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STUDY IN A SAMPLE OF GYNECOLOGICAL CANCER PATIENTS

Valentina Di Mattei1,2_{, Letizia Carnelli}2,3_{, Martina Mazzetti}2_,

Paola Taranto2_{, Martina Bernardi}4_{, Mariachiara Parmigiani}2_,

Gaia Perego3_{, Amedea Dehò}1_{, Paola MV Rancoita}5_{, Massimo Candiani}6,7 1_{1Vita-Salute San Raffaele University, Faculty of Psychology, Milan,}

Italy; 2_{2San Raffaele Hospital, Clinical and Health Psychology Unit-}

Department of Clinical Neurosciences, Milan, Italy; 3_{3University of}

Milan-Bicocca, Department of Psychology, Milan, Italy; 4_4University

of Parma, Languages Department, Parma, Italy; 5_{5Vita-Salute San}

Raffaele University, University Centre of Statistics in the Biomedical Sciences CUSSB, Milan, Italy; 6_{6San Raffaele Hospital, Department}

of Obstetrics and Gynecology, Milan, Italy; 7_{7Vita-Salute San Raffaele}

University, Faculty of Medicine, Milan, Italy

Background/rationale or Objectives/purpose: Despite improvements

in antiemetic prophylaxis, Chemotherapy-Induced Nausea (CIN) still represents one of the most distressing side effects of chemotherapy treatment. Previous studies showed that psychological factors may be involved in the development of both acute and delayed nausea. The cur- rent study aimed to investigate the role of anxiety and coping strategies in the prediction of CIN.

Methodology or Methods: One hundred and sixty-five patients

(mean age = 58.23, SD = 13.19) treated for gynecological cancer at the San Raffaele Hospital completed the State-Trait Anxiety Inventory and the Coping Orientation to Problems Experienced. Data concerning nausea was collected after the first and the third chemotherapy infusion using the MASCC Antiemesis Tool (MAT). Logistic regression analyses were performed; p-values of < 0.05 were considered significant.

Impact on practice or Results: Both anxiety and coping strategies

are involved in the development of delayed nausea; no association was found with acute nausea at both infusions. Specifically, a higher state anxiety represents a risk factor for delayed CIN (OR = 1.030, p = .020) after the first infusion of chemotherapy; having a higher problem-fo- cused coping style is a risk factor (OR = 1.062, p = .022) for delayed CIN after the third infusion.

Discussion or Conclusions: This study found that patients’ psycho-

logical characteristics represent risk factors for developing delayed nausea during chemotherapy treatment. In order to contrast CIN, the influence of patient-related risk factors should be considered, along with those related to treatment: specific psychological interventions aimed at encouraging more adaptive coping strategies and at managing anxiety could in turn help to control CIN.

160 | Applying the conceptual framework for action on the social determinants of health to a Canadian late- effects clinic for adult survivors of childhood cancer

Sharon Paulse, MSW, RSW, CCLS, Bronwyn Barrett, MSW, RSW, Melanie McDonald, MSW, RSW

Background/rationale or Objectives/purpose: The World Health Orga-

nization’s conceptual framework for action on the social determinants of health (CSDH) offers a broad, systems analysis of issues affecting the health of populations and individuals (Solar, 2010). This presentation will review the CSDH and apply this theoretical model to issues faced by adult survivors of childhood cancer at LEAF (Late Effects, Assess- ment and Follow-up) Clinic in British Columbia, Canada.

Late-effects of childhood cancer treatment present an array of issues, including premature aging, chronic health conditions, cognitive and emotional health challenges (Hudson, 2018) and financial dependence (Teckle, 2018). Adult survivors are also situated within political con- texts which determine their eligibility and access to services.

Methodology or Methods: This presentation will apply the CSDH to

a case study in order to highlight priorities and perspectives of patients, their families, and health care professionals.

Impact on practice or Results: This framework helps to analyze the

expectations and realities of patients and their families as they attempt to navigate services which directly impact health, but which fall outside of the current scope and budget of the health system.

Discussion or Conclusions: The CSDH can help health care profes-

sionals to understand and to frame discussions of intersecting issues, competing practice priorities within their organizational and political structures and to explore potential advocacy strategies.

122 | Psychological and Physical Correlates of Insomnia Symptoms in Men with Prostate Cancer

Kathleen T. Galvin1_{, Sheila N. Garland}2_{, Erik Wibowo}1

1_{University of Otago, Dunedin, New Zealand;} 2_{Memorial University,}

St; John’s, Canada

Background/rationale or Objectives/purpose: Many men with prostate

cancer (PCa) experience insomnia symptoms (InS). We aimed to investi- gate factors associated with InS in men with PCa.

Methodology or Methods: Men diagnosed with PCa were invited to

complete an online survey of sleep, physical, sexual, and psychological functioning. Cancer organisations and support groups distributed this survey via social media and mailing lists.

Impact on practice or Results: 142 men with PCa [39.4% had re-

ceived radiotherapy, 59.2% prostatectomy, 33% androgen deprivation therapy (ADT)] participated. 54.8% and 70.2% of patients, who had and had not received ADT respectively, reported InS (≥8 Insomnia Se- verity Index score). Men who had been on ADT [70 years old (IQR = 11)] had significantly worse sleep due to hot flashes (P < 0.001), bother due to waking up to urinate (P < 0.01), fatigue (P < 0.01), sexual func- tion (P < 0.001), crying (P < 0.001) and feeling sad (P < 0.05) than ADT-naïve patients [68.5 years old (IQR = 13.5)]. Men on ADT with InS experienced worse urinary symptoms (P < 0.05), fatigue (P < 0.05), and anxiety (P < 0.01). ADT-naïve patients with InS had worse daytime sleepiness (P < 0.05), urinary bother (P < 0.01), fatigue (P < 0.01), anx- iety (P < 0.01), depression (P < 0.01) and orgasmic function (P < 0.05). Regardless of treatment type, men with InS more frequently went to bed “feeling stressed, angry, upset or nervous’’, and “thought, planned or worried when in bed’’ than patients without InS (both Ps < 0.05). Physically active patients on ADT had less problems with waking up too early than those who were less physically active (P < 0.05).

Discussion or Conclusions: InS is associated with poorer quality of

life outcomes in men with PCa and should be a focus of intervention.

28 | Screening for Cancer-Related Symptoms: Sensitivity and Specificity of Screening Tools for a Trial Testing a Collaborative Care Intervention

Jennifer Steel1_{, Eric Jang}1_{, Michael Antoni}2_{, Brittany Gunsalius}1_,

Shaymal Peddada1_{, Reyna Jones}1_{, Richaela Cowan}1_{, Donna Olejniczak}1_,

Qi Chen1_{, David Geller}1

1_{University of Pittsburgh, Pittsburgh, USA;} 2_{University of Miami, Miami,}

USA

Background/rationale or Objectives/purpose: Brief instruments to

screen patients for clinical levels of cancer-related symptoms are needed to facilitate the targeting of interventions to patients with the greatest severity of symptoms. The aims of this study were to examine the sen- sitivity and specificity of screening tools used to assess cancer-related symptoms.

Methodology or Methods: Patients were screened for cancer-related

symptoms with brief instruments and then assessed again approximately 2–3 weeks later using widely used reliable and valid instruments to assess cancer-related symptoms. Sensitivity and specificity analyses and Area Under the Receiver Operator Curve (AUROC) analyses were performed.

Impact on practice or Results: A total of 507 patients were screened

for symptoms of pain, depression, and fatigue. No differences by gender [Chi-square = 1.51, p = 0.469], race [Chi-square = 11.2, p = 0.509], or diagnosis [Chi-square = 2.5, p = 0.92] with regard to those who enrolled in the clinical trial, however younger patients were more likely to enroll in the intervention [F(1,362) = 4.8, p = 0.03]. Good to poor sensitivity and excellent specificity was observed for the screening of depressive symptoms (0.77 and 0.85), pain (0.47 and 0.91), and fatigue (0.11 and 0.91). The AUROC for depressive symptoms = 0.86 (95% CI = 0.80–0.92), pain = 0.75 (95% CI = 0.67–0.83), and fatigue = 0.40 (95% CI = 0.31–50) was good to poor. Using AUROC, the best cut point for depressive symptoms was 15.5 (Sensitivity = 0.85; Specificity = 0.77), for pain was 4.5 (Sensitivity = 0.81; Specificity = 0.662); and for fatigue was 2.5 (Sensitivity = 0.91; Specificity = 0.11).

Discussion or Conclusions: The 20 item CES-D and a 0–10-point

scale for pain were adequate to screen patients diagnosed with cancer. However, the use of a 0–10-point scale for fatigue was not recommend- ed.

u. theory Building in CliniCal researCh

504 | A Grounded Theory of How Patients Process their Cancer Experiences through a Mindfulness-based Expressive Arts Group

Kendra Rieger1_{, Tom Hack} 1_{, Miriam Duff}2_{, Heather Campbell-Enns} 3_,

Christina West1

1_{College of Nursing, Rady Faculty of Health Sciences, University of}

Manitoba, Winnipeg, Canada; 2_{CancerCare Manitoba, Winnipeg,}

Canada; 3_{Canadian Mennonite University, Winnipeg, Canada}

Background/rationale or Objectives/purpose: Given the challenges as-

sociated with cancer diagnosis and treatment, there is a growing interest in mindfulness-based expressive arts group interventions (MBAIs) for promoting patients’ well-being. Our study objective was to develop a theoretical understanding of how patients with cancer experience, uti- lize, and draw meaning from an MBAI.

Methodology or Methods: We used constructivist grounded theory

to explore how patients process their cancer experiences through an MBAI. Participants (N = 23) had participated in CancerCare Manito- ba’s Expressive Arts Group. We gathered narrative descriptions of their experiences through semi-structured interviews and field notes. Partici- pants brought their artwork to facilitate art elicitation. Data were ana- lyzed with grounded theory methods.

Impact on practice or Results: Our resulting grounded theory pro-

vides insight into the plausible mechanisms for the group’s therapeutic processes and outcomes. Participants described how mindfulness enabled them to let go of their ruminations and calm their minds so they could fully engage in expressive arts activities. Participants found inspiration for artistic expressions while meditating, and expressed themselves in new ways in their artwork. This process of mindfulness and art mak- ing within a group context became a powerful way of discovering and

processing hidden thoughts and emotions. Although it was challenging work, it created a unique healing space for numerous meaning-making processes and fostered a transformative group experience for many. Our presentation will include a PechaKucha which incorporates participants’ artwork to illuminate these findings.

Discussion or Conclusions: These findings provide a strong theoretical

foundation that will enable researchers and practitioners to design and implement more effective mindfulness-based expressive arts programs.

464 | Cognitive-Attentional Processes as Predictors of Fear of Cancer Recurrence at the End of Breast Cancer Treatment

Pauline Waroquier1,2_{, Isabelle Merckaert}1,2_{, France Delevallez}1,2_,

Jean-Louis Slachmuylder3_{, Darius Razavi}1,2

1_{Université libre de Bruxelles, Brussels, Belgium;} 2_{Institut Jules Bordet,}

Brussels, Belgium; 3_{Centre de Psycho-Oncologie, Brussels, Belgium}

Background/rationale or Objectives/purpose: Fear of cancer recurrence

(FCR) is highly prevalent among patients and disrupts their daily func- tioning. Hence, researchers took an interest in cognitive-attentional pro- cesses implied in the development of FCR. The aim of this study was to assess relationships between potential cognitive-attentional predictors (i.e., worry, intolerance of uncertainty, maladaptive metacognitions, intrusive thoughts, and attentional bias (AB)) and FCR in a post-treat- ment breast cancer population.

Methodology or Methods: Seventy-four patients treated for a

non-metastatic breast cancer were encountered at the end of active treatment. Patients completed self-report questionnaires using Fear of Cancer Recurrence Inventory-Short Form (FCRI-SF), Penn State Worry Questionnaire, Intolerance of Uncertainty Inventory-Part A, Metacog- nitions Questionnaire-30, and White Bear Suppression Inventory, and a dot-probe task assessing AB towards negative, positive, and neutral cancer related or unrelated words presented for 17, 500, and 1500 mil- liseconds.

Impact on practice or Results: Results showed a significant correla-

tion between FCR and worry (r = .551;p < .001), intolerance of un- certainty (r = .418;p < .001), maladaptive metacognitions (r = .384;p < .001), and intrusive thoughts (r = .359;p < .001). Worry (b=.081;p = .015) and intolerance of uncertainty (b=.056;p = .044) significantly predicted FCR in a logistic stepwise regression (FCRI-SF cut-off≥13,R2 = .255). No correlation was found between FCR and AB. However, all patients showed an AB towards negative cancer related words presented for 17 milliseconds (F = 8.802;p = .004).

Discussion or Conclusions: Worry and intolerance of uncertainty both

predicted FCR. Therefore, interventions designed to reduce FCR should specifically address these predictors. Moreover, the presence of an automatic AB towards cancer threat provided support for the use of attention training technique in a post-treatment breast cancer population. Further research is still needed to disentangle automatic versus strategic processing in AB.

340 | APOE e4 as a moderating risk factor for cancer related cognitive impairment – a systematic review

Cecilie Rask Buskbjerg1_{, Ali Amidi}1_{, Ditte Demontis}2_{, Eva Rames}

Nissen1_{, Robert Zachariae}1

1_{Unit for Psychooncology and Health Psychology, Department}

of Psychology and Behavioural Sciences, Aarhus University, and Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; 2_{The Lundbeck Foundation Initiative for Integrative}

Psychiatric Research, iPSYCH, Denmark Department of Biomedicine – Human Genetics, Aarhus University, Aarhus, Denmark

Background/rationale or Objectives/purpose: Cancer-related cognitive im-

pairment (CRCI) is a commonly reported complaint among non-CNS can- cer patients. A potential moderating risk factor for cognitive impairment is the gene APOE encoding the apolipoprotein isoform e4. In the present

study, we systematically reviewed the available studies evaluating APOE e4 as a moderating risk factor for CRCI.

Methodology or Methods: Keyword-based systematic searches were

undertaken on July 24, 2018 in PubMed, Web of Science, The Cochrane Library, and CINAHL. Three authors independently evaluated full-texts of identified papers and excluded studies. Ten studies reporting results from nine independent samples were included. Two authors independently qual- ity-assessed the included studies using the NIH Quality Assessment Tool. The review was preregistered with PROSPERO (CRD42018107689).

Impact on practice or Results: Six studies were rated “good quality’’

(>9 out of 14 criteria met), and four studies were rated “fair quality’’ (5–9 criteria met). Four studies reported that carrying at least one e4 al- lele was associated with CRCI with odds ratios ranging from 1.42 (95% CI: 0.81–2.49) to 12.7 (95% CI: 5.26–27.67). Six studies found no as- sociation. The only clear-cut methodological differences were that stud- ies that found an association had smaller sample sizes (mean N = 109) and a larger amount of e4 carriers (mean = 26%) compared to studies that found no association (mean N = 248, mean % carriers = 20).

Discussion or Conclusions: While there is some evidence to suggest

that variants encoding the e4 allele may act as moderating risk factors for CRCI, the literature is generally inconsistent and does not allow for clear- cut conclusions. Larger and more sufficiently powered studies are needed.

174 | The role of fear of cancer progression in changing health behaviors before and after surgery of colorectal cancer

Jaroslaw Ocalewski1_{, Pawel Izdebski}1_{, Michal Jankowski}2_,

Wojciech Zegarski2

1_{Kazimierz Wielki University, Bydgoszcz, Poland;} 2_{Oncology Center,}

Bydgoszcz, Poland

Background/rationale or Objectives/purpose: Research on fear of can-

cer progression (FoP) show its negative impact on human behavior. Whereas, the FoP seems to be a natural reaction to cancer and causes the fight or avoidance of the illness.

The aim of the study is to understand the relationship between FoP and health behaviors among people with colorectal cancer (CRC) be- fore and after colorectal tumor resection. The research is conducted as a part of the grant funded by the National Science Center in Krakow (2017/25/N/HS6/01365) entitled The role of cognitive and emotional factors in adaptation to cancer

Methodology or Methods: The participants were Polish patients (N =

155) at the age of 40–75 years, before (T1) and 6 months (T2) after the colorectal tumor resection at the Oncology Center in Bydgoszcz. The tools used to measure are: health behaviors (smoking, alcohol, eating habits, physical activities, stress), The Fear of Progression Question- naire - Short Form (FoPQ-SF), The Brief Illness Perception Question- naire (B-IPQ).

Impact on practice or Results: FoP is important to reduce unhealthy

behaviors: alcohol consumption (r = -.19), anti-healing food (r = -.24) and it is insignificant for changes in the consumption of health-pro- moting products. High fear of illness progression is not conducive to physical activity, sleep quality. FoP isn’t related with the time since the symptoms of cancer appeared before consultation by a physician.

Discussion or Conclusions: The occurrence of FoP may also have its

profits, as it may determine whether patients engage in better coping with disease. FoP plays an important role in limiting anti-health behav- iors such as alcohol consumption and unhealthy products.

99 | Can socio-emotional selectivity theory help to tailor psychooncological interventions?

Katrin R. Scharpf1,2_{, Saskia Höper}1_{, Bernd Kasper}2_{, Martin Bohus}1 1_{Central Institute of Mental Health, Mannheim, Germany;} 2_UMM,

Background/rationale or Objectives/purpose: Socio-emotional selectiv-

ity theory (SST, Carstensen 2006) postulates that motivational focus depends on time perspective, like expectation about remaining life span. With open future time perspective (FTP) humans focus on information gathering, whereas individuals with a restricted FTP focus on emotion regulation. We investigated whether SST can be used to differentiate psychooncological intervention strategies.

Methodology or Methods: To operationalize information search and

emotion regulation, two items from our routine distress screening in- strument (HSI) were examined. The sample included only those patients who died in the meanwhile (N = 454). Age did not differentiate the wish for psychooncological support. Younger patients‘ information gathering motivation was less satisfied by the medical staff (age split 67, p < .001). Additionally, younger patients tended to have less often somebody to talk about their sorrows and thus a deficit in emotion regulation (p < .07). A negative correlation between age and duration of psychoonco- logical intervention was found (p < .001).

Impact on practice or Results: Young and old patients showed simi-

lar needs for psychooncological counselling. However, younger patients have higher needs for information gathering and emotion regulation. Clinicians should be prepared and trained to those differential indica- tions of interventions.

Discussion or Conclusions: Currently FTP was operationalized by

the expected remaining life span (independent of oncological situation) which turned out relevant for the required psychological interventions as expected by SST. To investigate the usefulness of SST for tailoring in- terventions, questionnaires specifically designed to measure FTP should be tested. Emotion regulation should be examined in more sophisticated ways including specific psychotherapeutic manuals (e.g. Bohus et al., 2013).

82 | Understanding the role of psychological flexibility in depression and desire for hastened death in cancer patients

Nicholas J. Hulbert-Williams, Dawid S. Budzynksi, Liz Whelen University of Chester, Chester, United Kingdom

Background/rationale or Objectives/purpose: Individuals diagnosed

with cancer often suffer from distress and psychological comorbidities that remain unrecognized and can lead to increased suicidality or desire for hastened death. Predictors of this phenomenon remain largely un- known. This study explores the role of psychological factors and phys- ical symptoms (e.g. sleep disturbance, pain) as predictors of depression and desire for hastened death.

Methodology or Methods: 138 cancer patients have been recruited

for this cross-sectional study though a UK cancer charity and social media. Participants (male n = 52, female n = 85, not specified n = 1) are over 16 years of age (M = 48.56, SD = 16.02) with a cancer di- agnosis not restricted by site or stage (curative n = 93, palliative n = 33, unknown n = 12). Participants completed questionnaire assessments of sleep disturbance, pain, fear of cancer progression, adjustment to cancer, hopelessness, psychological flexibility, wish to hasten death and depression.

Impact on practice or Results: Statistically significant correlations (p

< .05) were found between all outcome and predictor measures except cognitive avoidance and fighting spirit. Effect sizes were considerable, ranging from d = .2 to d = .6. Preliminary analysis demonstrates that psychological flexibility may act as a moderator between fear of cancer progression and depression (R2 _{= .40, F(3,116) = 25.96, p < .001). No} other moderating effects have been identified between remaining predic- tor and outcome variable relationships.

Discussion or Conclusions: Cancer patients struggle with a wide

range of unmet needs that may require attention and support. Under- standing the moderating role of psychological flexibility between fear of

cancer progression and depression may suggest a theoretical rationale for using Acceptance and Commitment Therapy (ACT) based interven- tions in cancer care.

43 | Adaptive and maladaptive emotions in patients with cancer: design of the EMOCA Study

Joost Dekker

Amsterdam University Medical centers (VUmc), Amsterdam, Netherlands

Background/rationale or Objectives/purpose: It is generally acknowl-

edged that a distinction needs to be made between adaptive (normal) and maladaptive (psychopathological) emotions in response to a po- tentially traumatic event such as cancer. Current instruments to assess

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