- Email: [email protected]
1540 Attitudes and beliefs of patients and health professionals towards fertility issues in young women with breast cancer
Abstracts 1537 Do Egyptian patients know their diagnosis of cancer?
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S. Alsirafy1 , D. Farag1 , M. El-Haddad2 , R. Haggag3 , O. Zaki2 , N. Ibrahim2 , A. Hammad1 . 1 Kasr Al-Ainy School of Medicine − Cairo University, Palliative Medicine Unit − Kasr Al-Ainy Center of Clinical Oncology & Nuclear Medicine NEMROCK, Cairo, Egypt; 2 Kasr Al-Ainy School of Medicine − Cairo University, Department of Clinical Oncology − Kasr Al-Ainy Center of Clinical Oncology & Nuclear Medicine NEMROCK, Cairo, Egypt; 3 Faculty of Medicine, Zagazig University, Department of Medical Oncology, Zagazig, Sharkia, Egypt Background: The negative attitude towards honest disclosure of cancer diagnosis represents a barrier to cancer care in a number of countries. In Egypt, there is a long-standing belief that the culture is against cancer diagnosis disclosure and that patients are generally unaware of their cancer diagnosis. This study investigated the prevalence of and factors associated with unawareness of diagnosis among Egyptian cancer patients. Materials and Methods: The study took place in two Egyptian cancer centres in Cairo and Sharkia governorates, and included 119 adult patients with pathologically proven cancer. Patients were asked to name the disease they are treated for in the corresponding centre. They were considered aware of diagnosis if they answered that the disease is “cancer” or “tumour” or if they named the cancer. Results: The majority (100/119, 84%) of patients were aware of their cancer diagnosis. Among the 100 patients who were aware of their cancer diagnosis, 31% said that they have cancer, 60% said that they have tumour and 9% mentioned the name of the cancer. Older age, male gender, lower education level, being unmarried, living in Sharkia, and having a solid tumour were associated with lower prevalence of cancer diagnosis awareness. However, none of these associations was statistically significant (p = 0.4, 0.27, 0.27, 0.67, 0.33 and 0.27, respectively). Conclusions: Unlike a common belief, the current results suggest that the majority of Egyptian patients with cancer are aware of their cancer diagnosis. This may indicate a changing cultural attitude towards cancer in Egypt and a transition from the traditional paternalistic approach of care to a more patient-centred cancer care. Further research is needed to improve communication in the Egyptian cancer care setting. No conflict of interest. 1538 POSTER Anxiety and depression in patients with newly diagnosed metastatic gastrointestinal cancer H.S. Han1 , J.H. Chung1 , Y. Jeong1 , M.K. Choi1 , J. Kwon1 , K.H. Lee1 , G. Ju2 , S.T. Kim1 . 1 College of Medicine, Chungbuk National University, Department of Internal Medicine, Cheongju, South Korea; 2 College of Medicine, Chungbuk National University, Department of Psychiatry, Cheongju, South Korea Background: Anxiety and depression are the most prevalent psychological symptoms in cancer patients; however, there are few studies on psychological distress in patients with metastatic gastrointestinal cancer. Therefore, the objective of the present study was to assess the prevalence and associated factors of anxiety and depression in Korean patients with metastatic gastrointestinal cancer. Methods: One hundred and twenty consecutive patients with newly diagnosed, metastatic gastrointestinal cancer who were scheduled to receive palliative chemotherapy from July 2012 to June 2014 were enrolled in this prospective study. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS) and Patient Health Questionnaire-9 (PHQ-9). Results: HADS revealed the prevalence of anxiety and depression to be 9.2% and 26.7%, respectively. Thirty-one patients (25.8%) met the diagnostic criteria for major depressive syndrome according to PHQ-9. Overall, 37 patients (30.8%) were diagnosed with anxiety or depression according to HADS or PHQ-9. Multivariate analysis identified lower performance status (odds ratio [OR], 4.19; 95% CI, 1.22 to 14.35; P = 0.023), gastric cancer (OR, 5.39; 95% CI, 0.37 to 78.23; P = 0.018), and knowledge of cancer diagnosis (OR, 15.07; 95% CI, 1.80 to 125.90; P = 0.012) as significantly associated factors with anxiety or depression in patients with metastatic gastrointestinal cancer. Twenty-one patients with anxiety or depression that received therapy in the psycho-oncologic clinic showed greater improvements in the PHQ-9 scores (P = 0.008), global health status (P = 0.023), fatigue (P = 0.047), and appetite loss (P = 0.006) than patients who received no psychologic therapy at 3 months after the study enrollment. Conclusions: This study showed that approximately 30% of the patients with metastatic gastrointestinal cancer suffer from psychological distress.
Physicians should pay attention to the psychologic status of patients diagnosed with metastatic gastrointestinal cancer, particulary those with poor performance status, gastric cancer, and knowledge of cancer diagnosis. No conflict of interest. 1539 POSTER Loneliness during protective isolation in patients with haematological malignancies: A three-dimensional conceptual model V. Biagioli1 , M. Piredda2 , C. Barbaranelli3 , R. Alvaro1 , M.G. De Marinis2 . 1 Tor Vergata University, Biomedicine and Prevention, Roma, Italy; 2 Campus Bio-Medico di Roma University, Research Unit in Nursing Science, Rome, Italy; 3 Sapienza University, Psychology, Rome, Italy Background: Patients with haematological malignancies are often nursed in protective isolation for hematopoietic stem cell transplantation, in order to prevent hospital-acquired infections. Protective measures are implemented inconsistently across centres and are supported by recommendations with different level of evidence. During protective isolation, patients may experience stress, anxiety, anger, depression, insomnia and loneliness. Although a relevant determinant of poor health and quality of life, loneliness is under-conceptualized and measured. From a meta-synthesis of qualitative research on the lived experience of patients in protective isolation, a conceptual model of loneliness, as a consequence of isolation, was generated. It included 3 dimensions: suffering (+), relationship with oneself (−), problems in the relationship with others (+). The purpose of this study is to use these findings to develop a self-report questionnaire to assess loneliness in isolated patients with haematological malignancies. Material and Methods: Following the European Guidelines of the Statistical System, the conceptual model of loneliness was used to develop the items for the questionnaire. In order to verify face validity, two focusgroups were conducted with 10 experts, who systematically evaluated each indicator of patients’ loneliness with a structured form. The experts included: nurses, haematologists, psychologists, and a former patient. This first version of the questionnaire was pilot-tested in patients with haematological malignancies who experienced protective isolation for at least 10 days. Results: The questionnaire showed good face validity. Items for “suffering” refer to boredom, burden of loneliness, powerlessness, amplification of fears, feeling imprisoned, restriction in movement, distress, suffering orders, lack of privacy, helplessness. Items for “relationship with oneself” refer to being focused on oneself, cognitive reappraisal, attribution of meaning to isolation, inner growth, self-esteem. Items for “problems in the relationship with others” refer to loss of touch and closeness, fear of abandonment, lack of comprehension, lack of someone to talk to, danger in the contact with others, feeling cut off from the world. Conclusions: Both the face validity study with experts and the pilot study with haematological patients supported the conceptual model of loneliness generated from the meta-synthesis, and the indicators developed to measure loneliness as a consequence of isolation Further studies should conduct pre-field and field test of the questionnaire, and verify its psychometric properties in a sample of haematological patients in protective isolation for hematopoietic stem cell transplantation. No conflict of interest. 1540 POSTER Attitudes and beliefs of patients and health professionals towards fertility issues in young women with breast cancer R. Lee1 , S. Foy1 , L. Evans1 , S. Howell1 , A.M. Molassiotis1 , A. Armstrong1 . 1 Christie Hospital NHS Foundation Trust, Medical Oncology, Manchester, United Kingdom Background: Breast cancer (BC) is the most common cancer diagnosis in women under 40 years. As a consequence of social factors resulting in delayed age of childbirth and improvements in adjuvant treatment, there are increasing numbers of breast cancer survivors with fertility issues. Method: Two questionnaires were developed and validated using cognitive interviewing. An online survey was sent out to health professionals (HP) via professional bodies and cancer networks. Patients were recruited via national cancer research networks and charities throughout the United Kingdom. Results: 240 HPs and 530 patients participated between Sept 2010 and Nov 2014. 76.4% of patients recalled having a fertility conversation with a HP. Fertility issues were reported to be discussed all of the time by 62% (126/204) of HP and most of the time by 22% (44/204). Ovarian stimulation (OS) was felt to increase the risk of BC returning by 16% (77/489) patients and 28% (54/195) of HPs but 66% of patients
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(323/489) and 56% (109/195) of HPs were unsure. For women already with children, 11% (21/195) HPs felt they would discourage patients from fertility preservation, 67% (131/195) felt they would not and 22% (43/195) felt it would depend on pathology. 47% (237/502) of patients were unsure of the effect of pregnancy on risk of BC returning, 34% (173/502) felt it increased risk and 14% (68/502) felt it had no effect. Pregnancy a year post BC was thought to increase risk of recurrence by 37% (70/189) HPs, 31% (59/189) felt it had no effect, 8% (15/189) felt it decreased the risk and 24% (45/189) were unsure. 79% (45/57) of clinicians would consider changing a patient’s chemotherapy regimen to reduce the impact on fertility. 43% (63/145) of patients without children were prepared to delay chemotherapy in order to perform OS. 7.8% of patients had undergone OS post diagnosis. 35% (112/316) of patients would consider interrupting their tamoxifen to conceive. 15% (28/181) of HPs would not consider interrupting a patient’s tamoxifen for fertility reasons, 30% (55/181) would interrupt after 2 years of treatment and 33% (59/181) were unsure. 42% (63/151) of patients with no children prior to diagnosis and 13% (47/355) of patients with children thought they would try for a baby in the future. Their principal concerns were fear of BC returning (54%; 182/339) and leaving a child without a parent (53%; 180/342). Further analysis will be presented. Conclusions: Both patients and HPs have concerns regarding OS and pregnancy on the risk of BC returning. Studies have shown that pregnancy does not increase risk of recurrence yet this message has not filtered through to HPs and patients. Further research is required to understand risk of OS, which is a concern for HPs and patients. A high proportion of patients would consider having children post BC and it is important they are aware of their options. No conflict of interest. 1541 Metacognitive processes in cancer patients
POSTER
H.H. Mutlu1 , H.H. Mutlu2 , S. Selek2 , A. Mayadagli1 , H.M. Turk1 , M. Seker1 , M. Gumus1 . 1 Bezmialem Vakif University, Medical Oncology, Istanbul, Turkey; 2 Medeniyet University, Dept of Psychiatry, Istanbul, Turkey Background: Metacognition is defined as being aware of one’s own thinking processes and the ability to control these processes. In our study, we aimed to investigate the effect of demographic, pathological and clinical features of cancer patients on metacognitive differences. Materials and Methods: The study included 279 patients diagnosed with cancer who were the first applicants to Bezmialem Vakif University Medical Oncology clinics. They were grouped according to their diagnosis and stages of cancer as early stage, locally advanced stage and metastatic stage. The subscales anda total score of metacognition calculated from Metacognition Questionnaire (MCQ-30) (Turkısh Version) completed by participitants were compared with demographic, pathological and clinical features of participants. Results: 53.4% of the 279 participitants were male and 46.6% of them were female. 35.1% of patients had gastroıntestınal tumor, 28% of them had breast cancer and 14% of them had lung cancer. 36.2% of patients were in metastatic stage, 32.6% were in locally advanced stage, 31.2% were in the early stage. According to this results there is no statistically significant evidence showing that type of the cancer, stage of the cancer, gender and age, affect the subscales and total score of metacognition scale (p > 0.05). Conclusions: Metacognition system, plays a major role in the process of adaptation of patients to the current state through their cognitive processes. A malfunction that may occur in this system can give rise to many psychopathological situation. Considering the diagnosis and treatment process of these patients are chalenging, their metacognitive system is likely to be affected. Therefore, the evaluation of these patients with metacognition scale is important in terms of detecting potential mental disorders and refer them to psychiatry physician. No conflict of interest. 1542 POSTER Gaps and inconsistencies found in information available for men with mCRPC V. Jenkins1 , L. Matthews1 , L. Fallowfield1 . 1 University of Sussex, SHORE-C, Brighton & Sussex Med School, Brighton, East Sussex, United Kingdom Background: Men with prostate cancer (PC) may need to make multiple treatment choices over the course of their disease. Improvements in surgical and radiotherapy techniques together with hormones and new
systemic therapies offer prospects of extended survival. In many men PC will ultimately progress and become hormone refractory or castrate resistant (CR). Other lines of therapy such as docetaxel, enzalutamide, abiraterone and cabazitaxel may be offered if available, until supportive care for symptoms of uncontrollable disease remains the only option. We investigated the sources of information provided to men to aid their decision-making and examined healthcare professionals’ (HCPs) views about issues that guided discussions about treatment choices. Methods: First systematic reviews of the quality of life, information needs and decision-making of men with metastatic CRPC (mCRPC) were conducted. We also reviewed the descriptions of mCRPC found on UK PC charity websites and in information leaflets. Finally we ran a focus group with 4 clinical nurse specialists (CNSs) working with mCRPC patients and interviewed 8 oncologists to ascertain:-1) definitions of CRPC and terminology used with patients 2) content of discussions around mCRPC diagnosis and treatments 3) perceived treatment expectations of mCRPC patients 4) worse side effects (SEs) 5) how SEs are captured 6) pathways of care 7) information materials provided and 8) questions patients and their partners ask. Results: The systematic reviews revealed a paucity of good quality research in this specific patient group. Discussions with HCPs exposed needs for more resources to ensure men had access to evidence-based treatments and CNS care. Terminology (CRPC, advanced PC or mCRPC) that HCPs used to classify patients’ disease after treatment failures was inconsistent, as were definitions found in published information and website materials. SEs of treatment were rarely captured formally unless patients were enrolled in clinical trials. Patients and their partners asked questions related to prognosis, therapeutic aims, management of SEs, self-help and how to obtain new drugs. They disliked references to castration which HCPs said they tried to avoid. Conclusion: Compared with early PC, men with mCRPC are a neglected group. Less work has been done determining their specific care needs. The information provided verbally, via leaflets and websites is often confusing with gaps and inconsistencies. Too little research has been conducted demonstrating the impact that newer treatments have on quality of life although this is required to inform and assist decision-making. There is a need for research systematically examining the expectations and experiences of men having treatment which could help influence healthcare policy and improve the management of mCRPC. Conflict of interest: Other Substantive Relationships: Funding for the systematic review was provided from pH Associates via Sanofi. 1543 POSTER Trajectory of self-perceived cognitive impairment: A 15-month prospective, longitudinal study in Asian early-stage breast cancer (ESBC) patients Y.C.J. Lam1 , T. Ng2 , M. Shwe2 , Y.X. Gan3 , Y.T. Cheung2 , G. Fan4 , Y.P. Tan4 , W.S. Yong5 , P. Madhukumar5 , W.J.K. Loh1 , A. Jain1 , G.E. Lee1 , S.L. Koo1 , M. Wong1 , R.A. Dent1 , Y.S. Yap1 , C.H.R. Ng1 , A. Chan3 . 1 National Cancer Centre Singapore, Division of Medical Oncology, Singapore, Singapore; 2 National University of Singapore, Department of Pharmacy, Singapore, Singapore; 3 National Cancer Centre Singapore, Pharmacy, Singapore, Singapore; 4 National Cancer Centre Singapore, Psychosocial Oncology, Singapore, Singapore; 5 National Cancer Centre Singapore, Division of Surgical Oncology, Singapore, Singapore Background: Little is known if ESBC patients experience cognitive impairment that is clinically important. This study evaluates an Asian cohort for clinically significant cognitive decline over a 15-month period. Material and Methods: A multi-center, prospective, longitudinal study in Singapore recruited ESBC patients between 2011 and 2013. Each patient was assessed at four time points: (T1) at baseline, (T2) six weeks, (T3) three months and (T4) fifteen months from start of chemotherapy. FACTCog (v.3) was used to assess self-perceived cognitive function. Cognitive decline was defined as deterioration in FACT-Cog score 10.6 compared to individual baseline (Minimal Clinically Important Difference (MCID) 6.9– 10.6 had been determined in a prior study). Anxiety and cancer-related fatigue were measured using Beck Anxiety Inventory and Brief Fatigue Inventory. Results: 94 patients were recruited (mean age: 51.5±8.4 years; 78.7% Chinese; 81.9% received endocrine therapy post-chemotherapy). 47.9% (45/94) experienced clinically significant cognitive decline at one or more time points within fifteen months after starting chemotherapy. Of these patients, 40.0% (18/45) experienced onset of decline at six weeks (T2), 35.6% (16/45) at three months (T3) and 24.4% (11/45) at fifteen months (T4). Over half of those who experienced early decline at T2 did not recover (55.6% remained impaired), while majority with decline onset at T3 recovered (62.5% recovered) to baseline at T4. At up to twelve
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S. Alsirafy1 , D. Farag1 , M. El-Haddad2 , R. Haggag3 , O. Zaki2 , N. Ibrahim2 , A. Hammad1 . 1 Kasr Al-Ainy School of Medicine − Cairo University, Palliative Medicine Unit − Kasr Al-Ainy Center of Clinical Oncology & Nuclear Medicine NEMROCK, Cairo, Egypt; 2 Kasr Al-Ainy School of Medicine − Cairo University, Department of Clinical Oncology − Kasr Al-Ainy Center of Clinical Oncology & Nuclear Medicine NEMROCK, Cairo, Egypt; 3 Faculty of Medicine, Zagazig University, Department of Medical Oncology, Zagazig, Sharkia, Egypt Background: The negative attitude towards honest disclosure of cancer diagnosis represents a barrier to cancer care in a number of countries. In Egypt, there is a long-standing belief that the culture is against cancer diagnosis disclosure and that patients are generally unaware of their cancer diagnosis. This study investigated the prevalence of and factors associated with unawareness of diagnosis among Egyptian cancer patients. Materials and Methods: The study took place in two Egyptian cancer centres in Cairo and Sharkia governorates, and included 119 adult patients with pathologically proven cancer. Patients were asked to name the disease they are treated for in the corresponding centre. They were considered aware of diagnosis if they answered that the disease is “cancer” or “tumour” or if they named the cancer. Results: The majority (100/119, 84%) of patients were aware of their cancer diagnosis. Among the 100 patients who were aware of their cancer diagnosis, 31% said that they have cancer, 60% said that they have tumour and 9% mentioned the name of the cancer. Older age, male gender, lower education level, being unmarried, living in Sharkia, and having a solid tumour were associated with lower prevalence of cancer diagnosis awareness. However, none of these associations was statistically significant (p = 0.4, 0.27, 0.27, 0.67, 0.33 and 0.27, respectively). Conclusions: Unlike a common belief, the current results suggest that the majority of Egyptian patients with cancer are aware of their cancer diagnosis. This may indicate a changing cultural attitude towards cancer in Egypt and a transition from the traditional paternalistic approach of care to a more patient-centred cancer care. Further research is needed to improve communication in the Egyptian cancer care setting. No conflict of interest. 1538 POSTER Anxiety and depression in patients with newly diagnosed metastatic gastrointestinal cancer H.S. Han1 , J.H. Chung1 , Y. Jeong1 , M.K. Choi1 , J. Kwon1 , K.H. Lee1 , G. Ju2 , S.T. Kim1 . 1 College of Medicine, Chungbuk National University, Department of Internal Medicine, Cheongju, South Korea; 2 College of Medicine, Chungbuk National University, Department of Psychiatry, Cheongju, South Korea Background: Anxiety and depression are the most prevalent psychological symptoms in cancer patients; however, there are few studies on psychological distress in patients with metastatic gastrointestinal cancer. Therefore, the objective of the present study was to assess the prevalence and associated factors of anxiety and depression in Korean patients with metastatic gastrointestinal cancer. Methods: One hundred and twenty consecutive patients with newly diagnosed, metastatic gastrointestinal cancer who were scheduled to receive palliative chemotherapy from July 2012 to June 2014 were enrolled in this prospective study. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS) and Patient Health Questionnaire-9 (PHQ-9). Results: HADS revealed the prevalence of anxiety and depression to be 9.2% and 26.7%, respectively. Thirty-one patients (25.8%) met the diagnostic criteria for major depressive syndrome according to PHQ-9. Overall, 37 patients (30.8%) were diagnosed with anxiety or depression according to HADS or PHQ-9. Multivariate analysis identified lower performance status (odds ratio [OR], 4.19; 95% CI, 1.22 to 14.35; P = 0.023), gastric cancer (OR, 5.39; 95% CI, 0.37 to 78.23; P = 0.018), and knowledge of cancer diagnosis (OR, 15.07; 95% CI, 1.80 to 125.90; P = 0.012) as significantly associated factors with anxiety or depression in patients with metastatic gastrointestinal cancer. Twenty-one patients with anxiety or depression that received therapy in the psycho-oncologic clinic showed greater improvements in the PHQ-9 scores (P = 0.008), global health status (P = 0.023), fatigue (P = 0.047), and appetite loss (P = 0.006) than patients who received no psychologic therapy at 3 months after the study enrollment. Conclusions: This study showed that approximately 30% of the patients with metastatic gastrointestinal cancer suffer from psychological distress.
Physicians should pay attention to the psychologic status of patients diagnosed with metastatic gastrointestinal cancer, particulary those with poor performance status, gastric cancer, and knowledge of cancer diagnosis. No conflict of interest. 1539 POSTER Loneliness during protective isolation in patients with haematological malignancies: A three-dimensional conceptual model V. Biagioli1 , M. Piredda2 , C. Barbaranelli3 , R. Alvaro1 , M.G. De Marinis2 . 1 Tor Vergata University, Biomedicine and Prevention, Roma, Italy; 2 Campus Bio-Medico di Roma University, Research Unit in Nursing Science, Rome, Italy; 3 Sapienza University, Psychology, Rome, Italy Background: Patients with haematological malignancies are often nursed in protective isolation for hematopoietic stem cell transplantation, in order to prevent hospital-acquired infections. Protective measures are implemented inconsistently across centres and are supported by recommendations with different level of evidence. During protective isolation, patients may experience stress, anxiety, anger, depression, insomnia and loneliness. Although a relevant determinant of poor health and quality of life, loneliness is under-conceptualized and measured. From a meta-synthesis of qualitative research on the lived experience of patients in protective isolation, a conceptual model of loneliness, as a consequence of isolation, was generated. It included 3 dimensions: suffering (+), relationship with oneself (−), problems in the relationship with others (+). The purpose of this study is to use these findings to develop a self-report questionnaire to assess loneliness in isolated patients with haematological malignancies. Material and Methods: Following the European Guidelines of the Statistical System, the conceptual model of loneliness was used to develop the items for the questionnaire. In order to verify face validity, two focusgroups were conducted with 10 experts, who systematically evaluated each indicator of patients’ loneliness with a structured form. The experts included: nurses, haematologists, psychologists, and a former patient. This first version of the questionnaire was pilot-tested in patients with haematological malignancies who experienced protective isolation for at least 10 days. Results: The questionnaire showed good face validity. Items for “suffering” refer to boredom, burden of loneliness, powerlessness, amplification of fears, feeling imprisoned, restriction in movement, distress, suffering orders, lack of privacy, helplessness. Items for “relationship with oneself” refer to being focused on oneself, cognitive reappraisal, attribution of meaning to isolation, inner growth, self-esteem. Items for “problems in the relationship with others” refer to loss of touch and closeness, fear of abandonment, lack of comprehension, lack of someone to talk to, danger in the contact with others, feeling cut off from the world. Conclusions: Both the face validity study with experts and the pilot study with haematological patients supported the conceptual model of loneliness generated from the meta-synthesis, and the indicators developed to measure loneliness as a consequence of isolation Further studies should conduct pre-field and field test of the questionnaire, and verify its psychometric properties in a sample of haematological patients in protective isolation for hematopoietic stem cell transplantation. No conflict of interest. 1540 POSTER Attitudes and beliefs of patients and health professionals towards fertility issues in young women with breast cancer R. Lee1 , S. Foy1 , L. Evans1 , S. Howell1 , A.M. Molassiotis1 , A. Armstrong1 . 1 Christie Hospital NHS Foundation Trust, Medical Oncology, Manchester, United Kingdom Background: Breast cancer (BC) is the most common cancer diagnosis in women under 40 years. As a consequence of social factors resulting in delayed age of childbirth and improvements in adjuvant treatment, there are increasing numbers of breast cancer survivors with fertility issues. Method: Two questionnaires were developed and validated using cognitive interviewing. An online survey was sent out to health professionals (HP) via professional bodies and cancer networks. Patients were recruited via national cancer research networks and charities throughout the United Kingdom. Results: 240 HPs and 530 patients participated between Sept 2010 and Nov 2014. 76.4% of patients recalled having a fertility conversation with a HP. Fertility issues were reported to be discussed all of the time by 62% (126/204) of HP and most of the time by 22% (44/204). Ovarian stimulation (OS) was felt to increase the risk of BC returning by 16% (77/489) patients and 28% (54/195) of HPs but 66% of patients
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(323/489) and 56% (109/195) of HPs were unsure. For women already with children, 11% (21/195) HPs felt they would discourage patients from fertility preservation, 67% (131/195) felt they would not and 22% (43/195) felt it would depend on pathology. 47% (237/502) of patients were unsure of the effect of pregnancy on risk of BC returning, 34% (173/502) felt it increased risk and 14% (68/502) felt it had no effect. Pregnancy a year post BC was thought to increase risk of recurrence by 37% (70/189) HPs, 31% (59/189) felt it had no effect, 8% (15/189) felt it decreased the risk and 24% (45/189) were unsure. 79% (45/57) of clinicians would consider changing a patient’s chemotherapy regimen to reduce the impact on fertility. 43% (63/145) of patients without children were prepared to delay chemotherapy in order to perform OS. 7.8% of patients had undergone OS post diagnosis. 35% (112/316) of patients would consider interrupting their tamoxifen to conceive. 15% (28/181) of HPs would not consider interrupting a patient’s tamoxifen for fertility reasons, 30% (55/181) would interrupt after 2 years of treatment and 33% (59/181) were unsure. 42% (63/151) of patients with no children prior to diagnosis and 13% (47/355) of patients with children thought they would try for a baby in the future. Their principal concerns were fear of BC returning (54%; 182/339) and leaving a child without a parent (53%; 180/342). Further analysis will be presented. Conclusions: Both patients and HPs have concerns regarding OS and pregnancy on the risk of BC returning. Studies have shown that pregnancy does not increase risk of recurrence yet this message has not filtered through to HPs and patients. Further research is required to understand risk of OS, which is a concern for HPs and patients. A high proportion of patients would consider having children post BC and it is important they are aware of their options. No conflict of interest. 1541 Metacognitive processes in cancer patients
POSTER
H.H. Mutlu1 , H.H. Mutlu2 , S. Selek2 , A. Mayadagli1 , H.M. Turk1 , M. Seker1 , M. Gumus1 . 1 Bezmialem Vakif University, Medical Oncology, Istanbul, Turkey; 2 Medeniyet University, Dept of Psychiatry, Istanbul, Turkey Background: Metacognition is defined as being aware of one’s own thinking processes and the ability to control these processes. In our study, we aimed to investigate the effect of demographic, pathological and clinical features of cancer patients on metacognitive differences. Materials and Methods: The study included 279 patients diagnosed with cancer who were the first applicants to Bezmialem Vakif University Medical Oncology clinics. They were grouped according to their diagnosis and stages of cancer as early stage, locally advanced stage and metastatic stage. The subscales anda total score of metacognition calculated from Metacognition Questionnaire (MCQ-30) (Turkısh Version) completed by participitants were compared with demographic, pathological and clinical features of participants. Results: 53.4% of the 279 participitants were male and 46.6% of them were female. 35.1% of patients had gastroıntestınal tumor, 28% of them had breast cancer and 14% of them had lung cancer. 36.2% of patients were in metastatic stage, 32.6% were in locally advanced stage, 31.2% were in the early stage. According to this results there is no statistically significant evidence showing that type of the cancer, stage of the cancer, gender and age, affect the subscales and total score of metacognition scale (p > 0.05). Conclusions: Metacognition system, plays a major role in the process of adaptation of patients to the current state through their cognitive processes. A malfunction that may occur in this system can give rise to many psychopathological situation. Considering the diagnosis and treatment process of these patients are chalenging, their metacognitive system is likely to be affected. Therefore, the evaluation of these patients with metacognition scale is important in terms of detecting potential mental disorders and refer them to psychiatry physician. No conflict of interest. 1542 POSTER Gaps and inconsistencies found in information available for men with mCRPC V. Jenkins1 , L. Matthews1 , L. Fallowfield1 . 1 University of Sussex, SHORE-C, Brighton & Sussex Med School, Brighton, East Sussex, United Kingdom Background: Men with prostate cancer (PC) may need to make multiple treatment choices over the course of their disease. Improvements in surgical and radiotherapy techniques together with hormones and new
systemic therapies offer prospects of extended survival. In many men PC will ultimately progress and become hormone refractory or castrate resistant (CR). Other lines of therapy such as docetaxel, enzalutamide, abiraterone and cabazitaxel may be offered if available, until supportive care for symptoms of uncontrollable disease remains the only option. We investigated the sources of information provided to men to aid their decision-making and examined healthcare professionals’ (HCPs) views about issues that guided discussions about treatment choices. Methods: First systematic reviews of the quality of life, information needs and decision-making of men with metastatic CRPC (mCRPC) were conducted. We also reviewed the descriptions of mCRPC found on UK PC charity websites and in information leaflets. Finally we ran a focus group with 4 clinical nurse specialists (CNSs) working with mCRPC patients and interviewed 8 oncologists to ascertain:-1) definitions of CRPC and terminology used with patients 2) content of discussions around mCRPC diagnosis and treatments 3) perceived treatment expectations of mCRPC patients 4) worse side effects (SEs) 5) how SEs are captured 6) pathways of care 7) information materials provided and 8) questions patients and their partners ask. Results: The systematic reviews revealed a paucity of good quality research in this specific patient group. Discussions with HCPs exposed needs for more resources to ensure men had access to evidence-based treatments and CNS care. Terminology (CRPC, advanced PC or mCRPC) that HCPs used to classify patients’ disease after treatment failures was inconsistent, as were definitions found in published information and website materials. SEs of treatment were rarely captured formally unless patients were enrolled in clinical trials. Patients and their partners asked questions related to prognosis, therapeutic aims, management of SEs, self-help and how to obtain new drugs. They disliked references to castration which HCPs said they tried to avoid. Conclusion: Compared with early PC, men with mCRPC are a neglected group. Less work has been done determining their specific care needs. The information provided verbally, via leaflets and websites is often confusing with gaps and inconsistencies. Too little research has been conducted demonstrating the impact that newer treatments have on quality of life although this is required to inform and assist decision-making. There is a need for research systematically examining the expectations and experiences of men having treatment which could help influence healthcare policy and improve the management of mCRPC. Conflict of interest: Other Substantive Relationships: Funding for the systematic review was provided from pH Associates via Sanofi. 1543 POSTER Trajectory of self-perceived cognitive impairment: A 15-month prospective, longitudinal study in Asian early-stage breast cancer (ESBC) patients Y.C.J. Lam1 , T. Ng2 , M. Shwe2 , Y.X. Gan3 , Y.T. Cheung2 , G. Fan4 , Y.P. Tan4 , W.S. Yong5 , P. Madhukumar5 , W.J.K. Loh1 , A. Jain1 , G.E. Lee1 , S.L. Koo1 , M. Wong1 , R.A. Dent1 , Y.S. Yap1 , C.H.R. Ng1 , A. Chan3 . 1 National Cancer Centre Singapore, Division of Medical Oncology, Singapore, Singapore; 2 National University of Singapore, Department of Pharmacy, Singapore, Singapore; 3 National Cancer Centre Singapore, Pharmacy, Singapore, Singapore; 4 National Cancer Centre Singapore, Psychosocial Oncology, Singapore, Singapore; 5 National Cancer Centre Singapore, Division of Surgical Oncology, Singapore, Singapore Background: Little is known if ESBC patients experience cognitive impairment that is clinically important. This study evaluates an Asian cohort for clinically significant cognitive decline over a 15-month period. Material and Methods: A multi-center, prospective, longitudinal study in Singapore recruited ESBC patients between 2011 and 2013. Each patient was assessed at four time points: (T1) at baseline, (T2) six weeks, (T3) three months and (T4) fifteen months from start of chemotherapy. FACTCog (v.3) was used to assess self-perceived cognitive function. Cognitive decline was defined as deterioration in FACT-Cog score 10.6 compared to individual baseline (Minimal Clinically Important Difference (MCID) 6.9– 10.6 had been determined in a prior study). Anxiety and cancer-related fatigue were measured using Beck Anxiety Inventory and Brief Fatigue Inventory. Results: 94 patients were recruited (mean age: 51.5±8.4 years; 78.7% Chinese; 81.9% received endocrine therapy post-chemotherapy). 47.9% (45/94) experienced clinically significant cognitive decline at one or more time points within fifteen months after starting chemotherapy. Of these patients, 40.0% (18/45) experienced onset of decline at six weeks (T2), 35.6% (16/45) at three months (T3) and 24.4% (11/45) at fifteen months (T4). Over half of those who experienced early decline at T2 did not recover (55.6% remained impaired), while majority with decline onset at T3 recovered (62.5% recovered) to baseline at T4. At up to twelve