian (92.4%), males (56.3%) who received autologous HSCT. The majority of survivors had some college education (71.6%; 43.2% attained a 4 year degree or higher). RESULTS: Approximately half of survivors reported regular exercise pre-HSCT (50.6%) and at 1-year follow-up (52.0%), with 39.9% reporting regular exercise in the past 6 months (6–12 months post-HSCT). The majority of survivors reported intent to exercise (84.0%) and intent to exercise more (75.0%) in the next 6 months. Self-efficacy for exercise was >7 (0–10 Likert rating) for half of survivors (50.8%). Primary motivation factors for exercise were to improve © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Poster Abstracts of the APOS 11th Annual Conference

health (68.7%), relieve illness symptoms (29.8%), and respond to concerns by family, friends, or providers (32.5%). Primary barriers to exercise were fatigue (50.2%), stress (19.5%), and time (19.0%). CONCLUSIONS: In conclusion at least half of 1-year HSCT survivors endorse behavior theory constructs of intent and self-efficacy at levels associated with exercise adoption and maintenance in the exercise literature. Conversely near half may benefit from behavioral interventions targeting these constructs. Multiple risk interventions targeting exercise, fatigue, and stress with a focus on improving health and relieving illness symptoms may increase patient receptivity to intervention, especially if provided in a way that minimizes time commitment. RESEARCH IMPLICATIONS: This research helps identify potential intervention targets to be tested in behavioral intervention development research and clinical trials of exercise interventions. CLINICAL IMPLICATIONS: This research highlights factors important to survivors in their desire to increase exercise and health. This information can help clinicians start conversations about behavior change and promote behavior change among individual survivors. FUNDING: KL2 RR 02415 (PI: Ehlers). This research was made possible by CTSA Grant Number UL1 TR000135 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH). Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NIH. P2-42 Perceived Stigma and Social Discrimination Among Cancer Survivors in Japan – A Web-Based Survey Daisuke Fujisawa1,2, Maiko Fujimori3,4, Ado BasakiTange3, Shino Umezawa3,5, Junko Ueda- Nouno3, Akiko Adachi2, Kazuho Hisamura6, Yuriko Suzuki4, Mitsunori Miyashita7 1 Massachusetts General Hospital, Center for Psychiatric Oncology and Behavioral Sciences, Boston, MA, USA, 2 Keio Uniersity School of Medicine, Palliative Care Center, Tokyo, Japan, 3National Cancer Center East, Psycho-oncology Division, Kashiwa, Chiba, Japan, 4 National Center for Neurology and Psychiatry, Tokyo, Japan, 5Tokyo University of Medicine and Dentistry, Section of Liaison Psychiatry and Palliative Medicine, Tokyo, Japan, 6Komatsu Municipal Hospital, Komatsu, Ishikawa, Japan, 7Tohoku University, Department of Palliative Care Nursing, Sendai, Miyagi, Japan PURPOSE: Perceived stigma and social discrimination related to cancer have been associated with poor patient outcomes, including poor quality life, negative affect (e.g. depression and low self-esteem), low uptake of medical services, social isolation, and poor physical outcomes. However, little is known about the prevalence and content Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Poster Abstracts of the APOS 11th Annual Conference

of stigma and social discrimination among cancer survivors, especially in Asian culture. Therefore, this study aimed to examine the prevalence and content of perceived stigma and social discrimination among cancer survivors. METHODS: An anonymous web-based survey was conducted over a month in December 2012. 628 Japanese survivors of various types of cancer who has been diagnosed as cancer within ten years were enrolled. The participants were recruited through a nation-wide commercial-based website-monitoring system. Participants were asked to report the frequency of perceived stigma and social discrimination (PSSD) related to cancer, using a single self-rated four-point scale. Those participants who endorsed any PSSD were asked to describe their experiences of PSSD using free-text fields. Qualitative methods were used to extract PSSD themes, using the following process: 1) systematic coding and categorization of the codes by two independent researchers, 2) integration of categories through discussion until reached agreement, and 3) axial coding to characterize the nature of the themes, reviewed by a multidisciplinary team consisting of a cancer survivor, oncologist, nurse, social worker, clinical psychologist, psychiatrist, social psychologist and social-psychiatry researcher. RESULTS: 61.6% of the cancer survivors reported some degree of perceived stigma and social discrimination. 78 categories were extracted from 492 codes, and were integrated into eight themes under three major axes. Axis-1: Self-stigma included i) Negative attitude toward self and ii) Negative body image. Axis-2: Interpersonal discrimination included i) Discrimination at work (personal attitude from colleagues/ partners), which comprised the largest proportion of the response, ii) Change in social role, and iii) Undesirable personal attitude from other people. Axis-3: Social discrimination included i) Insufficient formal support in job-related issues, ii) insufficient formal support in areas other than job-related issues, and iii) negative attitude by medical professionals. CONCLUSIONS: This study illustrates preliminary conceptualization of perceived stigma and self-discrimination of cancer survivors, which allows deeper understanding of suffering that may be experienced by cancer survivors. RESEARCH IMPLICATIONS: Our preliminary conceptualization of perceived stigma and social discrimination warrants further verification through quantitive research. Subsequent research also should be conducted to evaluate social, institutional, family and personal risk factors for perceived stigma and discrimination among survivors, in order to identify targets for intervention. CLINICAL IMPLICATIONS: This study demonstrates that almost two-thirds of patients may continue to experience perceived stigma and social discrimination related to cancer, up to several years after cancer diagnosis. Clinicians should consider evaluating sources of both self-stigma (e.g., negative attitudes toward self) and social stigma and discrimination (e.g., negative attitudes and actions of other) among survivors, and their potential implications on outcomes such as © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.


self-esteem, social relationships, and employment stability. FUNDING: This study was supported by a grand-in-aid from Japan Ministry of Health Labor and Welfare. P2-43 Survivor Net: Developing a Breast Cancer Survivorship Care Plan Template for a Safety Net Hospital Sofia Garcia1,2, Elizabeth Hahn1,2, Crystal Johnson1, Mallory Snyder1, Pam Khosla3 1 Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA, 2Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA, 3Sinai Health System, Chicago, IL, USA PURPOSE: Leading oncology professional societies and accrediting agencies recommend providing survivorship care plans (SCPs) at the end of primary cancer treatment to improve continuity of care and address survivors’ needs. However, SCPs have yet to be broadly adopted. Despite the existence of SCP templates, the primary implementation barrier is the time spent by providers completing them. We are attempting to reduce that burden and maximize usefulness to patients by designing an SCP template that is tailored to a safety net hospital that provides care to vulnerable populations. METHODS: We conducted in-depth (30–60 minute) individual interviews with physicians and nurses who treat breast cancer survivors in a safety net hospital. We conducted two focus groups with women within 4 months to 2 years of completing primary breast cancer treatment. The interviews and focus groups inquired about common post-treatment survivorship concerns and opinions about SCPs (including specific templates, timing and delivery). We conducted a review of existing SCP templates and recommendations, gathering over 200 clinical data fields from which we selected those that best met clinic needs. We drafted our SCP template from the chosen fields, formatting them such that a majority (>70%) include dropdown options for easier completion. RESULTS: Clinicians (n = 8) were largely in favor of SCPs but unfamiliar with them and concerned about the time and training involved. Breast cancer survivors (n = 12) reported unmet needs after completing treatment, had favorable views of SCPs and the majority preferred more comprehensive templates. In response to stakeholder input, we drafted 1) an SCP template with the comprehensive introduction and follow-up care recommendations preferred by survivors, and the brief treatment summary and drop-down options preferred by clinicians; and 2) a manual to standardize SCP completion and delivery. CONCLUSIONS: Breast cancer survivors and clinicians provided complementary perspectives that we used to inform development of an SCP intervention. An SCP intervention (template and implementation manual) were tailored for use in a new safety net hospital survivorship clinic. The SCP intervention will be piloted in a feasibility study with breast cancer Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


survivors in that clinic and, if successful, it will inform how to develop SCPs for other cancers. RESEARCH IMPLICATIONS: Despite the abundance of recommendations for the use of SCPs in standard clinical practice, there is limited empirical evidence of their feasibility and efficacy. This study contributes to that growing body of research, focusing on ways SCPs can be tailored to meet local needs. CLINICAL IMPLICATIONS: The American College of Surgeons’ Commission on Cancer (CoC) has included in its new standards for patient-centered care that by 2015 all accredited institutions must deliver SCPs to patients when they complete primary cancer treatment. Our study is investigating how a CoC-accredited safety net hospital can do so feasibly. FUNDING: This study is funded by the American Cancer Society, Illinois Division (Grant# #254698). A portion of Dr. Garcia’s time is also supported by a National Institutes of Health-funded supplement to the Patient-Reported Measurement Information System initiative (U54AR057951-S1). P2-44 Pilot Implementation of Cancer Survivorship Care Plans in Veterans Affairs: Challenges and Opportunities M. Bryant Howren1,2, Peter J. Kaboli1,2 1 VA Iowa City Healthcare System, Iowa City, IA, USA, 2 The University of Iowa, Iowa City, IA, USA PURPOSE: The number of persons living with a cancer diagnosis continues to rise, primarily due to improvements in detection and treatment of cancer. Diagnosis and treatment are well-recognized as difficult periods associated with numerous deleterious outcomes, but the time beyond the completion of treatment has received relatively less attention, despite recent estimates indicating that more than 13 million Americans are now considered cancer survivors. Cancer survivors may experience a number of late and long-term effects that require coordinated follow-up care after completion of primary treatment. Consequently, in 2006, the Institute of Medicine issued a report recommending that every cancer patient receive an individualized survivorship care plan (SCP) that includes complete treatment summaries and guidelines for monitoring and maintaining health. Uptake of SCPs in practice, however, has been slow and fraught with challenges. This may be especially problematic for rural, underserved Veterans who often experience barriers related to access and problems with care coordination. Thus, this project recruited rural Veteran lung cancer survivors to evaluate the process and impact of SCP implementation in Veterans Affairs (VA) using aspects of the Consolidated Framework for Implementation Research (CFIR), a theory-based taxonomy of constructs related to the implementation of healthcare interventions. METHODS: Specifically, rural Veteran lung © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Poster Abstracts of the APOS 11th Annual Conference

cancer survivors receiving care from the VA Iowa City Healthcare System were delivered a tailored SCP within 1 week of treatment completion. A brief, phone-based nurse counseling session was administered to orient survivors to the SCP. Each plan consisted of the following: (1) a complete treatment summary including details of the diagnosis, treatments received, and contact information for all VA providers (ie, primary care, oncology, psychology/mental health, social work, rehabilitative care); (2) a detailed follow-up plan with specific recommendations for ongoing care, symptom self-management, and health promotion strategies. RESULTS: Challenges and opportunities related to the implementation process within the CFIR framework—including information on the implementation climate, intervention complexity and adaptability, and reflection/evaluation—will be discussed and strategies for overcoming implementation obstacles will be highlighted. CONCLUSIONS: Future directions, including possibilities for broader VA expansion, will also be discussed. RESEARCH IMPLICATIONS: This presentation will cover challenges and opportunities related to the implementation of survivorship care plans according to the Consolidated Framework for Implementation Research (CFIR), a theory-based taxonomy of constructs related to the implementation of healthcare interventions. CLINICAL IMPLICATIONS: Clinicians will be able to learn about challenges related to the implementation of survivorship care plans and what they should contain, which has immediate implications for patients and individual practices. FUNDING: VA Office of Rural Health. P2-45 Cancer Survivors’ Adherence to the American Cancer Society Post-treatment Health and Wellness Guidelines Kelly Hyland1, Inga Lennes1, William Pirl1, Kelly Smith2, Elyse Park1 1 Massachusetts General Hospital, Boston, MA, USA, 2 University of British Columbia Department of Obstetrics and Gynaecology, Vancouver, BC, Canada PURPOSE: The American Cancer Society (ACS) recommends that cancer survivors manage post-treatment health and wellness by maintaining a healthy lifestyle, which includes avoiding cigarettes, limiting alcohol, being physically active, eating a healthy diet, maintaining a healthy weight, protecting skin from exposure to ultraviolet radiation, and seeing one’s doctor regularly. The National Comprehensive Cancer Network (NCCN) recommends screening survivors for psychological distress. Our study objectives were to 1) examine rates of adherence to these ACS recommendations and 2) assess associations between survivor health behaviors and distress. METHODS: Patients attending a cancer survivorship clinic between 1/11-5/12 completed a survey assessing health behaviors and psychological distress. Behavioral Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Poster Abstracts of the APOS 11th Annual Conference

adherence cutoffs were established for 6 ACS recommended health behaviors. Distress was measured on a 10-point analog scale modeled after the NCCN distress thermometer; 6 was established as cutoff. Chi-square analyses examined associations between non-adherence to ACS post-treatment recommendations and distress. RESULTS: 67 cancer survivors (Mean = 51.8 yrs, 61.2% female) participated. 53.7% of had a BMI score above or below the normal range. 49.3% did not meet sunscreen adherence guidelines. 40.3% did not meet the minimum suggested physical activity guidelines. 14.9% reported drinking beyond the ACS gender-based recommendations. 10.4% reported they did not have a primary care provider. 9.0% were current smokers. 56.1% endorsed a high level of distress. Only 15.3% met adherence criteria for all 6 ACS post-treatment health behaviors examined, and 20.4% met adherence criteria for 3 or fewer ACS guidelines. All smokers’ distress levels exceeded the distress cutoff score (p = .043). Of non-adherent sunscreen appliers, 65.6% endorsed levels of distress exceeding the cutoff score (p = .083). CONCLUSIONS: The majority of adult cancer survivors did not adhere to ACS post-treatment health and wellness guidelines. More than half of survivors met criteria for elevated distress. Albeit a small sample, there are relationships between some unhealthy behaviors and distress. RESEARCH IMPLICATIONS: This research explores the potential relationship between cancer survivor health behaviors and distress. CLINICAL IMPLICATIONS: Clinicians should be screening for psychological distress and assessing major health behaviors to meet NCCN and ACS guidelines. This information could assist clinicians with intervening on survivor health behaviors and screening for psychological distress to meet national guidelines. FUNDING: This study was supported by internal funds from the Massachusetts General Hospital Cancer Center. P2-46 The Active Patient (TAP): A Qualitative Study of the Patients’ Experience and Appraisal of a Multimodal Rehabilitation Intervention During Hematopoietic Stem Cell Transplantation Mary Jarden1,2, Jeanette Holder1, Dorte Hovgaard1, Lis Adamsen2 1 Department of Hematology, Copenhagen University Hospital, Copenhagen, Denmark, 2University Hospitals Centre for Health Research, Copenhagen University Hospital, Copenhagen, Denmark PURPOSE: The purpose of this abstract is to present the results of a qualitative study nested within a randomized controlled trial (n = 42) exploring the patients’ experience and appraisal of the multimodal intervention while undergoing a myeloablative hematopoietic stem cell transplantation (HSCT). METHODS: This investigation applies a descriptive and explorative design using a thematic analysis and NVIVO computer program. Semi-structured interviews © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.


were conducted with participants assigned to the intervention group (n = 20) after six weeks participation in the intervention. The intervention group received standard HSCT; and a supervised 6 week structured exercise program, progressive relaxation and psychoeducation. RESULTS: The results are presented in two overarching themes and subthemes as follows: Theme 1: Intervention appraisal - a. Feasiblity: safety issues, acceptability and realistic, good compliance b. Intervention played a natural role in treatment and care, viewed as a beneficial adjunct to treatment c. Benefits (include family’s role and supervision) and barriers (symptoms, busy care-schedules). Theme 2: Meaning attached to the Intervention - I Teachable Moment (timing, possibilities and outcome) -The intervention was a catalyst to ’activity awareness’, allowed ’personal engagement’ and was a means of activating the patient psychologically, cognitively and physically, thus reducing the symptom burden. II The active patient (identity, new role, strategy and experience) a. The intervention gave the patient an active and meaningful role during treatment especially in regards to symptom management b. Patients used diverse, individual and fluctuating motivational strategies c. Meeting daily goals led to the experience of success regularly despite the symptom burden and uncertainty of the situation, and this was experienced as hope. CONCLUSIONS: Patients reported favorable appraisal of the multimodal intervention and would recommend it to future patients undergoing HSCT. These recommendations are based on the themes that support the patients’ sense of purpose and control while living restrictively under potentially threatening treatment conditions. Patients reported a heightened sense of physical and emotional awareness that was used as a catalyst for motivation. Key findings were that most participants experienced improvement in treatment related symptoms, more energy, able to spend more time out of bed, confidence in being physically active and aware. The intervention succeeded in satisfying the patients’ need for active participation in own treatment and care. The patients’ accounts reflect the need to normalize a demanding treatment situation with the goal of health maintenance. RESEARCH IMPLICATIONS: Exploring the multimodal intervention through the patients’ perspective supplements and contributes to the quantitative methods that found the intervention to be feasible and safe, shown to reduce the symptom burden with physiological and quality of life benefits. An implementation project is presently underway at the Department of Hematology, Copenhagen University Hospital, Denmark: Patient Activation through Counseling and Exercise Hematopoeitic Stem Cell Transplantation (PACE-HSCT). CLINICAL IMPLICATIONS: This qualitative inquiry suggests that patients are health seeking and motivated to be active participants even during rigorous treatments. These results have the potential to enhance the development of important strategies in the HSCT regime for prevention, care, treatment and rehabilitation. Greater emphasis needs to be placed upon educating patients about the benefits of activity Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


during intensive cancer treatments - and that benefits can be two-fold, both physical and emotional benefits can be obtained. It will inform current policies, guidelines and programs designed to promote health, prevent deconditioning, improve patient outlook, and change activity behavior in patients undergoing intense cancer treatments. FUNDING: The research was supported by grants from Lundbeck Foundation, The Novo Nordic Foundation, The Danish Cancer Society, Copenhagen University Hospital, The Danish Nursing Society, The Danish Cancer Nursing Society and Novartis. P2-47 Healing the Heart: Helping Cancer Survivors Tell Their Stories Cheryl Krauter1,2 1 Women’s Cancer Resource Center, Oakland, CA, USA, 2 Alta Bates Summit Medical Center- Survivorship Steering Committee, Oakland/Berkeley, CA, USA PURPOSE: To introduce a narrative, humanistic psychotherapeutic approach for all cancer survivors, patients, partners, families, friends, colleagues, that gives each of them an opportunity to tell their stories of illness and healing. To communicate the value of providing a client-centered structure for each individual to express the unique story of their experience with cancer, with an emphasis on treatment that allows time and space for exploration without the pressure to move on to "the new normal." METHODS: Participants will be encouraged to expand and deepen their psychotherapeutic work with cancer survivors. I will share my personal story as a cancer patient, survivor, and psychotherapy practitioner interwoven with examples of my work with survivors. Participants will be introduced to a structure they can implement for themselves as well as utilize with their patients/clients. Brief period for questions and comments. RESULTS: Participants will acquire a new perspective and practical structure for their work of helping cancer survivors heal from the emotional trauma of cancer. CONCLUSIONS: In 2013 Institute of Medicine reports 14 million people with cancer, more than 1.6 million new cases diagnosed each year. To effectively address the complexity of quality integrated cancer care there is a need to include excellent long term psychosocial care based on a client-centered model. RESEARCH IMPLICATIONS: Study the efficacy of post-treatment psychotherapeutic programs. Case studies over an extended period with markers at one, five, and ten years post-treatment. Patient surveys on quality of life. Unstructured (informal) interviews with survivors. CLINICAL IMPLICATIONS: Humanistic psychotherapy places the focus on authentic exploration with the intention of deep healing. Clinicians can implement the creative and pragmatic structure presented to build a client-centered model serving the need for a long-term © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Poster Abstracts of the APOS 11th Annual Conference

perspective in the emotional healing of a cancer diagnosis. By personalizing treatment the clinician introduces meaning and self-advocacy to the patient/client. FUNDING: None. P2-48 Development of a Meaning-Centered Group for Breast Cancer Survivors: Focus Group Findings and Preliminary Effects Wendy Lichtenthal1, Malwina Tuman1, Geoffrey Corner1, Dawn Wiatrek2, Corinne Sweeney1, Kailey Roberts1, Caraline Craig1, Maria Farberov1, Katherine Sharpe2, William Breitbart1 1 Memorial Sloan-Kettering Cancer Center, New York, NY, USA, 2American Cancer Society, Atlanta, GA, USA PURPOSE: Surviving cancer often heightens one’s desire to live a meaningful life, yet breast cancer survivors (BCS) frequently describe feeling “stuck” following completion of their cancer treatment. Interventions that target such existential concerns are lacking despite their promise for improving adjustment. This collaborative project with the American Cancer Society addresses this need through a two-phase study designed to adapt Meaning-Center Psychotherapy (MCP) for advanced cancer patients into a Meaning-Centered Group for Breast Cancer Survivors (MCG-BCS). METHODS: Phase 1 of this study involved conducting 3 two-hour “virtual” (using telephone and Internet) focus groups to evaluate the relevance and wording of the existing MCP workbook. Participants were 12 earlystage BCS (4 per group) at least 3 months post-treatment. Four independent raters coded the focus group transcripts using thematic content analysis to identify proposed intervention changes, which the investigative team discussed until consensus about the revisions was reached. Phase 2, now underway, is examining the feasibility and promise of 8 90-minute “virtual” sessions of MCG-BCS by comparing it to a “virtual” standardized support group in a pilot randomized controlled trial with 60 BCS reporting at least moderate distress. RESULTS: Phase 1 participants were on average 58.3 years old (SD = 8.6 years) and all college-educated. They consistently provided positive overall impressions of MCG-BCS and confirmed the relevance of the intervention content. Recommendations to change language and exercises to be more future-oriented and hopeful were incorporated into the adapted intervention. Content related to death and dying was eliminated. Questions were added to assist BCS with reflection about future goals and with making concrete changes. Preliminary efficacy results from the Phase 2 pilot trial of MCG-BCS will also be presented. CONCLUSIONS: MCG-BCS appears relevant and helpful to BCS, whose feedback helped tailor the intervention to their preferences, creating a more acceptable group intervention that can be delivered over the telephone and Internet. RESEARCH IMPLICATIONS: This study addresses a gap in Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon

Poster Abstracts of the APOS 11th Annual Conference

empirically-supported interventions focusing on post-treatment cancer survivors and on common existential concerns. CLINICAL IMPLICATIONS: MCG-BCS may improve BCS’ sense of meaning, purpose, and identity, and reduce their feelings of isolation. The virtual group platform can connect BCS across the country, which will facilitate wider dissemination of the program, should it prove efficacious. FUNDING: This research is supported by a collaborative agreement with the American Cancer Society (#11656). P2-49 Cancer Survivorship in Rural and Urban Adults: A Descriptive and Mixed Methods Study Julie McNulty1,2, Lillian Nail1, Rebecca Block1 1 Oregon Health and Science University, Portland, OR, USA, 2Arizona State University, Phoenix, AZ, USA PURPOSE: Cancer survivors are living longer, growing in number and are at risk for decrements in health and well-being due to cancer and treatment. Effects of treatment may persist years after diagnosis, and include physical, psychological, social and spiritual impact. Rural dwelling survivors are at risk for decrements in health and well-being due to decreased access to healthcare, specialty services and support resources. The purpose of this descriptive and mixed methods design study was to explore and compare the impact of cancer, in rural and urban dwelling adults cancer survivors living in Alaska and Oregon. Both states have high levels of rurality. METHODS: The convenience sample (N = 132) included adult survivors of all cancer types, who had completed cancer treatment, and were cancer free. Participants were recruited through survivorship programs and networking. The sample was predominantly middle aged (mean age 58) and female (84%). Time since treatment was completed ranged from 3 months to 36 years (mean 6.7). The most common types of cancer included breast, gynecologic, lymphoma, head and neck and colorectal. Measures included the Impact of Cancer version 2 and the Memorial Symptom Assessment Scale-Short Form. Comparisons were made within and between region (state) and location (rural/urban). RESULTS: Comparisons across the regions showed significant differences in body concerns, worry, negative impact and employment concerns. Overall, the Alaska rural group reported the most positive outcomes. 19 participants were interviewed and findings revealed a temporal pattern, with major post treatment themes identified as reconciling, cancer/life perspective, survivor identify and long term impact. Themes reflecting rural/urban difference included access to healthcare, travel, care coordination/navigation, connecting and community, thinking about death and dying, public/private journey, and advocacy. CONCLUSIONS: The study results challenge prevalent assumptions about rural-dwelling cancer survivors and their risk for negative outcomes. A profile of rural © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.


survivorship emerged, with a common thread being community. Access to healthcare may not be the driver of the survivorship experience. There is an opportunity to influence healthcare providers and to develop quality programs serving this growing population with complex issues, building on the strengths of both rural and urban living, and the engagement of the survivorship community. RESEARCH IMPLICATIONS: Rural cancer survivors are understudied, and very few studies have compared psychosocial outcomes in rural and urban survivors, utilizing both quantitative and qualitative methods. This study helps to build evidence toward effective interventions for long term and rural cancer survivors. In addition, a preliminary framework is offered that outlines survivorship in a temporal pattern. The mixed findings, showing very subtle rural/urban differences suggest that other factors may be at play such as gender, ethnicity, education, socioeconomic status, support systems, type of cancer, co-morbidities and personality characteristics. The identified positive impacts of the rural community networks and connectedness may be a protective factor for rural survivors. CLINICAL IMPLICATIONS: Study findings will raise awareness for clinicians with regard to the unique needs of rural and urban cancer survivors. Clinical providers need to remain vigilant about assessing for symptoms (physical and psychological) even into later stages of survivorship. Worry emerged as a common thread across the study, and warrants attention of clinicians. The Impact of Cancer instrument, with its focus on positive and negative impact, and employment and relationship concerns, can be useful in clinical practice to identify survivors at risk for negative sequelae. Several themes emerged that were related to needed improvements in healthcare, such as access, travel and care coordination/navigation. FUNDING: Oregon Health and Science University Dean’s Scholarship. P2-50 Development and Evaluation of a Physical ActivityBased Book Club to Improve Mental Health and Promote Physical Activity in Cancer Survivors — Study Protocol for the ABC Trial Julie Midtgaard Copenhagen University Hospital, Copenhagen, Denmark PURPOSE: Because of accumulating evidence on the effects of exercise on survival, cancer survivors are recommended to avoid physical inactivity. However a majority of cancer survivors continue to report sedentary behavior and/or suboptimal PA behavior. Reported barriers to PA in cancer survivors include fatigue and lack of energy, and studies repeatedly document that a majority of cancer survivors prefer low-to-moderate intensity home-based activities that can be performed individually. Burgeoning research into the healing effects of narratives reveals that story reading as well as storytelling may improve mental health and promote sustainment of physical activity. The purpose of this abstract is to present Psycho-Oncology 23: (Suppl. 1): 1–144 (2014) DOI: 10.1002/pon


the rationale behind and study protocol for a feasibility study aimed to evaluate an innovative and pragmatic narrative intervention (an ‘Active Book Club’, ABC) to improve mental health and promote PA in cancer survivors. METHODS: The study is intended to include fifteen self-referred cancer survivors with mild-to-moderate depressive symptoms (i.e. score >2 and

Abstracts of the APOS 11th Annual Conference, 13-15 February 2014, Tampa, Florida.

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