Psycho-Oncology Psycho-Oncology 23 (Suppl. 2): 1–16 (2014) Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1111/pon.3495

ORAL PRESENTATIONS

Using a patient reported outcome measure to detect emotional distress during cancer treatment Absolom K, Takeuchi E, Holch P, Warrington L, Hector C, Taylor S, Kenyon L, Ingleson E, Velikova G University of Leeds, Leeds, UK BACKGROUND: Research has demonstrated the potential value of patient reported outcome measures (PROMs) for detecting and monitoring health related quality of life issues. Using appropriate measures and providing staff training is essential. We developed a chemotherapy specific PROM (assessing symptoms/side-effects/emotional distress) for use during review consultations, along with a PROMs doctor training session. A pilot study evaluated the impact of the PROM and training on oncology consultations. AIMS: To report preliminary results describing levels of: • Emotional distress (ED) detected by the PROM • ED discussion during consultations METHODS: A before-after design study with 3 oncologists (from breast/colorectal/gynaecology services) was conducted. A minimum of 10 patients per doctor were recruited before, then after training.Patients completed the PROM and ‘topics to discuss’ checklist on touchscreens before consultations. Oncologists received the results graphically; symptom/ED scores were coded red/amber/green to denote severity.Consultations were audiorecorded and analysed using content-analysis to assess discussed topics and actions/advice provided. RESULTS: 61 patient-consultations (31 pre-training/30 post-training) were analysed. Nineteen patients (31.1%) reported severe/red ED scores, 6/ 19 (31.6%) did not discuss ED during consultations. Only 9/61 patients (14.8%) specified wanting to discuss anxiety/depression/worries with staff. Patients raised ED issues more frequently than doctors (61.3% vs 35.6%, p < 0.001). CONCLUSIONS: These findings highlight the complexity of using PROMS for ED detection/management. Although patients experience ED, many do not specify wanting to talk about this during consultations- though they are more likely to raise issues. Future analysis will explore the quality of ED discussions and if doctor-training was associated with improved management (referrals/advice).

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

One-to-one telephone support provided by volunteers to women with breast cancer: What makes a successful client–volunteer relationship? Scott E1, Armes J1, Gillett K1, Scanlon K2, Lewis M3, MacKenzie M3, Shewbridge A4, Dale C5, Ream E1 1 King’s College London, London, UK, 2Breast Cancer Care, London, UK, 3Service User Research Partnership, Breast Cancer Care, London, UK, 4 Guy’s and St Thomas’ NHS Foundation Trust, London, UK, 5King’s Health Partners, London, UK BACKGROUND: Peer support – provided by someone who has been through a similar experience – is an important source of support for some people with cancer. Benefits include reduced isolation, reassurance and increased knowledge about cancer. Studies have primarily focused on peer support delivered face-to-face. Little is known about the effectiveness of telephone peer support. AIMS: Explore factors influencing the relationship between clients and peer support volunteers and identify characteristics of a successful relationship. METHODS: As part of a larger mixed-method evaluation of Breast Cancer Care’s peer support service, semi-structured telephone interviews were conducted with 10 women recently diagnosed with breast cancer and their trained volunteer(s) (n = 21). Interviews were analysed dyadically, informed by social comparison theory, which posits that comparing one’s experience with someone similar may normalise the experience and provide positive role-modelling. RESULTS: Factors leading to a successful relationship include: ‘matching’ clients and volunteers, particularly on treatment characteristics; upward social identification, which provides hope, and instils confidence; ascertaining the most beneficial time for the first call (when needs are greatest); consideration of the optimal length of time the volunteer is post-diagnosis (dependent on what the client seeks from the relationship); shared understanding of the client’s needs; volunteer skills; and recognition of challenges of telephone-based support. It is also important to consider the potential negative impact of downward social identification. CONCLUSIONS: We have a greater understanding of the mechanisms that lead to successful telephone peer support relationships. Breast Cancer Care is using the findings to make improvements to the service.

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‘Do you mean I’m not whole?’: An interpretative phenomenological analysis of younger women’s experiences of electing to not undergo breast reconstruction after mastectomy following breast cancer Archer S1, Holland F2, Montague J2 1 Royal Derby Hospital, Derby, UK, 2University of Derby, Derby, UK BACKGROUND: Within the psychological and medical literature, publications have tended to focus either on the body image/esteem of women who have opted for breast reconstruction, the cosmetic outcomes that they perceive, or immediate versus delayed reconstruction. The decision to undergo/not undergo breast reconstruction has psychological implications for women both in terms of their personal and social identities and for their close personal relationships and warrants exploration. AIM: The current research aims to explore the experiences of six women who had been diagnosed and treated for breast cancer in their 30s or 40s and who had decided not to have reconstruction after mastectomy. METHODS: The women were recruited through a Breast Cancer Care website and were interviewed over the phone using a semi-structured format. The resulting data were transcribed verbatim and analysed using interpretative phenomenological analysis. RESULTS: A number of themes emerged; the focus in this presentation is on how and why the women chose to go against ‘the norm’ of reconstruction and the effects this had on their relationships with self and others. Their experiences raise questions for practitioners in breast cancer care to consider. CONCLUSION: The participants highlight both supportive factors and the challenges they faced. They also give recommendations for other breast cancer patients, health professionals and organisations supporting women facing mastectomy to see non-reconstruction as a viable and recognised choice. Patient experiences of neo-adjuvant chemotherapy for breast cancer: A qualitative study Beaver K1, Williamson S1, Briggs J2 1 University of Central Lancashire, Preston, UK, 2 Blackpool, Fylde & Wyre Hospitals NHS Foundation Trust, Blackpool, UK BACKGROUND: Neo-adjuvant chemotherapy is recommended for ‘inoperable’ locally advanced and inflammatory breast cancers to enable surgery and assess response to therapy. For women with operable breast cancer, evidence indicates no survival differences between chemotherapy given pre or post-surgery. Communicating information to patients on this form of treatment is complex and studies examining the patient experience of neoadjuvant chemotherapy are lacking. AIMS: To © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Oral Abstracts

explore if this patient group have particular information needs and concerns and are receiving the support they need. METHODS: A qualitative approach using in-depth interviews with women (n = 20) who had completed neo-adjuvant chemotherapy for breast cancer. Interview data were analysed using thematic analysis. RESULTS: The sample was relatively young (mean 49 years); many had young children and work commitments. Five main themes emerged from the data: coping with the rapid transition from ‘well’ to ‘ill’, information needs and decision making, needing support and empathy, impact on family, and creating a new ‘normal’. Participants had specific information and support needs related to key time points in the treatment trajectory. Information provision and support from health professionals was reported as variable. Most participants reported feeling left alone to cope with debilitating side effects (that often warranted hospital admission) and complex emotional problems. CONCLUSIONS: Participants were able to identify key time points when information and support would have been most beneficial. This information is vital in developing services and interventions that will meet the complex needs of these patients and potentially prevent hospital admissions and late referral to psychological services. The psycho-social impact of chemotherapy-induced cognitive deficits Lindner O, Wearden A, McCabe M, Mayes A, Talmi D University of Manchester, Manchester, UK BACKGROUND: Previous research investigating cognitive and psycho-social well-being in cancer patients found that cognitive deficits are not related to distress or fatigue. However, psycho-oncology research often finds that cancer survivors have a low quality of life and high distress, contradicting the chemotherapy-induced cognitive changes literature. AIMS: The main aim was to investigate the links between distress, fatigue, quality of life, illness perceptions, and subjective and objective cognitive performance. METHODS: Several measures were administered to newly diagnosed patients, cancer survivors, and control participants individually matched to patients. Ages ranged between 16–50 years old. The tests were EORTC Quality of life, Hospital Anxiety and Depression Inventory, the Illness Perceptions Questionnaire, Subjective Cognitive Complaints Questionnaire, and Chalder Fatigue Scale, and Birt Memory and Information Processing Battery. RESULTS: In survivors, depression and cognitive complaints were linked to a low quality of life, heightened illness identity, a longer perceived timeline of the illness, and perceived negative illness consequences. In addition, in Psycho-Oncology 23 (Suppl. 2): 1–16 (2014) DOI: 10.1111/pon.3495

Oral Abstracts

both patients groups we found relationships between a high level of distress, fatigue, subjective cognitive complaints and a low objective cognitive performance. CONCLUSIONS: Cancer survivors experience high distress and low quality of life, linked to subjective and objective chemo-brain symptoms. It is yet unknown whether higher distress leads to the objective cognitive problems, or if the awareness of a lower objective performance is what gives rise to both low mood and poor quality of life. We discuss future directions on how to address this question. The assessment of psychological wellbeing in Teenagers and Young Adults with cancer Coad J1, Kelly J1, Kaur J1, Vaughan K2, Finch A3, Holch P4, Morgan S5, Wright D6, Smith S7, Stark D4 1 Coventry University, Coventry, UK, 2The University of Manchester, Manchester, UK, 3 University College London, London, UK, 4The University of Leeds, Leeds, UK, 5Leeds Teaching Hospital NHS Trust, Leeds, UK, 6Christie Hospital, Manchester, UK, 7Teenage Cancer Trust, London, UK BACKGROUND: Practice and literature tells us that psychological distress is common in TYA who develop cancer (Armes 2009). Prevalence of distress varies between studies, due either to methodological or actual variation (Zabora 2001; Mor 1994). In relation to psychological distress in young people with cancer reports estimate 1.67-fold greater (p < 0.01) unmet needs in survivors aged 19–59, compared to >69. AIMS: We performed a narrative literature review to identify validated assessment instruments, as part of a funded Teenage Cancer Trust project aiming to improve care outcomes when TYA with cancer develop psychological distress. METHODS: Scholarly databases were searched for relevant publications from 1998–2013. Search terms included Psychosocial needs; Cancer; TYA/ Adolescents; Clinical Practice/Services; Assessment Tools; Effects; Coping; Support; Models and Challenges, both singularly and in combination. Articles meeting inclusion criteria were systematically read and summarised by two reviewers. RESULTS: The search revealed 17 published articles. A narrative synthesis identified five overarching themes; communication exchanges; assessment tools; distress levels; barriers and training/ education needs. A concern was that TYA’s perspective on preference of tools was sparse, particularly during extreme distress points. Research was found to be dated and had variable validation before use in clinical practice. CONCLUSIONS: We will apply this review in a multicentre prospective longitudinal study comparing screening instruments for acceptability and sensitiv© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

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ity to change in the assessment of TYA with psychological distress with Canteen (Australia) collaborators testing instruments. This paper will be of interest to delegates around improving psychological assessments in oncology settings. Prostate cancer survivors who were symptomatic at diagnosis have an increased risk of poor psychological wellbeing than men who were asymptomatic. Results from an all-Ireland survey Drummond F1, Kinnear H2, O’Leary E1, Donnelly D2, Gavin A2, Sharp L1 1 National Cancer Registry Ireland, Cork, Ireland, 2 Northern Ireland Cancer Registry, Belfast, Ireland BACKGROUND: Many asymptomatic men are diagnosed with prostate cancer (PCa) following prostate specific antigen (PSA) testing, others are symptomatic. Rising incidence and survival means more men are living longer with PCa, however, information on long-term psychological wellbeing is lacking. AIMS: To explore factors associated with psychological well-being of PCa survivors, including symptoms at diagnosis. METHODS: A postal questionnaire was developed and administered in 2012 to 6647 PCa (ICD10 C61) survivors 2–15 years post-diagnosis, identified through population-based cancer registries in the Republic of Ireland (RoI) and Northern Ireland (NI). “Asymptomatic” men were without symptoms, diagnosed via PSA testing, “symptomatic” men had urinary symptoms. Psychological well-being was assessed using DASS-21. Logistic regression was used to investigate predictors of depression, anxiety and stress (any severity). RESULTS: Response was 52%. Two-thirds of men were asymptomatic. Depression, anxiety and stress were present in 16.6%, 16.5% and 10.6%, respectively. In adjusted analysis, depression risk was increased in unmarried men (1.56 95% CI 1.19,2.05), those with co-morbidities (1.62 95% CI 1.29,2.03), current incontinence (1.73 95% CI 1.34,2.24), fatigue (2.46 95% CI 1.95,3.09) and those whose sideeffects were worse than expected (2.22 95% CI 1.66,2.97). Depression risk was higher in symptomatic compared to asymptomatic men (1.30 95% CI 1.04,1.61). Similar associations were found for anxiety and stress. CONCLUSIONS: Groups of PCa survivors, including those with symptoms at diagnosis, are at increased risk of poor psychological health. This suggests that screening survivors for depression, anxiety and stress during follow-up maybe beneficial. Development of interventions to support survivors’ long term psychological wellbeing is required.

Psycho-Oncology 23 (Suppl. 2): 1–16 (2014) DOI: 10.1111/pon.3495

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The experience of living with Brain Metastases: A study looking at the impact of Brain Metastases on daily life MacDonald-Smith C1, Morrison V2 1 Cardiff University, Cardiff, UK, 2Bangor University, Bangor, UK BACKGROUND: Whilst significant advances in the diagnosis and treatment of cerebral metastases have been made, the mainstay of care remains palliative. Brain metastases patients are an understudied group and description of their experience and evidence of their needs is limited. AIMS: To gain insight into the personal experiences of those living with brain metastases and the physical, psychosocial and emotional impact on their daily lives. METHODS: A qualitative study of 9 patients – 4 men (all lung cancer) and 5 women (2 lung cancer/ 3 breast cancer) – using semi-structured interviews, transcribed verbatim and analysed using interpretative phenomenological analysis (IPA). RESULTS: Patients described the unexpectedness and uncertainty the diagnosis brought to their lives and how this led to fears of death with a need to face their own mortality. Physical symptoms experienced led to complete lifestyle changes, including confinement and feelings of regression. All patients yearned for normality and reported a loss of independence, self-image and identity issues with variable consequences. Patients displayed varied coping responses, but for all, family support was highly beneficial. Healthcare, in particular palliative care, played a major role for these patients, with supportive and complimentary care from hospices and palliative HCPs, as well as provision of supportive physical aids being considered beneficial. For some, steroid use and radiotherapy with resulting sideeffects were seen as burdensome and detrimental to QOL. CONCLUSIONS: Our findings lead to recommendations for patient care; essentially highlighting a need for good communication as well as identifying and tailoring multi-disciplinary, holistic input to individual patient needs to preserve independence.

Oral Abstracts

Clinical, sociodemographic and psychological predictors of health-related quality of life (HRQoL) and employment 15 months after cancer diagnosis Ashley L1, Marti J2, Hall P2, Jones H2, Velikova G2, Wright P2 1 Leeds Metropolitan University, Leeds, UK, 2 University of Leeds, Leeds, UK BACKGROUND: The NCSI prioritises increased assessment and understanding of cancer Patient Reported Outcomes (PROs). We recently developed and tested a novel electronic system (ePOCS) for collecting PROs online and linking them to patients’ clinical cancer registry data. A secondary aim of the ePOCS project is to analyse the PROs collected during system testing. AIMS: To explore the clinical, sociodemographic and psychological factors associated with HRQoL and employment 15 months after cancer diagnosis. METHODS: Patients with potentially curable breast, colorectal or prostate cancer joined ePOCS (n = 636) and completed the Illness Perception Questionnaire-Revised within 6 months post-diagnosis, and the EQ-5Dv2 and employment questions 15 months post-diagnosis. Sociodemographic and clinical data were obtained from patients’ registry records. Regression analyses (n range = 111–346) explored predictors of 15-month HRQoL (EQ-5D utility score and VAS) and employment. RESULTS: Preliminary findings show gender and age were unrelated to 15-month HRQoL and employment, and there were very few associations between cancer and treatment types and the outcomes. The illness perception dimensions of identity, emotional representations and illness coherence were each significantly associated with 2/3 outcomes, such that patients who attributed fewer physical symptoms to cancer, experienced less emotional distress, and who reported less understanding of their illness, and had higher HRQoL at 15 months and/or were more likely to be working (if employed pre-diagnosis). Illness perceptions accounted for more of the variance than sociodemographic and clinical factors in 2/3 outcomes. CONCLUSIONS: Illness perceptions contribute to understanding cancer PROs and unlike many other variables offer a modifiable target for interventions. Clinical impact of ESAS screening on health-related quality-of-life and patient satisfaction with care Ellis J, Haddad S, McGarragle K, Yoon D-H, Ehrlich R, Myers J, Al-Allaq Y, Hawkins M, Fitch M, Karanicolas P Sunnybrook Health Sciences Centre, Toronto, ON, Canada BACKGROUND: Edmonton Symptom Assessment Scale (ESAS) is a distress screening tool mandated by Cancer Care Ontario for use in oncology, aimed at increasing communication between

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

Psycho-Oncology 23 (Suppl. 2): 1–16 (2014) DOI: 10.1111/pon.3495

Oral Abstracts

patients and their health care team and improving symptom management. Although proven to be both reliable and valid among cancer patients, there is little evidence for its impact on patient outcomes. Previous research indicates that symptom screening alone does not improve outcomes. For this study, all oncology clinic nurses underwent training in symptom assessment and referral pathways. AIMS: To examine the impact of routine symptom screening with ESAS on patient satisfaction with care (PSC) and health-related qualityof-life (HRQoL) among a diverse population of cancer patients. METHODS: Responses to questionnaires on HRQoL and PSC were compared among two groups of study participants; 160 participants before implementation of ESAS screening, and by 108 participants after routine ESAS screening (at recruitment and 2 weeks later). RESULTS: Univariate comparisons of HRQoL and PSC between groups was conducted by applying two independent sample t-tests. No significant differences in either HRQoL functional outcomes or PSC were found between patients who completed ESAS and those who did not, at either time point. Furthermore, when two groups of 29 patients were matched for gender, age, site, and stage, this finding persisted. CONCLUSIONS: Despite staff training in assessment and management of symptoms, ESAS screening did not lead to improved outcomes. Future research should explore improving interprofessional team symptom assessment and management, increasing clinician response to distress screens, as well as targeted patient education to increase knowledge and self-management of symptoms. The experience of surviving testicular cancer - a literature review Mullan F, Porter S, Prue G Queens University, Belfast, Ireland BACKGROUND: Testicular cancer is the most curable solid tumor with a reported ten year survival of over 95%. It is prevalent within the adolescent and young adult age (AYA) range, commonly defined as 15–29 years old. Due to the high cure rate and young age at diagnosis, these men spend a significant proportion of their lives as testicular cancer survivors. AIMS: The aim of the review was to summarise the biological, psychological and social impacts of testicular cancer. The review explored the interaction of these factors on quality of life. It identified gaps in existing literature and included recommendations for future research and clinical practice. METHODS: Relevant literature was identified through an electronic database search using specified keywords. Precise inclusion and exclusion criteria were used to obtain only relevant studies which were then critically appraised © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

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for methodological quality. RESULTS: 42 papers were included in the review. The findings would suggest that testicular cancer has the potential to impact on the pyscho-social functioning of an individual at any age. However the high incidence of diagnosis between the ages 15–29 poses a greater risk. This AYA continuum represents a critical developmental period in which a number of important transitions occur including sexual self-concept and a development of a sense of self. CONCLUSIONS: Further research is required to explore the potential interactions of the experience of and treatment for testicular cancer and the developmental tasks of AYA in order to develop an evidencebased model for testicular cancer survivorship. Fear of recurrence in head and neck cancer patients Hulbert-Williams N1, Swash B1, Ozakinci G2, Fenemore J1, Humphris G2, Rogers S3 1 University of Chester, Chester, UK, 2University of St Andrews, St Andrews, UK, 3Aintree University Hospital NHS Foundation Trust, Liverpool, UK BACKGROUND: Fear of recurrence (FoR) is common in head and neck cancer survivors and is associated with distress. It is difficult to predict which patients will experience FoR and whether this will diminish over time. The Patient Concerns Inventory (PCI) is a means of identifying FoR and can facilitate a discussion of real vs. perceived risk. AIMS: To explore patients’ experiences of discussing FoR with oncologists/surgeons in the clinical setting. METHODS: Head and neck cancer survivors attending follow-up clinics completed the PCI prior to consultation. Those identifying FoR were invited to take part (n = 11) and had their consultation recorded. A telephone-based, one-to-one interview was also arranged to explore FoR and patient’s experiences of how well this was managed in their consultation. RESULTS: Thematic analysis highlighted the following as relating to participant’s FoR: participant’s background; coping style; personality; physical triggers; gender differences in how the fear presents; the nature of the fear itself; and a sense of gratefulness towards the clinician. Of particular interest was the novel finding that patients were reluctant to address FoR with their clinician for fear of appearing ungrateful or upsetting their valued relationship with their clinician. CONCLUSIONS: Whilst many findings mirror those of other cancer survivors, within head and neck cancer survivors particularly, prevalence might be higher than previously appreciated. Survivors are reluctant to raise this issue with their clinician, and clinicians often don’t prioritise this issue within rushed consultations; the PCI may present a more acceptable way for patients to raise this issue with clinicians.

Psycho-Oncology 23 (Suppl. 2): 1–16 (2014) DOI: 10.1111/pon.3495

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“Healthcare Professionals as Emotional Beings” The Emotional Impact on Healthcare Professionals When Providing Palliative Care. Stewart C1, Archer S2 1 University of Nottingham, Nottingham, UK, 2 Royal Derby Hospital, Derby, UK BACKGROUND: Serious deficiencies in end of life care are still being reported. Considerable effort has therefore been focused on reducing inequalities and improving the provision of palliative care, particularly in non-specialist settings. Further education has been proposed but this often focuses on clinical knowledge rather than wider psychosocial aspects. Furthermore, little work has explored other ‘human factors’ behind inequalities in care. AIMS: This study aims to explore the understanding, perceptions and experiences of palliative care amongst Healthcare Professionals (HCPs) in the Gynaecology setting, and to explore the ‘human factors’ affecting the provision of care. METHODS: Semi-structured interviews were completed

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

Oral Abstracts

with 11 HCPs from the Gynaecology department of a large tertiary hospital. Interpretative Phenomenological Analysis was used to facilitate the collection of detailed descriptive data from each participant. RESULTS: Breaking bad news and providing palliative care were recognised as some of the most difficult parts of the clinicians’ job. “Healthcare Professionals as Emotional Beings” was identified as a main super-ordinate theme, with subthemes of inadequacy, responsibility, trauma, adaptation and existential conflict. CONCLUSIONS: Much focus is placed on recognising and supporting the emotional needs of patients and their loved ones, but the emotional needs of the HCPs caring for these patients are often forgotten. Further support is needed for all HCPs who may be involved in breaking bad news or the provision of palliative care. Moreover, when planning further training, it is essential to acknowledge and address the emotional impact upon clinicians, and help staff develop coping strategies and appropriate support networks.

Psycho-Oncology 23 (Suppl. 2): 1–16 (2014) DOI: 10.1111/pon.3495

Poster Abstracts

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POSTER PRESENTATIONS

An examination of the quality of life of adult haematological cancer survivors Immanuel A1, Hunt J1, McCarthy H2, van Teijlingen E1 1 Bournemouth University, Bournemouth, UK, 2 Royal Bournemouth Hospital, Bournemouth, UK BACKGROUND: Haematological cancer survivors have a relatively favourable prognosis and their population is increasing. Their treatments, however, can lead to potentially debilitating symptoms and health related quality of life problems AIMS: To enhance an understanding of the quality of life among adults who have survived haematological cancers. • To identify factors influencing the quality of life among survivors of haematological cancer • To assess the impact of demographic variables on the quality of life among haematological cancer survivors • Compare the quality of life in different patient groups at different time points following completion of treatment for haematological cancers METHODS: Using a mixed methods design, the first phase uses quality of life questionnaires validated for use in cancer by the European Organization on Research and Treatment of Cancer and two disease specific questionnaires. This will inform the design of a second qualitative phase comprising interviews aiming to explain the results of the first phase. The target population in this study is planned to be adults who have been diagnosed with a lymphoid malignancy and have completed treatment 1–5 years prior to the commencement of this study. CONCLUSIONS: The study will prove significant in contributing to the underdeveloped area of research related to adult haematological cancer survivors. Knowledge and understanding of the factors that affect the quality of life of such adults may provide an insight into implementation of measures to enhance the same I am currently collecting data for the first phase of the study

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

A meta-analysis of prevalence rates and moderating factors for cancer-related post-traumatic stress disorder Abbey G1, Thompson S1, Heathcote D1, Hickish T1,2 1 Bournemouth University, Dorset, UK, 2Royal Bournemouth & Christchurch Hospitals BACKGROUND: Systematic reviews highlight a broad range of PTSD prevalence estimates in cancer survivors. AIMS: This meta-analysis was conducted to provide a general prevalence estimate of significant PTSD symptoms and full diagnoses to facilitate the psychological aftercare of cancer survivors. METHODS: A systematic literature search of studies using samples of cancer survivors using validated clinical interviews and questionnaires to assess the prevalence of cancer-related PTSD (k = 25, n = 4189). Prevalence point estimates were calculated for each assessment method using random-effects meta-analysis. Mixed-effects metaregression and categorical analyses were used to investigate study-level moderator effects. RESULTS: Studies using the Posttraumatic Stress Disorder Checklist – Civilian Version (PCL-C) yielded lower event rates using cut-off (7.3%, 95% CI=4.5–11.7, k = 10) than symptom cluster (11.2%, 95% CI=8.7–14.4, k = 9). Studies using the Structured Clinical Interview (SCID) yielded low rates for lifetime (15.3%, 95% CI=9.1–25, k = 5) and current PTSD (4.8%, 95% CI=2.7–8.3, k = 10). There was substantial between-study heterogeneity (I2 = 54-86%). Studies with higher-staged samples yielded significantly higher rates with PCL-C cluster scoring (p = 0.05), and when assessing current cancer-related PTSD on the SCID (p = 0.05). The effect of mean age on prevalence was significance on the SCID (p = 0.05). SCID lifetime prevalence rates decreased with time post-treatment (R2 = 0.56, p < 0.05). CONCLUSIONS: The cancer experience may be sufficiently traumatic as to induce PTSD in a minority of cancer survivors. Post hoc analyses suggest that cancer survivors who are younger, have more advanced disease, and have recently completed treatment, may be at greater risk of PTSD. More research is needed to investigate vulnerability factors for PTSD in cancer survivors.

Psycho-Oncology 23 (Suppl. 2): 1–16 (2014) DOI: 10.1111/pon.3495

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Patients’ experiences of Breast Cancer Care’s HeadStrong Service: A camouflage-based support service for patients with treatment-related hair loss Pilkington M1, Harcourt D1, Rumsey N1, O’Connor D2, Brennan J3 1 University of the West of England, Bristol, UK, 2 University of Leeds, Leeds, UK, 3Bristol Haematology and Oncology Centre, Bristol, UK BACKGROUND: The psychosocial impact of cancer treatment is wide-ranging, including changes to appearance, such as hair loss. The visible nature of hair loss (alopecia) can affect individuals’ body image, self-esteem and quality of life. To date, there has been relatively little evaluation of the support services currently available to people affected by hair loss and so the extent to which they meet the needs of patients affected by hair loss is unknown. One of the most widely available services is HeadStrong – a volunteer-led service offering information and support in the use of headwear to camouflage hair loss. AIMS: To explore service users’ experiences of hair loss, their support needs and experiences of the HeadStrong service. METHODS: A semi-structured interview schedule was used to explore women’s experiences of hair loss and use, or otherwise, of the HeadStrong service. Participants were recruited through the national charity, Breast Cancer Care which offers the HeadStrong service across the UK. 30 telephone interviews were conducted, transcribed verbatim and subjected to a thematic analysis. RESULTS: Five themes were identified; feelings towards hair loss, coping with hair loss, positive and negative aspects of HeadStrong, need for further support. CONCLUSIONS: These findings are informing the development and evaluation of further support for breast cancer patients affected by treatmentrelated hair loss, including an expressive writing intervention. Needs assessment in cancer: From development to the beginnings of implementation Morrison V1, Holmes M1, Gollins S2 1 Bangor University, Bangor, UK, 2Betsi Cadwaladr University Health Board, Denbighshire, UK BACKGROUND: Health and social care should, wherever possible, address the needs of individual cancer patients and their families given evidence that unmet needs of individual cancer patients and their families impact upon quality of life and associated outcomes. AIMS: Based on our earlier research this study seeks to develop and implement a needs assessment within routine clinical practice METHODS: In this Tenovus funded study, analysis of our existing 80-item needs assessment tool identified 20 items with a high position in at least two of three domains; frequency, saliency, ‘met© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Poster Abstracts

ness’. These items formed a draft short-form assessment which was critically reviewed in 5 focus groups with cancer patients, cancer care professionals, and family carers in terms of item inclusion, wording, scoring, relevance, comprehensibility, timing and potential utility. A resulting CancerCAN-22 (12 Psychosocial items, 10 Treatment & Care related items), was implemented by nurses in a feasibility trial with 40 cancer patients. In addition to identifying needs presence, salience and degree of metness we evaluated nurse and patient perceptions of its’ utility and any influence on care decisions or on-referrals (compared to 40 matched controls). RESULTS: Responses to the CancerCAN-22 administration were positive. Many needs were identified, some of which patients reported they otherwise would have left unspoken. Quantitative and qualitative results will be presented. CONCLUSIONS: Given perceived acceptability and utility in enabling patients to report, and health professionals to respond to, individually identified salient and unmet needs we currently seek larger scale implementation as part of a randomised controlled trial. Patient perspectives about reducing frequency of H&N oncology review appointments Rogers S1, Lowe D2 1 Edge Hill University, Merseyside, UK, 2Head and Neck Unit, Aintree University Hospital, UK BACKGROUND: The emotional impact of cancer has a bearing on the aspirations of patients attending oncology review clinics. The Patient Concerns Inventory might be a tool that can help modulate this. AIMS: The aim is to correlate emotional concerns of H&N cancer patients from the PCI to their views on using their PCI to reduce number and frequency of clinic appointments. METHODS: Purposeful sampling of early and late stage larynx, oral and oropharyngeal cancer patients attending routine clinics 6–24 months after completing treatment between 22nd January and 1st May 2013. Semi-structured interview after at least one PCI used in clinic. RESULTS: 66 patients, mean (SD) age 63 (9) years, two-thirds (68%) male. 62% (39 of 63 with PCI data) wanted to discuss psychological emotional and spiritual well-being issues during their consultation. Common issues were fear of the cancer coming back 49% (31), anxiety 13% (8), depression 11% (7), mood 10% (6), coping 6% (4). “If the frequency of clinics was reduced by using something like the Patient Concerns Inventory for you would that be a helpful or unhelpful for you?”: Definitely helpful: 15%, Maybe Helpful: 14%, Not sure: 21%, Maybe Unhelpful: 20%, Definitely Unhelpful: 30%. CONCLUSIONS: Cancer patients display high levels of emotion when attending clinic review. Psycho-Oncology 23 (Suppl. 2): 1–16 (2014) DOI: 10.1111/pon.3495

Poster Abstracts

They greatly value physical examination to exclude the possibly of recurrence. In a strategy of stratified clinics with reduced frequency based on high, medium and low risks of recurrence, patient education, information, open access to review and enhanced emotional support is essential. Do online support groups benefit people affected by a cancer diagnosis? Harkin L, Beaver K, Dey P, Choong K University of Central Lancashire, Preston, UK BACKGROUND: Despite efforts to increase participation in offline cancer support groups, their popularity for survivors and families remains limited. Alternatively, 21 million UK households have internet access, a figure rising by one million per year. Increasingly, websites are providing platforms for online cancer support group (OCSG) communication. Enabling communication across geographical barriers may benefit populations isolated by a cancer diagnosis. This presents a culturally relevant way to meet support needs. However we do not know how beneficial OCSGs are in terms of support. AIMS: To examine the recent literature and explore gaps in current understanding of the experience and outcomes of OCSGs METHODS: A systematic approach to searching literature published from 2008–2013 was undertaken using the following databases: Web of knowledge, PsychINFO, PsychARTICLES, MEDLINE, and CINAHL. English language only papers were included. Papers were divided into those exploring experience and outcomes of OCSG use. Quality was assessed with the CASP critical appraisal tool. RESULTS: Individuals in OCSGs participate in a virtual community. The users respond to one another’s emotional and informational needs and use OCSGs as an outlet for emotional expression. However messages expose vulnerabilities of those posting and not all posts receive responses. Additionally large numbers of users merely observe without posting. CONCLUSIONS: OCSGs have a number of potential benefits. Unlike offline support groups there is an increased likelihood of non-response to concerns. This could enhance feelings of isolation. Furthermore the impact of non-posting members on the community is unknown. Further research into the community of OCSGs is warranted.

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The Information and decision support needs of older women (>75 yrs) facing treatment choices for breast cancer: A qualitative study Collins K1, Burton M1, Caldon L2, Lifford K3, Brain K3, Wyld L2, Reed M2 1 Sheffield Hallam University, Sheffield, UK, 2 Academic Unit of Surgical Oncology, Sheffield, UK, 3Cardiff University, Cardiff, UK BACKGROUND: Primary Endocrine Therapy (PET) is an alternative to surgery for breast cancer in older frailer women with equivalent survival rates. At present there is little research regarding the decision support needs of older breast cancer patients. AIMS: To explore the decision support needs of older breast cancer patients offered a choice of surgery or PET, as the basis to develop appropriate decision support and optimise practice. METHODS: Semi-structured interviews were undertaken with older women (>75 years) with breast cancer (from 5 UK hospital clinics) offered a choice of PET or surgery at diagnosis. Women’s involvement in their treatment decision and support desired for the process were explored. Interviews were recorded, transcribed verbatim and analysed using Framework. RESULTS: 36 interviews were conducted (75–98 years). All women were satisfied with their treatment choice. A large proportion made the decision before options were discussed in consultations. Most were based on prior experiences and pre-existing knowledge; some of which were inaccurate. Women wanted tailored information from their clinician focusing on treatment effectiveness, risk of recurrence and spread, impact on relatives, and side-effects. Surgery was the treatment of choice in women wanting optimal disease control; those choosing PET felt they were ‘too old’ for surgery and wanted minimal disruption. CONCLUSIONS: Contrary to prior studies, older women described making active treatment decisions. However, some knowledge was inaccurate. Women primarily wanted information and decision support from their clinicians. But about half wanted a specific tailored information booklet, as an adjunct to support the process. A qualitative exploration of men’s strategies for preserving emotional well-being in advanced prostate cancer Levy A2, Cartwright T1 1 University of Westminster, London, UK, 2Prostate Cancer UK, London, UK BACKGROUND: Prostate cancer is the most common cancer in men in the United Kingdom. Advanced prostate cancer is incurable, but can be controlled through palliative treatments. Research has documented the physical and psychological burden of advanced prostate cancer, however much

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

Psycho-Oncology 23 (Suppl. 2): 1–16 (2014) DOI: 10.1111/pon.3495

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less attention has been given to the ways in which these men use strategies to manage the emotional impact of the disease and promote positive wellbeing. AIMS: To explore the strategies used by men with advanced prostate cancer, to promote and maintain emotional well-being. METHODS: Semistructured, in-depth interviews with five men with advanced prostate cancer from around the UK. Transcripts were analysed using Interpretative Phenomenological Analysis (Smith, et al., 2009). RESULTS: Within narratives of lost and regained well-being, two super-ordinate themes emerged‘living with an imminent and uncertain death’ and ‘strategies to manage living with death and uncertainty.’ Well-being was threatened by reduced sense of the future, isolation and uncertainty. Yet, the men pursued well-being by managing their emotions, striving for the future whilst enjoying life in the present, taking care of their families and renegotiating purpose. Running through participant’s accounts was a preference for taking action and problem-solving. CONCLUSIONS: Practitioners could encourage men with advanced prostate cancer to explore their own existing resilience and coping strategies. In particular sense of purpose, social connectedness and life-engagement were revealed to be concepts central to improving wellbeing. The findings also add weight to the evidence for use of practical behaviour change approaches, such as CBT, in men with prostate cancer. Patient testimonies: A useful intervention for prospective Bone Marrow Transplant recipients? Johnson T, Hill M St James’s Institute for Oncology, Leeds, UK BACKGROUND: Bone Marrow Transplants (BMT) are offered to a small number of patients with haematological malignancies as the last chance of a cure where other treatments have failed. This is a life threatening procedure which can lead to psychological distress (Mosher et al, 2009). Taylor et al (1993) have found that individuals use the real-life experiences of others to help prepare for a challenging experience but in this group opportunities for this are limited due to the isolation required by the treatment. AIMS: This study aimed to obtain patients’ views on a resource of stories about the experience of going through BMT; how helpful this might be and what form the stories should take. METHODS: Opportunity sampling was employed in a University hospital setting. 25 participants took part in total. 12 participants completed pre-transplant and post-transplant questionnaires and 13 participants took part in a focus group. RESULTS: The majority of participants supported the introduction of such a resource, for example one said: “I had info on what would happen through the process but was not prepared for any of the emo© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

Poster Abstracts

tional aspects”. There was a mixed response about the inclusion of positive, negative, or both types of information, but most participants thought the best time for the intervention would be during the period of isolation on the unit prior to transplant. CONCLUSIONS: The results indicated patients would value a resource of patient stories and they have provided guidance on its design. A pilot study to measure the effectiveness of the resource is underway. Younger adults’ experiences of adjustment to Testicular Cancer during early survivorship: A grounded theory study Matheson L, Watson E, Lavender V, Boulton M Oxford Brookes University, Oxford, UK BACKGROUND: Testicular Cancer (TC) commonly affects men in the prime of their lives. Although survival rates are high, very little previous research has examined men’s experiences of adjustment and recovery during early survivorship. AIMS: To explore younger TC survivors’ evolving experiences during early recovery and the psychosocial impact on their lives. METHODS: Patients were recruited from four NHS hospitals by their oncology nurse or clinician. Semi-structured interviews were conducted within 6 months of treatment completion with TC patients (n = 17) between 20–45 years old. Interviews lasted approximately 90 minutes. Follow-up interviews are currently being conducted (n = 9). Data are being analysed using Grounded Theory. RESULTS: Adjustment involved men ‘weighing up the significance of TC’, which often declined from a major to relatively minor biographical event, especially if fatherhood was already achieved. Men commonly rejected societal notions of cancer survivorship. TC was often perceived as more significant for partners. Men engaged in a process of resolving the discrepancy between their initial assumptions vs. actual experience of TC; this could lead to ambivalent acceptance. ‘Striving for normality’ involved several key processes: ‘accepting and normalising a new body normality’, ‘enhancing masculinity and selfidentity’, ‘regaining normality through work’ and ‘managing uncertainty’. Men sought to find their own strategies to self-manage and valued peer support. A recurrence was a major ‘body blow’ as men struggled to regain a sense of coherence. CONCLUSIONS: This study has implications for the development of psychosocial interventions aimed at promoting positive adjustment in TC survivors, particularly one-on-one peer support.

Psycho-Oncology 23 (Suppl. 2): 1–16 (2014) DOI: 10.1111/pon.3495

Poster Abstracts

Developing a theoretical framework of the experience of future disorientation in adults living with and beyond cancer. McGeechan Grant J1, Roberts K1, McPherson K2 1 Northumbria University, Newcastle-Upon-Tyne, UK, 2Glasgow Caledonian University, Glasgow, UK BACKGROUND: Future disorientation has been defined as a response to the chaos that emerges out of a cancer diagnosis and a realisation that people who have had a cancer diagnosis are living with an uncertain future life expectancy. Failure to adapt to a life after cancer diagnosis can be distressing if patients are unable to come to terms with the possibility that the future lives they had envisioned may no longer be achievable. Previous studies of future disorientation have focussed only on women and none have been longitudinal. Therefore there is a need to develop a theoretical framework of future disorientation in order to fully understand what impact it may have on men and women living with and beyond cancer. AIMS: The aim of this research was to develop a theoretical framework of the experience of future disorientation amongst adults living with and beyond cancer. METHODS: A review of the literature informed the development of a preliminary theoretical framework. Qualitative interviews were conducted with four men and four women on two occasions, six months apart, to assess the real life experience, and long term impact of future disorientation. RESULTS: The interviews were analysed using interpretative phenomenological analysis. Four superordinate themes emerged from the data which informed the updated theoretical framework. CONCLUSIONS: Cancer related fears and consequences of cancer treatment explored what may cause future disorientation to develop. Coping with life after treatment explored potential buffers to its impact and Future Disorientation explored potential consequences of future disorientation. The effectiveness of psychosocial interventions to improve body image in adult women with, and without, breast cancer: A systematic review Lewis-Smith H, Harcourt D, Diedrichs P, Rumsey N University of the West of England, Bristol, UK BACKGROUND: The appearance changes brought about by treatment for breast cancer (e.g. alopecia) can impose an adverse impact on body image, causing substantial distress for many women (Harcourt & Frith, 2008). AIMS: This systematic review was conducted to identify and evaluate psychosocial interventions which target the body image of two separate groups of women: those with breast cancer, and those without. METHODS: Inclusion criteria consisted of female adults (>35 years) with © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

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non-metastatic breast cancer or without cancer. Any psychosocial intervention including a control group, and a pre- and post- comparison of body image were considered. Electronic searches were conducted through 14 databases and 5 sources of grey literature. 8921 studies were initially identified. Following the several stages of review, 18 articles targeting women with breast cancer consequently remained for in-depth evaluation and quality assessment. RESULTS: Seven of the eighteen programmes targeting women with breast cancer demonstrated a significant improvement on at least one measure of body image, however methodological quality varied. Half of these effective interventions constituted physical activities, whilst the remaining studies focused on general or theory-based psychological support. Body image was the exclusive focus and target of only two studies. CONCLUSIONS: Given the vast research literature which has identified appearance dissatisfaction amongst women with breast cancer, the severe lack of body imagefocused interventions for these women is surprising. The development of methodologically rigorous programmes that target appearance concerns has the potential to benefit women with breast cancer who are unhappy with their appearance. Does talking about patients’ fears of cancer recurrence in clinic make any difference? Rogers S1, Lowe D1, Humphris G2 1 Edge Hill University, Ormskirk, UK, 2University of St Andrews, St Andrews, UK BACKGROUND: The Patient Concerns Inventory (PCI) has consistently identified Fear of Recurrence (FoR) as the most frequent issue that head and neck cancer patients wish to discuss in follow-up clinics. AIMS: To explore temporal changes in FoR using the PCI. METHODS: 83 patients with multiple PCI (total 758 PCI assessments), July 2007 to October 2011 seen by one consultant (SNR). These data were collected as an audit, meeting the local Clinical Governance Department criteria for service evaluation. Patients were disease-free and under routine follow-up at least 6 weeks after completing treatment. Nonparticipation was minimal. RESULTS: The percentage selecting FoR for discussion decreased with successive PCI assessment. For 183 with two or more PCI completions: 39% (first, median 11 months) and then 31% (second, median 19 months) selected FoR. For 131 with three or more PCI: 44% (first, median 9 months) 35% (second, median 15 months) and then 27% (third 23 months) selected FoR. However these grouplevel results in FoR selection mask considerable within-patient variation between successive assessments. FoR selection in relation to other emotions items (e.g. anxiety and mood) changed little over Psycho-Oncology 23 (Suppl. 2): 1–16 (2014) DOI: 10.1111/pon.3495

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Poster Abstracts

time, with about half of those selecting FoR wishing only to discuss FoR and no other emotions item. Apart from age (FoR more likely if < 65 years) there were no obvious clinical predictors of FoR selection. CONCLUSIONS: Repeated brief discussions about cancer recurrence triggered by patients wishing to talk about it, based on information, context and empathy may benefit patients, though the processes involved require further investigation.

Distress following colposcopy examination for cervical abnormalities: A qualitative study O’Connor M1, Waller J2, Gallagher P3, Martin C4, O’Leary J4, Sharp L1 1 National Cancer Registry Ireland, Cork, Ireland, 2 Health Behaviour Research Centre, University College London, London, UK, 3School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland, 4Coombe Womens and Infants University Hospital, Dublin, Ireland

Using patient-directed and outcome-informed outcome measures with psycho-oncology patients in a clinical health psychology setting Pereira B1, Brookes S2, Court D2, Phull M3, Tolosa I1 1 Birmingham and Solihull Mental Health NHS Foundation Trust, West Midlands, UK, 2University of Hospitals Birmingham NHS Foundation Trust, West Midlands, UK, 3Aston University, West Midlands, UK

BACKGROUND: Women who have an abnormal cervical smear test may be referred for a colposcopy examination. Distress prior to and during colposcopy has been widely researched. Less is known about psychological wellbeing post-colposcopy and what influences this. This exploratory study aimed to identify the factors associated with psychological distress post-colposcopy. AIMS: Face-to-face semi-structured interviews were conducted with 23 women who had undergone colposcopies at two clinics. Interview transcripts were analysed thematically using the Framework Approach. RESULTS: Four groups emerged from analysis: (1) women with short-term distress; (2) women with long-term distress; (3) women with both short- and long-term distress; and (4) women without distress. Group 1 felt unprepared for how their colposcopy would feel/what it entailed. They experienced distress while undergoing the investigation, and had often attended the colposcopy alone. Group 2 had fertility worries, physical after-effects that impacted on their lives, and were still attending the clinic for follow-up. Group 3 had factors that overlapped with those of groups 1 and 2. Group 4 felt reasonably prepared for the procedure, did not find it as bad as they had anticipated, and were accompanied to the clinic. CONCLUSIONS: Colposcopy can lead to short-term and long-term post-procedural distress. These results suggest a lack of sensory and procedural preparation, lack of support while attending the clinic, fertility worries and still being monitored by the clinic may affect post-colposcopy psychological distress. Targeted psycho-educational interventions to help alleviate distress after colposcopy and related procedures are required.

BACKGROUND: Therapeutic alliance and similarity in the patient-therapist model of change are associated with better outcomes (Duncan et al., 2003). The Outcome Rating Scale (ORS) measures the patient’s perception of functional improvement, and the Session Rating Scale (SRS) measures the therapeutic alliance (Miller, Duncan, Sorrell & Brown, 2005). AIMS: To measure the outcomes of psychological interventions in cancer patients using the ORS/SRS to explore if a patient’s feedback on the quality of the therapeutic relationship is correlated with better outcomes in cancer patients. METHODS: ORS/SRS data for all outpatient psychology patients presenting across different health presentations were analysed (Pereira, Phull, Ohlhausen, Court & Tolosa, 2013). In Phase 2, the ORS/SRS data for outpatient psycho-oncology patients will be collected and collated with Phase 1 data. ORS data will assess individual, interpersonal, social and overall functioning. The SRS data will assess the quality of the therapeutic relationship and consensus on goals, method and approach. RESULTS: The Phase 1 Audit (Pereira et al., 2013) found that psycho-oncology patient ORS and SRS scores improved from intial to final session. Data from Phase 2 is anticipated to show similar trends and will focus on looking at the specific ORS/SRS variables, showing better therapeutic alliance and agreement on goals, methods and approach may be correlated with improvements in patient report of individual, relational, social and overall functioning of cancer patients. CONCLUSIONS: Results will highlight the need for continuous measurement of therapeutic alliance and outcomes. Better alliance may allow for more targeted therapies and engagement.

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

Using text mining to facilitate qualitative analysis of patient comments within the colorectal cancer survivorship survey Wagland R, Recio-Saucedo A, Simon M, Foster C, Hunt K, Corner J University of Southampton, Southampton, UK BACKGROUND: Currently 40,000 individuals in the UK are diagnosed each year with colorectal cancer, with around 240,000 survivors. Measurement of patient reported outcomes (PROMs) has become a priority for healthcare providers and can Psycho-Oncology 23 (Suppl. 2): 1–16 (2014) DOI: 10.1111/pon.3495

Poster Abstracts

facilitate service improvement. Surveys often ask patients to provide text-box comments regarding their experience. While these comments may provide important and valuable information, analysing these data may be time-consuming. Text-mining techniques may facilitate analysis of particular areas of interest. AIMS: Analyse free-text comments using text-mining techniques, to gain insights into quality of experience from a survey of colorectal cancer survivors one to three years from diagnosis. METHODS: Of 21,802 survey respondents, a quarter (n = 5634, 25.8%) added free-text comments. Following development of a thematic framework, machine learning algorithms (MLA) were trained to identify comments describing both positive and negative experiences of care within the remaining unclassified comments. A detailed manual coding and analysis was then conducted on retrieved comments (n = 2076). RESULTS: A tentative model was developed to illustrate findings. Patients described challenges to quality of life (QoL), including: treatment side-effects; emotional problems; social/ financial issues and comorbidities. Respondents perceived service quality according to whether QoL challenges were effectively addressed. Elements of care leading to positive experiences included: preparation for physical and psychological side-effects of treatment and diagnosis; teaching of coping strategies; coordinated care delivery; access to on-going emotional support; and adequate aftercare. CONCLUSIONS: Analysis of text-comments complements quantitative analysis of PROMs, and text mining is an effective tool for facilitating analysis of large volumes of patient comments. Development and preliminary evaluation of guidelines for emotional distress management in oncology practice Holch P, Absolom K, Velikova G University of Leeds, Leeds, UK BACKGROUND: Emotional distress (ED) is a significant unmet need experienced by up to a third of cancer patients. Oncologists are reluctant to explore these issues perhaps due to lack of (i) awareness of referral pathways and (ii) expertise in psychotropic prescribing. AIMS: To develop and evaluate brief, accessible, evidence based guidelines for oncologists outlining local service contacts and prescribing information to support the assessment and management of ED. METHODS: Guidelines were developed following a literature review and mapping of local services. Using Browman’s 1998 framework, an iterative consultation process was employed with n = 33 (doctors, nurses, support workers psycho-oncologists, patient advocates). The guidelines were included in a study evaluating a training programme to interpret and manage © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

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QOL data. Following this, Oncologists (n = 3) views of their utility in clinical practice with breast, gynaecological and colorectal patients were ascertained via thematic analysis of semi-structured interviews. RESULTS: Brief, accessible evidence based guidelines in an A4 format have been achieved via consensus with major stakeholders. All oncologists endorsed their inclusion in routine clinical practice describing the information and contact numbers as ‘really useful’, and also that they ‘generated a couple of psychology referrals’ and increased awareness of previously unknown services. Prescribing information led one doctor to use pharmacological intervention, while another remained uncomfortable, describing lack of experience. Suggestions for layout improvement were also generated. CONCLUSIONS: Future work will evaluate guideline efficacy in routine clinical care via an audit of service referral, coding of audiorecorded consultation, assessment of patient centeredness and completion of outcome measures. Establishing a cohort of lung cancer patients to investigate recovery following surgery with curative intent – a feasibility study Foster C1, Calman L1, Foster R1, Richardson A2, Smith P1, Baird J3, Beaver K4, Edwards J5 1 University of Southampton, Southampton, UK, 2 University Hospital Southampton NHS Foundation Trust, Southampton, UK, 3MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Southampton, UK, 4University of Central Lancashire, Preston, UK, 5Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK BACKGROUND: Little is known about recovery following surgical treatment with curative intent among lung cancer patients. Consequently, there is insufficient evidence to guide the development of services to support patients after treatment. AIMS: We are conducting an innovative study to test the feasibility of establishing a cohort of patients to investigate the impact of surgery on lung cancer patients. METHODS: In this prospective, longitudinal cohort study, patients due to undergo surgery with curative intent are being recruited, at nine geographical sites across the UK (recruitment period: August 2013 to early 2014). Participants complete questionnaires before surgery and three months later. Questionnaires include validated Patient Reported Outcome Measures (PROMs) assessing quality of life, recovery and wellbeing. Study procedures will be evaluated via interviews with patients and local site staff. RESULTS: We will assess the feasibility of recruiting eligible patients to a cohort study and of retaining these patients for the duration of the study. Qualitative data collection will help determine the acceptability of study procedures including questionnaires and Psycho-Oncology 23 (Suppl. 2): 1–16 (2014) DOI: 10.1111/pon.3495

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methods for gathering patients’ medical details. CONCLUSIONS: We believe this is the first study to test the feasibility of recruiting a cohort of surgically treated lung cancer patients, to assess wellbeing and understand recovery. Informed by this feasibility work, we plan to undertake a larger, study involving a similar cohort of patients, followed up over a number of years. This novel approach to understanding lung cancer survival will enhance our ability to offer patients appropriate and timely support during recovery. Do changes in ESAS scores reflect corresponding changes in Health Related Quality of Life? Ellis J, McGarragle K, Haddad S, Yoon D-H, Ehrlich R, Myers J, Al-Allaq Y, Hawkins M, Fitch M, Karanicolas P Sunnybrook Health Sciences Centre, Toronto, ON, Canada BACKGROUND: Edmonton Symptom Assessment Scale (ESAS) is used by cancer centers across Ontario to screen for physical and emotional symptoms. While ESAS has been found to correlate with Health Related Quality of Life (HRQoL), it is unknown whether changes in ESAS reflect corresponding changes in HRQoL. AIMS: This study explored the relationship between change in ESAS and change in HRQoL. METHODS: 108 participants completed ESAS screening and a questionnaire on HRQoL at recruitment and again 2 weeks later. Pearson correlations were calculated to assess the relationships between ESAS and HRQoL and between changes in ESAS (physical, emotional, and total scores) and changes in HRQoL (Physical and Emotional functioning, and Global Health Status). RESULTS: A significant correlation was found between higher ESAS total and worse overall global health status (r = 0.61; p < 0.0001). Also, higher ESAS physical symptom scores and ESAS emotional distress scores were significantly correlated with worse physical functioning (r = 0.56; p < 0.0001) and emotional functioning (r = 0.77; p < 0.0001), respectively. Significant correlations were further found between changes in ESAS total score and global health status (r = 0.39; p < 0.0004), ESAS physical symptoms and physical functioning (r = 0.39; p < 0.0003), and ESAS emotional distress and emotional functioning (r = 0.55; p < 0.0001). CONCLUSIONS: Our results indicate that changes in ESAS total score, physical symptom and emotional distress subtotals are significantly correlated with changes in similar domains of HRQoL. Future research should examine the clinical significance of this relationship in tracking symptom management; determine when change in ESAS is meaningful, and whether ESAS may be used to predict health outcomes.

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

Poster Abstracts

Interventions to improve the well-being of breast cancer survivors at the end of active treatment: A systematic review of the literature Flynn S1, Hulbert-Williams N1, Heaton-Brown L1, Scanlon K2 1 University of Chester, Chester, UK, 2Breast Cancer Care, London, UK BACKGROUND: Breast cancer is the most commonly diagnosed cancer in the UK and significant numbers of patients are now living far beyond the end of active treatment. Physiological and psychological effects of diagnosis and treatment can continue reducing longer-term wellbeing. AIMS: To systematically review literature on interventions delivered at the time of transition from active treatment to follow-up. METHODS: Literature searching included electronic databases of published literature and ongoing research, and handsearching of conference proceedings. Inclusion screening and data extraction were conducted by two reviewers independently. Twenty studies were included but due to methodological heterogeneity, statistical meta-analysis was not possible. RESULTS: Methodological quality was varied, though no study was excluded on quality grounds. Included studies grouped into four design categories: psychotherapeutic interventions (4 studies), psychoeducational interventions (4 studies), healthrelated behaviour change interventions (4 studies), and, combination interventions (8 studies). A range of theoretical frameworks was employed and though some beneficial impacts on psychological wellbeing were reported, this evidence is small and somewhat inconsistent. CONCLUSIONS: Generally, psychotherapeutic interventions were more effective for depression; psychoeducational interventions for anxiety; and combination interventions for health behaviour change. All interventions improved quality of life and/or perceived health status, though few studies reported statistically or clinically large effect sizes. Interventions are unlikely able to improve all aspects of well-being; it is important therefore to match to individual patient need and desired outcome. This work forms part of Breast Cancer Care’s research programme ‘Improving breast cancer survivors well-being posttreatment: A focus on inequalities’ (BIG Lottery UK Funded). Breast cancer in the over 70s: Women’s perceptions and campaign trainers views Tarling R, Dey P University of Central Lancashire, Preston, UK BACKGROUND: The UK government is investing in national and regional campaigns to raise awareness of cancer symptoms and promote earlier consultation at primary care. Regional pilots were Psycho-Oncology 23 (Suppl. 2): 1–16 (2014) DOI: 10.1111/pon.3495

Poster Abstracts

delivered to promote awareness and earlier consultation with breast cancer symptoms targeted at women over 70. In addition to national mass media interventions the campaign aimed to raise awareness through established community groups relevant to the target age group. AIMS: This study involved Age UK affiliated groups across Lancashire and aimed to elicit experiences, understanding and awareness of the campaign in service users and to explore the experiences of trained volunteers in delivering the key messages METHODS: Five focus groups took place with service users (one of which was undertaken with a group of women from a South Asian Community) and three with volunteer trainers across Lancashire. RESULTS: Findings will be discussed in terms of: Training of campaign promoters and best practice; women’s perceptions of breast cancer screening and their understanding of the importance of attending early with symptoms of breast cancer. For example, women did not know enough about breast cancer signs and symptoms and many were not confident performing breast self-examination. Most did not know that they could request a mammogram even if they no longer attend for breast cancer screening. CONCLUSIONS: The findings have implications for the effectiveness of such campaigns in terms of their influence upon the perceptions and behaviour of service users over 70 and implications for future training of campaign promoters. Acceptability of a brief Acceptance and Commitment Therapy (ACT) intervention for cancer survivors Hulbert-Williams N1, Swash B1, Storey L2 1 University of Chester, Chester, UK, 2Queen’s University Belfast, Belfast, UK BACKGROUND: Acceptance and Commitment Therapy (ACT) is emerging as a promising intervention for reducing distress in people living with cancer. Group interventions are a particularly costeffective and are often reported to be an acceptable method of delivering this type of support to patients within the medical setting. AIMS: To evaluate the acceptability and benefits of an ACTbased group intervention for cancer survivors. METHODS: Seven participants were recruited from a five-week cancer survivorship support group. They had all attended the ACT-based session (week 4). A focus group evaluation of the session using ACT was conducted. Audio recordings of the focus group were transcribed and analysed using thematic analysis. RESULTS: Three broad themes were identified: practical aspects of running a support group; social support; and the added contribution of ACT. Participants enjoyed the session and felt that ACT was appropriately suited to their psychological needs at this point of survivorship. CONCLUSIONS: Participants were © 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.

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supportive of the use of ACT as a psychologically supportive intervention for cancer survivors and this intervention now needs developing and testing using trial methodology. The three themes identified can be brought together to suggest a new model for the process of psychological change within the support group environment. This new model has potential practical implications for how support groups should be designed and run but also makes a theoretical contribution to the current understanding of the psychological benefits of attending such a group. Experiences of bowel cancer patients at time of recurrence: A qualitative longitudinal study Wanat M, Watson E, Boulton M, Wee B Oxford Brookes University, Oxford, UK BACKGROUND: Cancer recurrence is a difficult stage of the cancer journey as it challenges patients’ hopes that cancer can be cured and emphasises the life threatening nature of illness. It is often associated with physical and psychological difficulties. AIMS: This study aims to explore the psychosocial impact of recurrence of colorectal cancer on the daily lives of patients. METHODS: Ten patients between 40 and 61 years old with a diagnosis of bowel cancer recurrence have been recruited from 3 NHS hospitals as well as Social Media. Semi-structured interviews have been conducted within 3–5 months of being diagnosed and 3–5 months later. Data has been analysed longitudinally within each case first followed by group analysis using Interpretative Phenomenological Approach. RESULTS: Four themes captured patient’s experiences of recurrence. Patients were living in quickly changing reality where they were enduring emotional turmoil of constantly changing prognosis, navigating complex clinical information and doubting the accuracy of their prognosis. They were also trying to finding their way in the health care system which lessening as well as adding to the burden of cancer. Cancer also had major impact on their sense of self which was negotiated in the context of social relationships. CONCLUSIONS: This study highlights the complex psychological processes patients with recurrent disease engage with on individual as well as social level. Communicating with patients need to strike a balance between providing realistic information while maintaining hope. This study will help to inform the further development of health care services to support patients.

Psycho-Oncology 23 (Suppl. 2): 1–16 (2014) DOI: 10.1111/pon.3495

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Colonoscopy-related distress in individuals undergoing faecal immunochemical testing-based colorectal cancer screening: A population-based study Sharp L1, Shearer N2, Lean R2, O’Morain C2, McNamara D2 1 National Cancer Registry, Cork, Ireland, 2Adelaide & Meath Hospital, Dublin, Ireland BACKGROUND: Recognition is increasing that participation in cancer screening may have an adverse psychological impact on some individuals. Little is known about psychological after-effects of colorectal cancer screening. AIMS: We investigated psychological distress following diagnostic colonoscopy in people with a positive screening faecal immunochemical test (FIT) in a populationbased screening programme. METHODS: Approximately 10,000 individuals aged 50–74 years registered with seven Dublin general practices were invited to complete a FIT. Those who tested positive were assessed by a specialist nurse and, if suitable, offered diagnostic colonoscopy within four weeks. Colonoscopies were performed by experienced gastroenterologists at one hospital. Two months post-colonoscopy those without

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

Oral Abstracts

cancer were invited, by post, to complete the Impact of Event Scale (IES). Distributions of distress scores, and percentages with significant colonoscopy-related distress (IES≥9), were compared between subgroups. RESULTS: 201 completed questionnaires were received. The median distress score was 6 (inter-quartile range 2–17). 42% scored in the range for significant colonoscopy-related distress. Distress scores were significantly higher in those with only primary-level education (medians: primary=8.5; secondary=5; tertiary=6; p = 0.03) and who perceived colonoscopy as more serious (not/slightly serious=4; serious/very serious=8; p = 0.01). Current depression and higher levels of health anxiety were significantly associated with higher distress (medians, depression: current=17; past=6; none=6; p = 0.05; health anxiety: low=2; medium=7.5; high=17; p < 0.01). Age, sex, social support, colorectal cancer family history, self-rated health pre-screening and previous screening participation were unrelated to distress. CONCLUSIONS: Substantial proportions of people experience psychological distress following diagnostic colonoscopy. Distress is an important, albeit unintended, cost of colorectal cancer screening.

Psycho-Oncology 23 (Suppl. 2): 1–16 (2014) DOI: 10.1111/pon.3495