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0201 Evidence-based recommendation for discussing complementary and alternative therapy use with cancer patients
Friday, 13 March 2009
0198
Morbidities after local/regional treatment of breast cancer and patients’ quality of life
B. Ozcinar1 , S.A. Guler2 , V. Ozmen1 , B.M. Gulluoglu2 , N. Kocaman3 , M. Ozkan3 , E. Sen Oran4 , G. Saricam1 , M.E. Muslumanoglu1 , A. Igci1 , M. Kecer1 , T. Dagoglu1 , M. Parlak1 . 1 General Surgery Department, I.U. Istanbul Medical Faculty, 2 General Surgery Department, Marmara University, Medical Faculty, 3 Pschiatry Department, I.U. Istanbul Medical Faculty, 4 General Surgery Department, Memorial Hospital, Istanbul, Turkey Goals: The aim of this prospective clinical study is to evaluate early and late complications of different surgical procedures, and find factors that are related to these complications in patients with early stage breast cancer. Methods: 218 early stage breast cancer patients (stage I and II) are enrolled in this prospective study. Physical complications (restrictions in shoulder motions, shoulder functional capacity, pain, lymphedema and sensory loss), psychological complications (depression, decreased quality of life) and the factors related to these complications are studied in patients after breast cancer surgery and/or radiotherapy at first week, at 9th–12th months and at mean follow up time of 34 months. Results: Median age was 48 (19−82) years. Lymphedema rates after surgery were 14.7%, 24.8% and 17.0% at first week, 9th–12th months, and long term respectively. In early postoperative period, pain and functional capacity of the effected shoulder were worse than preoperatively measured values and all axis of motion of shoulder joint were affected significantly. On the other hand, at 9th–12th months, only internal flexion was still affected. At the long term period, all shoulder motions, pain and functional capacity were in normal range. The factors related to lymphedema were axillary lymph node dissection (p = 0.002), radiation therapy to axillae (p < 0.001), and drain usage (p = 0.005). The patients who had both axillary lymph node dissection and axillary radiotherapy had more lymphedema than the patients who only had axillary lymph node dissection or sentinel lymph node biopsy (p = 0.004). The factors related to postoperative depression at early period were cigarette smoking (p = 0.008), axillary lymph node dissection (p = 0.045) and arm lymphedema (p = 0.005). At long term period they were axillary lymph node dissection (p = 0.021), mastectomy (p = 0.036), drain usage (p = 0.028) and sensory loss (p = 0.027). Conclusion: The patients who had sentinel lymph node biopsy, axillary dissection without axillary radiotherapy, and patients who had no drain or drain with less than ten days had better quality of life.
0199
The impact of adjuvant chemotherapy on quality of life in women with early breast cancer
G. Bulotiene1 , V. Ostapenko2 . 1 Physical Medicine and Rehabilitation Department, 2 Breast Surgery and Oncology Department, Institute of Oncology, Vilnius University, Vilnius, Lithuania Goals: The goal of the present study was to investigate the impact of adjuvant chemotherapy on quality of life (QOL) and emotional status of women with early stage breast cancer. Methods: An open prospective non-randomized study of women with cT1−T2/N0−N1/M0 stages of breast cancer was carried out through the period of 2003–2006 at the Institute of Oncology, Vilnius University. 117 patients were included into the study. On the 6th day after the surgery, the study participants filled in FACT-An and HADS questionnaires. Nine months after the surgery, 79 (67%) patients sent answers to the questionnaires they had received by mail. The data on the patients’ diagnosis were taken from their hospital case-records. Changes in QOL and emotional status of patients after mastectomy with/ without adjuvant chemotherapy (ChT) or breast conserving treatment (BCT) with/ without ChT were compared. Binomial logistical regression analysis was carried out to determine the factors predisposing the patients’ depression and anxiety. Results: The mean age of the patients was 53.1±10.6 years. Nine months after the surgery, the social and emotional well-being, total FACT-G and total FACT-An scores decreased in cases of mastectomy with ChT and BCT with ChT. The functional well-being and TOI-Anemia scores decreased in mastectomy with ChT cases. All QOL scores remained unchanged in cases of mastectomy without ChT and only social well-being scores decreased in the BCT without ChT While analyzing the impact of treatment methods on depression or anxiety, no influence of surgery extent (mastectomy/BCT) and adjuvant chemotherapy (applied/not applied) was observed.
Poster Session II. Supportive care/Psychology
S69
Conclusion: After adjuvant chemotherapy (first 2 months), QOL of patients was lower when compared with early post-operational period. The adjuvant chemotherapy has an impact on quality of life of women with early stage breast cancer.
0200
The impact of culture, sociological and psychological issues on Muslim breast cancer patients in Pakistan
M. Banning1 , M. Hassan2 , H. Hafeez3 , S. Faisal2 , A. Zafar2 . 1 School of Health Sciences and Social Care, Brunel University, Uxbridge, United Kingdom, 2 Clinical Research, 3 Clinical medicine, SKM cancer Hospital and Research Centre, Lahore, Pakistan Goals: This study had two goals. 1. To examine women’s experiences of breast cancer and coping strategies that they utilised t manage the illness. 2. To investigate whether there are any cultural, socio-psychological or religious factors that influenced Pakistani Muslim women’s experience of managing their illness. Methods: This qualitative study used semi-structured interviews to explore the views of women in relation to the lived experience of breast cancer. Thirty women were interviewed. Women were 22−60 years of age, Muslim belief, and receiving treatment for breast cancer. Two women were under the age of 26 years. The majority of women were married and housewives and had between two and five children. Women were interviewed in the hospital clinical areas. Interviews were digitally tape recorded and translated from Urdu to English. Interviews lasted up to 60 minutes. Data was analysed using thematic analysis. Results: Prior to diagnosis, four of the thirty women concealed their breast lump from their immediate family for prolonged periods of time before seeking medical treatment. The patient experience of breast cancer focused on a range of emotions that developed throughout the illness trajectory. The importance of religion and family support were essential coping strategies that women employed to manage the symptoms of the disease and the adverse effects of chemotherapy such as needing to be alone and avoid company. Conclusion: Although the experience of Pakistani Muslim women living with breast cancer may mirror the sociological and psychological adjustments that many breast cancer patients endure and make as a result of their illness, particularly the emotional chaos that occurs during the illness and future insecurity, there were also several dominant features that appear to be unique to these women. These included seeking spiritual advice from imams before seeking medical treatment and concealing the breast lump from family and husbands, often for periods of up two years. Among the overarching findings, was the strength of maternal responsibility that Pakistani women relate to and the need to ensure that children are looked after if necessary, but also coping with the illness through individual prayer and reading the holy Koran.
0201
Evidence-based recommendation for discussing complementary and alternative therapy use with cancer patients
P.E. Schofield1 , J. Diggens2 , R.X. Marigliani3 , M. Jefford4 . 1 Nursing and Supportive Care Research, 2 Clinical Psychology, Peter Mac Callum Cancer Centre, East Melbourne, 3 Consumer Representative, The Young Ones, Melbourne, 4 Haematology and Medical Oncology, Peter Mac Callum Cancer Centre, East Melbourne, Australia Goals: The use of Complementary/Alternative Medicine (CAM) continues to evoke strong debate and diverse views within the medical community. Most doctors are concerned about the lack of scientifically credible research to support CAM use. However, the prevalence of CAM use continues to grow. Research shows health professionals (HP) do not discuss CAM use appropriately with their patients. Enhanced dialogue between health care professionals and patients about CAM may generate a more open and trusting relationship and ultimately, improve outcomes for patients. The aim of this work was to develop evidence-based guidelines to enable HPs to have respectful, well-informed and balanced discussion with patients about CAM. Methods: A systematic review was conducted, covering the relevant literature from 1997 to 2007 using MEDLINE, CINAHL, and PSYCINFO databases. Reference lists were hand searched, and further searches were undertaken of authors commonly publishing in this field. The level
S70
Poster Session II. Supportive care/Psychology
of evidence provided in relevant papers was rated using a standardised rating system. Results: The search identified 78 original papers; 36 directly related to discussing CAM. No randomised controlled trials directly related to discussing CAM were identified. The evidence based guidelines are presented as recommended steps: 1. Elicit the person’s understanding of his/her situation; 2. Respect cultural and linguistic diversity and different epistemological frameworks; 3. Ask questions about CAM use at critical points in the illness trajectory; 4. Explore details and listen actively; 5. Respond to the person’s emotional state; 6. Discuss relevant concerns about CAM while respecting the person’s beliefs; 7. Provide balanced, evidencebased advice; 8. Document CAM-related discussions; 9. Monitor/follow-up CAM-discussions at subsequent consultations. Conclusion: CAM discussions are an opportunity to explore the patient’s psychosocial and existential needs. These guidelines provide the necessary basis for a communication skills training program, which has been developed concurrently, to improve these discussions in the conventional oncology treatment setting.
0202
Fatigue in early breast cancer patients receiving adjuvant postoperative chemotherapy
P. Heras1 , A. Hatzopoulos1 , K. Kritikos1 , A. Kapouralos1 , N. Androutsos1 . 1 Hellenic Medical Society for the Study of Psychosomatic Problems, Athens, Greece Goals: The aim of the study was to assess the level of fatigue during and after adjuvant postoperative chemotherapy in early breast cancer patients. Methods: 52 patients (age 31−75 years) with early breast cancer were recruited between May 2004 and October 2008. Fatigue intensity was measured according to 10-score visual analogue scale (VAS, 0 − no fatigue, 10 − fatigue as bad as it could possibly be) before the start of adjuvant postoperative chemotherapy, once weekly during chemotherapy, 20 days and 4 months after. Results: Over half of the patients (57%) demonstrated no fatigue before the start of adjuvant postoperative chemotherapy. Fatigue intensity increased gradually during chemotherapy. It highest in the last week of treatment 20 days after the end of chemotherapy, fatigue intensity was still higher than before treatment, but 4 months after it was lower than the pretreatment level (mean fatigue-VAS was 1.17, 2.41, 1.45 and 0.61, respectively). However, 16% of the patients defined their fatigue as 2 or more in VAS four months after chemotherapy had ended. About 1/4 of the patients reported no fatigue during chemotherapy. Increased level of fatigue was associated with an increased need of rest. Patients with pain (pain-VAS 1 or more) manifested a higher fatigue level in comparison to individuals without pain (mean fatigue-VAS 3.20 vs 1.02 in the last week of treatment). Older patients (>65 years) estimated their fatigue in the last week of treatment on lower level than younger patients (fatigue-VAS 1.79 vs. 2.83). Conclusion: The level of fatigue was highest in the last week of treatment and 20 days after the end of chemotherapy. Also, older patients estimated their fatigue in the last week of treatment on lower level than younger patients
0203
Evaluating the needs of women living with metastatic breast cancer: A global survey
M. Mayer1 , A. Hunis2 , R. Oratz3 , C. Glennon4 , P. Spicer5 , E. Caplan6 , L. Fallowfield7 . 1 AdvancedBC.org, USA, 2 University of Buenos Aires School of Medicine, Argentina, 3 New York University School of Medicine, 4 Intl Society of Nurses in Cancer Care/University of Kansas Hospital, 5 Cancer Care, Inc, 6 Living Beyond Breast Cancer, USA, 7 Brighton and Sussex Medical School, United Kingdom Goals: Globally, >1 million new cases of breast cancer (BC) are diagnosed each year, and >400,000 women die from the disease. In developed countries, ~30% of women with primary BC have a metastatic recurrence. Life expectancy after metastatic BC (MBC) diagnosis is ~2−3 years, although advances in treatment mean that some patients live longer. Over 60% of BC deaths occur in the developing world, despite a lower incidence, as most patients are diagnosed at later stages, with fewer treatment options available. In the US alone, which accounts for 10% of global BC deaths, ~155,000 women are thought to be living with MBC. Clearly,
Friday, 13 March 2009 the global burden of MBC should also be measured by the experiences of women living with advanced disease. Resources/support networks for MBC patients are limited compared with those available to primary BC patients. Additionally, MBC patients may have a lack of understanding of, and access to, clinical trials. The goal of this survey is to evaluate the unmet needs of women living with MBC in the US, Europe, Latin America and Africa. Methods: A Committee comprising 3 thought leaders, 4 patient advocates, and a global public health organization, was set up to develop a survey with the support of Harris Interactive® . There were 5 sections: resources/information/knowledge; support; attention from society; impact on self/lifestyle; clinical trials. The 23-min questionnaire comprised 34 questions and a set of country-specific questions. The survey was conducted in the USA, UK, France, Spain, Poland, Belgium, Argentina, Mexico and Egypt. Globally, 900 women with Stage IV/metastatic disease were interviewed. Survey methods included telephone, mail, and in-person interviews. Topics included MBC resources, support networks, attention given to MBC relative to primary BC and personal impact of the disease. Results: The results of this first ever global MBC survey will be presented. Conclusion: This global survey will identify the unmet needs of women living with MBC. The results will help improve collaboration across the MBC community and raise awareness of country-specific issues and global discrepancies relating to information resources.
0204
Targets and sources of the psychological help for breast cancer patients
J.V. Malova1 . 1 Psychological Rehabilitation, Russian Scientific Centre of Radiology, Moscow, Russian Federation Goals: The improvement of breast cancer treatment and reduction of side effects change structure of the targets of the psychological help. Among the most evident psychological problems in breast cancer patients today we should consider the stress of diagnosis and possible prognosis; decision-making regarding options of treatment process; the psycho-emotional changes in patients with the post-castration syndrome after ovarian ablation or tamoxifen use. Among the great variety of the methods of psychological diagnostics and supportive help we look for the most effective variants suitable for different cases. Methods: Two complexes of diagnostics were used a: multifactorial personality test, depressive scale (DSM-IV), anxiety scale (Spilberger), locus control test; b: clinical conversation, partly formalized interview, projective methods. Accordingly to the results of diagnostics the supportive psychological help was provided. The effectiveness of the psychological intervention was evaluated by the patients and clinical experts. The diagnostics and psychological help were managed before the diagnosis manifestation (1), before the treatment options decision (2), in the beginning of the treatment process in ovarian ablation (3.1) and tamoxifen use (3.2). Results: The use of complex b is related with higher level of reported psychological well-being in groups 2 and 3.1. In groups 1 and 3.2 complex a was more related with the patient’s satisfaction. Experts match complex a with more effective psychological help in group 2. The use of personality test significantly increases the satisfaction with the decision making process and psychological assistance in this process. Conclusion: There is an evidence of the possibility to use the optimal complex of psychological help accordingly to the different target psychological problems and stadiums of treatment experience in breast cancer patients. The individual medical psychological diagnostics is the necessary background of the effective psychological help.
0198
Morbidities after local/regional treatment of breast cancer and patients’ quality of life
B. Ozcinar1 , S.A. Guler2 , V. Ozmen1 , B.M. Gulluoglu2 , N. Kocaman3 , M. Ozkan3 , E. Sen Oran4 , G. Saricam1 , M.E. Muslumanoglu1 , A. Igci1 , M. Kecer1 , T. Dagoglu1 , M. Parlak1 . 1 General Surgery Department, I.U. Istanbul Medical Faculty, 2 General Surgery Department, Marmara University, Medical Faculty, 3 Pschiatry Department, I.U. Istanbul Medical Faculty, 4 General Surgery Department, Memorial Hospital, Istanbul, Turkey Goals: The aim of this prospective clinical study is to evaluate early and late complications of different surgical procedures, and find factors that are related to these complications in patients with early stage breast cancer. Methods: 218 early stage breast cancer patients (stage I and II) are enrolled in this prospective study. Physical complications (restrictions in shoulder motions, shoulder functional capacity, pain, lymphedema and sensory loss), psychological complications (depression, decreased quality of life) and the factors related to these complications are studied in patients after breast cancer surgery and/or radiotherapy at first week, at 9th–12th months and at mean follow up time of 34 months. Results: Median age was 48 (19−82) years. Lymphedema rates after surgery were 14.7%, 24.8% and 17.0% at first week, 9th–12th months, and long term respectively. In early postoperative period, pain and functional capacity of the effected shoulder were worse than preoperatively measured values and all axis of motion of shoulder joint were affected significantly. On the other hand, at 9th–12th months, only internal flexion was still affected. At the long term period, all shoulder motions, pain and functional capacity were in normal range. The factors related to lymphedema were axillary lymph node dissection (p = 0.002), radiation therapy to axillae (p < 0.001), and drain usage (p = 0.005). The patients who had both axillary lymph node dissection and axillary radiotherapy had more lymphedema than the patients who only had axillary lymph node dissection or sentinel lymph node biopsy (p = 0.004). The factors related to postoperative depression at early period were cigarette smoking (p = 0.008), axillary lymph node dissection (p = 0.045) and arm lymphedema (p = 0.005). At long term period they were axillary lymph node dissection (p = 0.021), mastectomy (p = 0.036), drain usage (p = 0.028) and sensory loss (p = 0.027). Conclusion: The patients who had sentinel lymph node biopsy, axillary dissection without axillary radiotherapy, and patients who had no drain or drain with less than ten days had better quality of life.
0199
The impact of adjuvant chemotherapy on quality of life in women with early breast cancer
G. Bulotiene1 , V. Ostapenko2 . 1 Physical Medicine and Rehabilitation Department, 2 Breast Surgery and Oncology Department, Institute of Oncology, Vilnius University, Vilnius, Lithuania Goals: The goal of the present study was to investigate the impact of adjuvant chemotherapy on quality of life (QOL) and emotional status of women with early stage breast cancer. Methods: An open prospective non-randomized study of women with cT1−T2/N0−N1/M0 stages of breast cancer was carried out through the period of 2003–2006 at the Institute of Oncology, Vilnius University. 117 patients were included into the study. On the 6th day after the surgery, the study participants filled in FACT-An and HADS questionnaires. Nine months after the surgery, 79 (67%) patients sent answers to the questionnaires they had received by mail. The data on the patients’ diagnosis were taken from their hospital case-records. Changes in QOL and emotional status of patients after mastectomy with/ without adjuvant chemotherapy (ChT) or breast conserving treatment (BCT) with/ without ChT were compared. Binomial logistical regression analysis was carried out to determine the factors predisposing the patients’ depression and anxiety. Results: The mean age of the patients was 53.1±10.6 years. Nine months after the surgery, the social and emotional well-being, total FACT-G and total FACT-An scores decreased in cases of mastectomy with ChT and BCT with ChT. The functional well-being and TOI-Anemia scores decreased in mastectomy with ChT cases. All QOL scores remained unchanged in cases of mastectomy without ChT and only social well-being scores decreased in the BCT without ChT While analyzing the impact of treatment methods on depression or anxiety, no influence of surgery extent (mastectomy/BCT) and adjuvant chemotherapy (applied/not applied) was observed.
Poster Session II. Supportive care/Psychology
S69
Conclusion: After adjuvant chemotherapy (first 2 months), QOL of patients was lower when compared with early post-operational period. The adjuvant chemotherapy has an impact on quality of life of women with early stage breast cancer.
0200
The impact of culture, sociological and psychological issues on Muslim breast cancer patients in Pakistan
M. Banning1 , M. Hassan2 , H. Hafeez3 , S. Faisal2 , A. Zafar2 . 1 School of Health Sciences and Social Care, Brunel University, Uxbridge, United Kingdom, 2 Clinical Research, 3 Clinical medicine, SKM cancer Hospital and Research Centre, Lahore, Pakistan Goals: This study had two goals. 1. To examine women’s experiences of breast cancer and coping strategies that they utilised t manage the illness. 2. To investigate whether there are any cultural, socio-psychological or religious factors that influenced Pakistani Muslim women’s experience of managing their illness. Methods: This qualitative study used semi-structured interviews to explore the views of women in relation to the lived experience of breast cancer. Thirty women were interviewed. Women were 22−60 years of age, Muslim belief, and receiving treatment for breast cancer. Two women were under the age of 26 years. The majority of women were married and housewives and had between two and five children. Women were interviewed in the hospital clinical areas. Interviews were digitally tape recorded and translated from Urdu to English. Interviews lasted up to 60 minutes. Data was analysed using thematic analysis. Results: Prior to diagnosis, four of the thirty women concealed their breast lump from their immediate family for prolonged periods of time before seeking medical treatment. The patient experience of breast cancer focused on a range of emotions that developed throughout the illness trajectory. The importance of religion and family support were essential coping strategies that women employed to manage the symptoms of the disease and the adverse effects of chemotherapy such as needing to be alone and avoid company. Conclusion: Although the experience of Pakistani Muslim women living with breast cancer may mirror the sociological and psychological adjustments that many breast cancer patients endure and make as a result of their illness, particularly the emotional chaos that occurs during the illness and future insecurity, there were also several dominant features that appear to be unique to these women. These included seeking spiritual advice from imams before seeking medical treatment and concealing the breast lump from family and husbands, often for periods of up two years. Among the overarching findings, was the strength of maternal responsibility that Pakistani women relate to and the need to ensure that children are looked after if necessary, but also coping with the illness through individual prayer and reading the holy Koran.
0201
Evidence-based recommendation for discussing complementary and alternative therapy use with cancer patients
P.E. Schofield1 , J. Diggens2 , R.X. Marigliani3 , M. Jefford4 . 1 Nursing and Supportive Care Research, 2 Clinical Psychology, Peter Mac Callum Cancer Centre, East Melbourne, 3 Consumer Representative, The Young Ones, Melbourne, 4 Haematology and Medical Oncology, Peter Mac Callum Cancer Centre, East Melbourne, Australia Goals: The use of Complementary/Alternative Medicine (CAM) continues to evoke strong debate and diverse views within the medical community. Most doctors are concerned about the lack of scientifically credible research to support CAM use. However, the prevalence of CAM use continues to grow. Research shows health professionals (HP) do not discuss CAM use appropriately with their patients. Enhanced dialogue between health care professionals and patients about CAM may generate a more open and trusting relationship and ultimately, improve outcomes for patients. The aim of this work was to develop evidence-based guidelines to enable HPs to have respectful, well-informed and balanced discussion with patients about CAM. Methods: A systematic review was conducted, covering the relevant literature from 1997 to 2007 using MEDLINE, CINAHL, and PSYCINFO databases. Reference lists were hand searched, and further searches were undertaken of authors commonly publishing in this field. The level
S70
Poster Session II. Supportive care/Psychology
of evidence provided in relevant papers was rated using a standardised rating system. Results: The search identified 78 original papers; 36 directly related to discussing CAM. No randomised controlled trials directly related to discussing CAM were identified. The evidence based guidelines are presented as recommended steps: 1. Elicit the person’s understanding of his/her situation; 2. Respect cultural and linguistic diversity and different epistemological frameworks; 3. Ask questions about CAM use at critical points in the illness trajectory; 4. Explore details and listen actively; 5. Respond to the person’s emotional state; 6. Discuss relevant concerns about CAM while respecting the person’s beliefs; 7. Provide balanced, evidencebased advice; 8. Document CAM-related discussions; 9. Monitor/follow-up CAM-discussions at subsequent consultations. Conclusion: CAM discussions are an opportunity to explore the patient’s psychosocial and existential needs. These guidelines provide the necessary basis for a communication skills training program, which has been developed concurrently, to improve these discussions in the conventional oncology treatment setting.
0202
Fatigue in early breast cancer patients receiving adjuvant postoperative chemotherapy
P. Heras1 , A. Hatzopoulos1 , K. Kritikos1 , A. Kapouralos1 , N. Androutsos1 . 1 Hellenic Medical Society for the Study of Psychosomatic Problems, Athens, Greece Goals: The aim of the study was to assess the level of fatigue during and after adjuvant postoperative chemotherapy in early breast cancer patients. Methods: 52 patients (age 31−75 years) with early breast cancer were recruited between May 2004 and October 2008. Fatigue intensity was measured according to 10-score visual analogue scale (VAS, 0 − no fatigue, 10 − fatigue as bad as it could possibly be) before the start of adjuvant postoperative chemotherapy, once weekly during chemotherapy, 20 days and 4 months after. Results: Over half of the patients (57%) demonstrated no fatigue before the start of adjuvant postoperative chemotherapy. Fatigue intensity increased gradually during chemotherapy. It highest in the last week of treatment 20 days after the end of chemotherapy, fatigue intensity was still higher than before treatment, but 4 months after it was lower than the pretreatment level (mean fatigue-VAS was 1.17, 2.41, 1.45 and 0.61, respectively). However, 16% of the patients defined their fatigue as 2 or more in VAS four months after chemotherapy had ended. About 1/4 of the patients reported no fatigue during chemotherapy. Increased level of fatigue was associated with an increased need of rest. Patients with pain (pain-VAS 1 or more) manifested a higher fatigue level in comparison to individuals without pain (mean fatigue-VAS 3.20 vs 1.02 in the last week of treatment). Older patients (>65 years) estimated their fatigue in the last week of treatment on lower level than younger patients (fatigue-VAS 1.79 vs. 2.83). Conclusion: The level of fatigue was highest in the last week of treatment and 20 days after the end of chemotherapy. Also, older patients estimated their fatigue in the last week of treatment on lower level than younger patients
0203
Evaluating the needs of women living with metastatic breast cancer: A global survey
M. Mayer1 , A. Hunis2 , R. Oratz3 , C. Glennon4 , P. Spicer5 , E. Caplan6 , L. Fallowfield7 . 1 AdvancedBC.org, USA, 2 University of Buenos Aires School of Medicine, Argentina, 3 New York University School of Medicine, 4 Intl Society of Nurses in Cancer Care/University of Kansas Hospital, 5 Cancer Care, Inc, 6 Living Beyond Breast Cancer, USA, 7 Brighton and Sussex Medical School, United Kingdom Goals: Globally, >1 million new cases of breast cancer (BC) are diagnosed each year, and >400,000 women die from the disease. In developed countries, ~30% of women with primary BC have a metastatic recurrence. Life expectancy after metastatic BC (MBC) diagnosis is ~2−3 years, although advances in treatment mean that some patients live longer. Over 60% of BC deaths occur in the developing world, despite a lower incidence, as most patients are diagnosed at later stages, with fewer treatment options available. In the US alone, which accounts for 10% of global BC deaths, ~155,000 women are thought to be living with MBC. Clearly,
Friday, 13 March 2009 the global burden of MBC should also be measured by the experiences of women living with advanced disease. Resources/support networks for MBC patients are limited compared with those available to primary BC patients. Additionally, MBC patients may have a lack of understanding of, and access to, clinical trials. The goal of this survey is to evaluate the unmet needs of women living with MBC in the US, Europe, Latin America and Africa. Methods: A Committee comprising 3 thought leaders, 4 patient advocates, and a global public health organization, was set up to develop a survey with the support of Harris Interactive® . There were 5 sections: resources/information/knowledge; support; attention from society; impact on self/lifestyle; clinical trials. The 23-min questionnaire comprised 34 questions and a set of country-specific questions. The survey was conducted in the USA, UK, France, Spain, Poland, Belgium, Argentina, Mexico and Egypt. Globally, 900 women with Stage IV/metastatic disease were interviewed. Survey methods included telephone, mail, and in-person interviews. Topics included MBC resources, support networks, attention given to MBC relative to primary BC and personal impact of the disease. Results: The results of this first ever global MBC survey will be presented. Conclusion: This global survey will identify the unmet needs of women living with MBC. The results will help improve collaboration across the MBC community and raise awareness of country-specific issues and global discrepancies relating to information resources.
0204
Targets and sources of the psychological help for breast cancer patients
J.V. Malova1 . 1 Psychological Rehabilitation, Russian Scientific Centre of Radiology, Moscow, Russian Federation Goals: The improvement of breast cancer treatment and reduction of side effects change structure of the targets of the psychological help. Among the most evident psychological problems in breast cancer patients today we should consider the stress of diagnosis and possible prognosis; decision-making regarding options of treatment process; the psycho-emotional changes in patients with the post-castration syndrome after ovarian ablation or tamoxifen use. Among the great variety of the methods of psychological diagnostics and supportive help we look for the most effective variants suitable for different cases. Methods: Two complexes of diagnostics were used a: multifactorial personality test, depressive scale (DSM-IV), anxiety scale (Spilberger), locus control test; b: clinical conversation, partly formalized interview, projective methods. Accordingly to the results of diagnostics the supportive psychological help was provided. The effectiveness of the psychological intervention was evaluated by the patients and clinical experts. The diagnostics and psychological help were managed before the diagnosis manifestation (1), before the treatment options decision (2), in the beginning of the treatment process in ovarian ablation (3.1) and tamoxifen use (3.2). Results: The use of complex b is related with higher level of reported psychological well-being in groups 2 and 3.1. In groups 1 and 3.2 complex a was more related with the patient’s satisfaction. Experts match complex a with more effective psychological help in group 2. The use of personality test significantly increases the satisfaction with the decision making process and psychological assistance in this process. Conclusion: There is an evidence of the possibility to use the optimal complex of psychological help accordingly to the different target psychological problems and stadiums of treatment experience in breast cancer patients. The individual medical psychological diagnostics is the necessary background of the effective psychological help.