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The cognitive-behavioral model of chronic insomnia in breast cancer survivors: a grounded theory study
15th St.Gallen International Breast Cancer Conference / The Breast 32S1 (2017) S78–S132
P322 Breast cancer diagnosed during pregnancy: patient and treatment factors in a contemporary cohort G. Eng Lee1 *, S. Rosenberg1, E. Mayer1, V. Borges2, M. Meyer1, A. Partridge1. 1Dana-Farber Cancer Institute, Boston, USA, 2University of Colorado Cancer Center, Denver, USA Aims: As more women postpone child-bearing, the incidence of breast cancer diagnosed during pregnancy is increasing. To improve clinical management and counseling, we characterized patient, treatment, pregnancy and lactation factors among young women with newly diagnosed breast cancer during pregnancy in a prospective cohort study. Methods: We identified all women who were pregnant when diagnosed with breast cancer among those enrolled in a multi-site, prospective cohort study of women with breast cancer age ≤40 years, between 2006 and 2016. Pregnancy, birth and lactation details were self-reported by patients on the baseline/1-year surveys. Gestational age at diagnosis, treatments including type and timing of surgery and chemotherapy; pathology and staging information were determined by chart review. Results: Of 1074 eligible women enrolled in the cohort, 39 (3.6%) patients reported being pregnant at diagnosis. Median age at diagnosis was 34 years (range: 25–40); with stage distribution: I 28%, II 44%, III 23%, and IV 5%. Most patients (29/39, 74%) had grade 3 disease, 59% (23/39) ER positive and 31% (12/39) HER2 positive. 23 (59%) had surgery during pregnancy, 4 (17%) during the first trimester. Among the women who had surgery during pregnancy, 61% (14/23) underwent lumpectomy, 35% (8/23) unilateral, and 4% (1/ 23) bilateral mastectomy, with only 1 complication of slow wound healing. 20 of 39 (51%) patients received chemotherapy during pregnancy, all beginning second trimester. All received AC × 4 (3 dose dense), with 4 also receiving taxol (3 weekly and 1 dose dense) during pregnancy. 90% of women who received chemotherapy while pregnant did not experience any chemo-related complications/ cycle delays; 1 women had a delay due to shingles and another developed ITP requiring induction, which resolved post-partum. There were 31 live births, 2 spontaneous, 5 therapeutic abortions and 1 missing data. Among live births, 40% were before 37 weeks of gestation, with 17 (44%) induced/planned caesarean. 3 women reported breast-feeding. Within 6 months after delivery, comprehensive staging imaging was completed in a select group of 13 patients, with upstaging (to either stage III or IV) in 4 patients. Conclusion: Within a prospective cohort study of young women with breast cancer, 4% of women reported a breast cancer diagnosis during pregnancy. Treatment was generally consistent with standard surgical and chemotherapy, with attention to timing of the chemotherapy, with limited complications reported. Disclosure of Interest: No significant relationships. P323 The cognitive-behavioral model of chronic insomnia in breast cancer survivors: a grounded theory study M. Wang, J. Liu*, C. Xue. Capital Medical University School of Nursing, Beijing, China Aims: To explore the experience of chronic insomnia in breast cancer survivors. Methods: A grounded theory design was adopted. Thirty-one breast cancer survivors with chronic insomnia were selected by theoretical sampling method in the Tiantan Hospital affiliated to Capital Medical University, between July 2013 and October 2014. Data were collected by face-to-face in-depth interviews mainly. The constant comparative method, coding analysis method and memo strategies were used to analyze the data. Results: The experience of chronic insomnia in breast cancer survivors included 5 stages: sleep neglect, sleep inspection, sleep anxiety, sleep burden and coexistence learning. Their sleep cognition
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consisted of 6 parts: insomniac reason, sleep function, cognition about behavior, sleep expectation, sleep predicting and the ability to deal with insomnia. Their sleep behaviors included solace, protective sleep behaviors, thought control, distraction and adjustment, which one-to-one matched to the experience. The risk factors comprised of insomnia enhancing factors and insomnia repeated factors. Insomnia enhancing factors were made up of collision, control and threaten. Insomnia repeated factors included frustration, lassitude, physical discomfort and negative resonance. Protective factors consisted of satisfied, hope, positive resonance and introspection. The experience of chronic insomnia in breast cancer survivors was a process of conflicts’ internalization. Sleep cognition was the background, and sleep behaviors were the basic driving force. Insomnia enhancing factors, together with the contribution of insomnia repeated factors, were the guide of their experience. Protective factors could slow down the negative function of risk factors, and promote active adaptation. Conclusion: Breast cancer survivors gradually became over-concerned with sleep during the development of chronic insomnia. Sleep cognition and the main sleep behaviors in different stages could have affected their feelings about insomnia. The findings provide information for health professionals to understand the experiences and attitudes about insomnia in breast cancer survivors. Disclosure of Interest: No significant relationships. P324 What do women and men feel about BRCA diagnosis? P. Modaffari1, R. Ponzone2, I. Cipullo1, M. D’Alonzo1, V. Bounous1, F. Maggiorotto2, N. Biglia1 *. 1Academic Department of Gynecology Oncology, Mauriziano Hospital, Turin, Italy, 2Department of Gynecology, IRCCS Candiolo, Candiolo, Italy Aims: BRCA carriers (BRCAcs) have an increased risk of developing breast and ovarian cancer. BRCAcs have different options to handle cancer risk: they can opt for surveillance or risk-reducing surgery RRS (mastectomy (RRM, including breast reconstruction) and/or salpingo-oophorectomy (RRSO)). Although, RRS may interfere with BRCAcs self-body image and cause early menopause, influencing their quality of life (QoL) and relationships. Methods: Two multiple-choice questionnaires (for the BRCAc and her partner, respectively) were created. Questions focused on QoL after diagnosis, RRS outcomes, sexual functions and parenthood. Results: 20 couples were interviewed: mean women and men age was 40 (29–64) and 51 (26–71) years, respectively. At the time of BRCA diagnosis, 33.3% of BRCAcs had already developed a breast cancer, 84.3% of the participants were already coupled and 75% of men spontaneously participated to informative meeting with clinicians. RRM has been performed in 35% of BRCAcs, while RRSO in 75% of them. BRCAcs reported to be more worried about cancer development or children inheritance than RRS results. Men agreed to RRS choice in 57.1% and 56.3% of RRM and RRSO, respectively. 83.3% of men were less afraid for partner’s health after RRS and they were all satisfied by RRM esthetical results. Overall, complete satisfaction was achieved by 93.8% and 100% of BRCAcs submitted to RRSO and RRM, respectively. Although, 42.9% of BRCAcs was not fully satisfied of nipple or breast perception and 34.4% of them reported severe sexual or menopause-related disorders. In fact, 17.7% and 43.7% of men and BRCAcs, respectively, was not completely honest with partner about sexual aspects after RRS. BRCAcs and men reported that BRCA diagnosis did not influence their choice in become parents as 61.9% of couples already had children at the diagnosis and 19% of them became parents after that. Finally, 47.6% of BRCAcs and 35% of men affirmed that they would consider embryos pre-implantation genetic diagnosis if available. Conclusion: Despite side effects, most of BRCAcs reported to be very satisfied by RRS and would undergo surgery again. Partners frequently agreed with BRCAcs in their decision on RRS and were
P322 Breast cancer diagnosed during pregnancy: patient and treatment factors in a contemporary cohort G. Eng Lee1 *, S. Rosenberg1, E. Mayer1, V. Borges2, M. Meyer1, A. Partridge1. 1Dana-Farber Cancer Institute, Boston, USA, 2University of Colorado Cancer Center, Denver, USA Aims: As more women postpone child-bearing, the incidence of breast cancer diagnosed during pregnancy is increasing. To improve clinical management and counseling, we characterized patient, treatment, pregnancy and lactation factors among young women with newly diagnosed breast cancer during pregnancy in a prospective cohort study. Methods: We identified all women who were pregnant when diagnosed with breast cancer among those enrolled in a multi-site, prospective cohort study of women with breast cancer age ≤40 years, between 2006 and 2016. Pregnancy, birth and lactation details were self-reported by patients on the baseline/1-year surveys. Gestational age at diagnosis, treatments including type and timing of surgery and chemotherapy; pathology and staging information were determined by chart review. Results: Of 1074 eligible women enrolled in the cohort, 39 (3.6%) patients reported being pregnant at diagnosis. Median age at diagnosis was 34 years (range: 25–40); with stage distribution: I 28%, II 44%, III 23%, and IV 5%. Most patients (29/39, 74%) had grade 3 disease, 59% (23/39) ER positive and 31% (12/39) HER2 positive. 23 (59%) had surgery during pregnancy, 4 (17%) during the first trimester. Among the women who had surgery during pregnancy, 61% (14/23) underwent lumpectomy, 35% (8/23) unilateral, and 4% (1/ 23) bilateral mastectomy, with only 1 complication of slow wound healing. 20 of 39 (51%) patients received chemotherapy during pregnancy, all beginning second trimester. All received AC × 4 (3 dose dense), with 4 also receiving taxol (3 weekly and 1 dose dense) during pregnancy. 90% of women who received chemotherapy while pregnant did not experience any chemo-related complications/ cycle delays; 1 women had a delay due to shingles and another developed ITP requiring induction, which resolved post-partum. There were 31 live births, 2 spontaneous, 5 therapeutic abortions and 1 missing data. Among live births, 40% were before 37 weeks of gestation, with 17 (44%) induced/planned caesarean. 3 women reported breast-feeding. Within 6 months after delivery, comprehensive staging imaging was completed in a select group of 13 patients, with upstaging (to either stage III or IV) in 4 patients. Conclusion: Within a prospective cohort study of young women with breast cancer, 4% of women reported a breast cancer diagnosis during pregnancy. Treatment was generally consistent with standard surgical and chemotherapy, with attention to timing of the chemotherapy, with limited complications reported. Disclosure of Interest: No significant relationships. P323 The cognitive-behavioral model of chronic insomnia in breast cancer survivors: a grounded theory study M. Wang, J. Liu*, C. Xue. Capital Medical University School of Nursing, Beijing, China Aims: To explore the experience of chronic insomnia in breast cancer survivors. Methods: A grounded theory design was adopted. Thirty-one breast cancer survivors with chronic insomnia were selected by theoretical sampling method in the Tiantan Hospital affiliated to Capital Medical University, between July 2013 and October 2014. Data were collected by face-to-face in-depth interviews mainly. The constant comparative method, coding analysis method and memo strategies were used to analyze the data. Results: The experience of chronic insomnia in breast cancer survivors included 5 stages: sleep neglect, sleep inspection, sleep anxiety, sleep burden and coexistence learning. Their sleep cognition
S129
consisted of 6 parts: insomniac reason, sleep function, cognition about behavior, sleep expectation, sleep predicting and the ability to deal with insomnia. Their sleep behaviors included solace, protective sleep behaviors, thought control, distraction and adjustment, which one-to-one matched to the experience. The risk factors comprised of insomnia enhancing factors and insomnia repeated factors. Insomnia enhancing factors were made up of collision, control and threaten. Insomnia repeated factors included frustration, lassitude, physical discomfort and negative resonance. Protective factors consisted of satisfied, hope, positive resonance and introspection. The experience of chronic insomnia in breast cancer survivors was a process of conflicts’ internalization. Sleep cognition was the background, and sleep behaviors were the basic driving force. Insomnia enhancing factors, together with the contribution of insomnia repeated factors, were the guide of their experience. Protective factors could slow down the negative function of risk factors, and promote active adaptation. Conclusion: Breast cancer survivors gradually became over-concerned with sleep during the development of chronic insomnia. Sleep cognition and the main sleep behaviors in different stages could have affected their feelings about insomnia. The findings provide information for health professionals to understand the experiences and attitudes about insomnia in breast cancer survivors. Disclosure of Interest: No significant relationships. P324 What do women and men feel about BRCA diagnosis? P. Modaffari1, R. Ponzone2, I. Cipullo1, M. D’Alonzo1, V. Bounous1, F. Maggiorotto2, N. Biglia1 *. 1Academic Department of Gynecology Oncology, Mauriziano Hospital, Turin, Italy, 2Department of Gynecology, IRCCS Candiolo, Candiolo, Italy Aims: BRCA carriers (BRCAcs) have an increased risk of developing breast and ovarian cancer. BRCAcs have different options to handle cancer risk: they can opt for surveillance or risk-reducing surgery RRS (mastectomy (RRM, including breast reconstruction) and/or salpingo-oophorectomy (RRSO)). Although, RRS may interfere with BRCAcs self-body image and cause early menopause, influencing their quality of life (QoL) and relationships. Methods: Two multiple-choice questionnaires (for the BRCAc and her partner, respectively) were created. Questions focused on QoL after diagnosis, RRS outcomes, sexual functions and parenthood. Results: 20 couples were interviewed: mean women and men age was 40 (29–64) and 51 (26–71) years, respectively. At the time of BRCA diagnosis, 33.3% of BRCAcs had already developed a breast cancer, 84.3% of the participants were already coupled and 75% of men spontaneously participated to informative meeting with clinicians. RRM has been performed in 35% of BRCAcs, while RRSO in 75% of them. BRCAcs reported to be more worried about cancer development or children inheritance than RRS results. Men agreed to RRS choice in 57.1% and 56.3% of RRM and RRSO, respectively. 83.3% of men were less afraid for partner’s health after RRS and they were all satisfied by RRM esthetical results. Overall, complete satisfaction was achieved by 93.8% and 100% of BRCAcs submitted to RRSO and RRM, respectively. Although, 42.9% of BRCAcs was not fully satisfied of nipple or breast perception and 34.4% of them reported severe sexual or menopause-related disorders. In fact, 17.7% and 43.7% of men and BRCAcs, respectively, was not completely honest with partner about sexual aspects after RRS. BRCAcs and men reported that BRCA diagnosis did not influence their choice in become parents as 61.9% of couples already had children at the diagnosis and 19% of them became parents after that. Finally, 47.6% of BRCAcs and 35% of men affirmed that they would consider embryos pre-implantation genetic diagnosis if available. Conclusion: Despite side effects, most of BRCAcs reported to be very satisfied by RRS and would undergo surgery again. Partners frequently agreed with BRCAcs in their decision on RRS and were