Support Care Cancer (2017) 25 (Suppl 2):S21–S266 DOI 10.1007/s00520-017-3704-x

ABSTRACTS

MASCC/ISOO 2017 Annual Meeting

Supportive Care in Cancer /

ANNUAL MEETING ON S UPP OR TIV E C ARE IN C ANCER Washington DC, USA 22-24 June 2017

Multinational Association of Supportive Care in Cancer

Supportive Care Makes Excellent Cancer Care Possible This supplement was not sponsored by outside commercial interests. It was funded entirely by the publisher and the Societies

Support Care Cancer (2017) 25 (Suppl 2):S21–S266

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Abstracts of the MASCC/ISOO 2017 Annual Meeting Explanation of the Abstract Coding System Each abstract type is assigned a special code: & PS: Parallel & eP: e-Poster The abstracts are presented in the following order with the below codes:

PS PS PS PS PS PS PS PS PS PS PS PS PS PS PS PS PS EP EP EP EP EP EP EP EP EP EP EP EP EP EP EP EP EP EP EP EP EP EP EP EP

Bone Health in Cancer: Advances in research and clinical practice Clinical tobacco intervention: role in supportive care JBI Session/Disability on Cancer Neurological Complications Palliative Care Integrating oncodermatology into practice: state of the science Challenges in pain control in pediatric oncology Neutropenai, Infection and Myelosuppression Study Group Mucositis: outcome measures Mucositis Proffered Papers Health related quality of life across the cancer trajectory Geriatric assessment as a supportive care strategy - how can technology help patients and clinicians care for older adults with cancer? Psychosocial Proffered Papers Scalp Coooling Session Nutrition and Cachexia Proffered Papers Cross Cultural Communication in Cancer Care A Taste of Vienna Antiemetics Bone Cancer Pain Education in Supportive Care Fatigue Geriatrics Late Breakers Lymphedema Mucositis Neurological Complications Neutropenia-Infections and Hematologic Toxicity Nutrition and Cachexia Oral Care Other Paediatrics Palliative Care and End-Stage Disease Psychooncology Quality of Life Rehabilitation Respiratory Skin toxicity Survivorship Thromboembolic Events Toxicity of Targeted Anti-Cancer Therapy

PS001-PS002 PS003-PS005 PS006-PS008 PS009-PS011 PS012-PS013 PS014-PS016 PS017-PS018 PS019-PS021 PS022-PS023 PS024-PS032 PS033-PS034 PS035-PS036 PS037-PS045 PS046-PS047 PS048-PS056 PS057-PS059 PS060-PS068 eP001-eP028 eP029-eP044 eP045-eP084 eP085-eP131 eP132-eP151 eP152-eP170 eP171-eP178 eP179-eP183 eP184-eP205 eP206-eP216 eP217-eP225 eP226-eP241 eP242-eP268 eP269-eP322 eP323-eP332 eP333-eP398 eP399-eP425 eP426-eP474 eP475-eP493 eP494-eP497 eP498-eP502 eP503-eP539 eP540-eP543 eP544-eP555

Support Care Cancer (2017) 25 (Suppl 2):S21–S266

Author Name Presentation No. Aapro, M. eP018, eP085, PS049 Aaronson, N. eP384 Abasher, S. eP086 Abbott, J. eP173 Abd el wahab, R. eP540 Abdel-Rahman, O. eP437 Abe, K. eP475 Abe, M. eP001 Abernethy, A. eP348 Aboudagga, H. eP023 Abraham, I. eP218 Abrams, G. eP216 Abu Al Hamayel, N. eP364 Acharya Mainali, A. eP258, eP259 Acharya, B.eP242, eP258 Adam, B. eP068 Adams, J. PS055, PS065 Adegboyega, A. eP403 Aditya, M. eP333, eP334 Affronti, M.L. eP178 AFSOS, E.G. eP090 Afzal, A. eP002 Agape, P. eP287 Agar, M.PS042 Agarwal, A. eP029, eP030, eP031, eP034, eP036, eP038, eP046, eP047, eP048, eP049, eP053, eP082, eP092, eP108, eP170, eP206, eP272, eP286, eP294, eP316, eP336, eP340, eP341, eP342, eP343, eP365, eP366, eP380, eP392, eP433, eP434, eP447, eP508, eP509, PS009 Agboola, O. eP087 Agnieszka, S.R. eP510 Aguti, V. eP426 Ahari, S. eP172 Ahles, T. PS011 Ahmed, S. eP055, eP057, eP069, eP457 Ahmed, Y. eP029, eP045 Ahmedzai, S. eP051 Ahmedzai, S.H. eP060 Ahn, J. eP438 Ahn, J.S. eP382 Ahn, S.Y. eP477 Ahrari, S. eP170 Ahrendt, G. eP183 Aiba, K. eP024 Aiken, A. eP522 Ajazi, E. PS053 Akashi, Y. eP386 Akbarov, K. eP427 Akins, L.eP062 akmansu, M. eP217 aksu, A. eP217 Aktas, A. eP239 Al Eid, A.A. eP196 AL TARAWNEH, N. eP540 Aladelusi, T. eP288, eP289 Alananzeh, I. eP399 Alba, E.eP429 Albrecht, T. eP171, eP338 Aldini, G. eP257 Alexander, K. PS033 Alexandre, S. eP308 ALFIERI, S. eP133, eP500 Ali, M. eP020 Alibhai, S. eP153, eP159, eP165, eP167 Alicia, L. eP201

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Aliyeva, N. Allam, A. Allard, M. Allende Perez, S. Allende-perez, S. Allenidekania, A. Almeida, A.M. Almeida, A.M.D. Alo Nesrallah, A.C. Alpert, A. Alton, D. Alves, M.T. Alvi, F. Amadori, F. Amanie, J. Ambroise, H. Amin, S.R. Ana, M. Anadkat, M. Anandi, P. Andalusia, R. Andersen, M. Anita, C.G. Anne, E. Annunziato, P. Antonio, B. Antonio, L.P. Antoniou, F. Antonuzzo, A. Aoki, E. Aoyama, T. Arad, M. Arai, H. Aranda, S. ARAPASLAN, B. Ardavanis, A. Armer, J. Armer, J.M. Armer, N.C. Armstrong, J. Armstrong, T. Arnav, A. ARORA, M. Arora, S. Arrais, C. Aruah, S.C. Arvin, A. Asare, M. Asher, R. Aslakson, R. Aslin, R. Asmis, T. Assal MD, A. Astori, A. Astras, G. Athanasiadis, I. Atkins, J. Atkins, L. Atsushi, H. Au, J. Aubaret, C. Augustine, D. Ault, P. Aurora, C. Auyeung, V. Avila, D.

eP427 eP063 PS045 eP390, eP493, eP387, eP389 eP388 eP088, eP132 eP511 eP279 eP200 eP269 eP503, eP515 eP199 eP330 eP184, eP185 eP350, PS034 eP089 eP357 eP211 PS015 eP530 eP004 PS031 eP510 eP201 eP462 eP418 eP201 PS002 eP224, eP229, eP300, eP404, eP417, eP420 eP136 eP226, eP160, eP162, eP487 eP080 eP226 eP101 eP408 eP042, PS002 eP180 eP179 eP180 eP369 eP146 eP068 eP416 eP017 eP200 eP270 eP462 eP271, eP067, eP135, eP164, PS041 PS010 eP362 eP067 eP282 PS032 eP223 eP499 eP042, PS002 eP521 PS052 eP386 eP212 eP307 eP460 eP424 eP418 eP107 eP261

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Awuah, Ayala, AYPAK, Ayvaz, Azad, A.

K.eP021 A.P.eP159 C.eP409 S.eP239 eP046, eP053, eP083, eP272, eP319, eP320, eP321, eP393, eP469, eP508, eP509, eP534, PS062 Azam, M. eP074 Babington, S. eP054, eP056 Bachelot, T. eP555 Bachi, A. eP530 Bäck, M. PS008 Backx, K. eP394 Badre, S. eP449 Badru, A. eP363 Bae, S.H. eP117 Bae, W.K. eP106 Baek-Yeol, R. eP543 Bagcivan, G. eP335, PS058 Bain, E. eP336, eP380 Bainbridge, D. eP486 Baines, K.A. eP536 Baird, K. eP261 Bajory, Z. eP037 Baker, J. eP349, eP451 Bakitas, M. eP335, PS058 Balding, L. eP214, eP238 Ball, I. PS024, PS051 Ballman, K. eP179 Balu, S. eP218 Bamford, L. eP406 Banipal, R.P.S. eP149 Barakat, T. eP206, eP047, eP082, eP447 Baranovsky, I.eP398 Barcelo, J.D. eP325 Bardellini, E. eP184, eP185 Barnes, E.eP032, eP047, eP049, eP172, eP340, eP341, eP433, eP434, PS009 Barnes, T. eP494 Barni, S. eP223 Barrett, A.J. eP530 Barrett, M. eP241, PS068 Barros Ferreira, E. eP096, eP138 Basen-Engquist, K. eP150 Bassier-Paltoo, M. eP533 Bassim, C. eP261 Basu, T. eP428 Bateman, E. PS051 Battiwalla, M. eP530 Bautista, J. eP051 Bauvin, E. eP273, eP274 Baylor, C. eP505, eP514 Beale, P. PS010 Beatriz, C. eP201, eP201 Beck Popovic, M. eP285 Beck, S. eP471 Bedard, G. eP439 Belanger, A. eP093 BENDIANE, M.K. eP065 Bensink Ph.D.- M.Sc.- M.Ed., M.PS020, PS021 Benvenuti, F. PS025 Beppu, T. PS027 Berezowska, A. PS057

BERGAMINI, C. Bergmann, O.J. Bernardi, M. Berry, L. Besa, R. Beuzeboc, P. Bevans, M. Bezjak, A.

eP500 PS031 eP431 eP328, eP327 eP294 eP287 eP146, eP419 eP083, eP165, eP393, eP469, PS062 BHARGAVA, R. eP227 Bhatia, A. eP439 Bhatnagar, S. eP453 Bhatt, G. eP154 Bhattacharya, B. eP016 Bianchi, R. eP133 Biasco, E. eP224, eP229, eP300, eP404, eP417, eP420 Biasotto, M. eP071, PS022, PS025 Bihan, C. eP313 Bikkina, M. eP218 Billett, A. eP546 Bilodeau, K. eP504, eP532 Binas, G. eP553 Binas, I. eP215 Biswas, S. eP016 Bittoni, A.M. eP154 Bjarnason, G.A. eP049, eP340, eP341 Black, J. PS052 Black, K. eP305, eP306 Blair, A. eP362 Blake, A. eP318, eP317, eP442, eP468, PS064, PS067 BLAZEJEWSKI, V. eP110 Bleiker, E. PS057 Blijlevens, N. eP246, eP245 Bobrowski, A. eP030, eP046, eP272, eP031, eP509 Boccia, G. PS056 Boccia, R. eP003 Bødker, J.S. PS031 Boeckh, M. eP462 Bøgsted, M. PS031 Bogusław, M. eP510 Bohac, C. eP449 Boileau, E. eP444 Boll, D. PS044 Bolt, S. eP505, eP514 Bonan, B. eP023 Bonaventura, M. eP183 Bonci, F. eP404, eP417, eP420 Bondil, P. eP090, eP155, eP273, eP274 BONFANTINI, F. eP500 Bonnet, K. eP538 Bontempo, P.S.M. eP096 Boonnuch, W. eP527 Boparai, R. eP430, eP498, eP544 Borean, M. eP047, eP082, eP206, eP447 Borges, M.L. eP280 Borgonovo, K.F. eP223 Bosnjak, S. eP028, eP058 BOSSI, P. eP133, eP197, eP500 Botella, L. eP418 Bottomley, A. eP447 Boughey, J.C. eP179 BOUHNIK, A.D. eP065 Bouzari, Z. eP275

Bouzid, K. Bowen, J. Boya, M.J. Brady, B. Braga, F. Brami, C. Brazzi, L. Brennan, M.

eP051 PS023, PS024, PS026, PS051 eP208, eP339 PS068, eP238 eP545 eP307 eP347 eP243, eP244, eP245, eP246, eP256 Brenner Prof., B. eP100 Brinch, L. eP267 Bristow, B. eP286 Broadus, J. eP306 Brocard, F. eP287 Brotherston, D. eP033 Brown, C. eP178 Brown, M.C. eP503, eP515 Bruera, E. eP150, eP151, eP277, eP281, eP326, eP352, eP357, eP358, eP359, eP360, eP396, PS004, PS048 Brundage, M. eP054, eP055, eP056, eP057, eP069, eP457 Brunetti, I. eP404 Brunetti, I.M. eP224, eP229, eP417, eP420 Buchanan, A.M. PS042 Buga, S. eP397 Buiret, G. PS012 Bujno, R. eP302 Burdaeva, O. eP555 Burke, H. eP093 Burns, M. eP505 Burris, H. eP429, eP555 Bussani, R. PS025 Bustamam, R.S. eP004 Butler, T. eP400 Butterbrodt, A. eP233 Bye, A. eP488 Byfieldt, N. eP346 Byrd, D.R. eP179 Byrne, A. eP309, eP394 Cabiddu, M. eP223 CABRERA, P. eP389 Caliolo, C. eP298 Caloro, M. eP298 Cameron, E. eP533 Campaniello, M. PS023 Campbell, F. eP324 Campbell, K. eP218 Campone, M. eP429 Candiani, M. eP431 Caraceni, A.T. eP359 Carafizi, N. eP337 Caran, E. eP199 Cardoni, M. eP327 Cardoso, D. PS043 Carey, C. eP123 Carey, S. PS050 Carides, M. eP467 Carlo, D. eP509 Carmack, C. PS004 Carmack, C.L. eP150 Carnelli, L. eP431 CARNICELLI, D. eP273, eP274, eP155 Caronni, N. PS025

Support Care Cancer (2017) 25 (Suppl 2):S21–S266

Carpenter, L. PS042 Carson, E.K. eP014 Carter, M. eP178 Cartmill, B. eP432 Caskenette, S. eP034, eP047 Cassel, B. eP338, eP081, eP329 Cassenote, A.J.F. eP279 CASTELAIN, S. eP110 Castellanos, E. eP276, eP266, eP538 Caswell, J. PS005 Cavaco, P. eP207 CAVALLO, A. eP500 Cavanagh, M. eP208, eP339 Celio, L. eP018 Cella, D. eP440, eP441, eP447 Celsi, F. eP071 Cevik, B. eP411 Cha, W.C. eP477 Chabot, P. eP055, eP057, eP069, eP457 Chae, J.W. eP506, PS047, PS061 Chafe, W. eP537 Chaiyakunapruk, N. eP004 Champlin, R. PS035 Chan, A. eP134, eP507, eP004, eP212, eP506, eP555, PS047, PS061 Chan, I. eP462 Chan, J. eP282 Chan, K. eP172 Chan, S. eP048, eP049, eP340, eP341, eP433, eP434, eP468, eP029, eP030, eP031, eP032, eP035, eP038, eP044, eP046, eP047, eP053, eP108, eP170, eP172, eP272, eP278, eP286, eP317, eP318, eP319, eP320, eP321, eP344, eP345, eP366, eP392, eP442, eP447, eP457, eP494, eP508, eP534, PS064, PS067 Chandiwana, D. eP429 Chandler- Ph.D., D. PS020, PS021 Chang, C.H. PS038 Chang, D.K. eP477 Chang, E. eP232 Chang, H.J. eP050 Chang, J. eP112 Chang, Y. eP061 Chang, Y.J. eP378 Chang, Y.P. eP435, eP436 Chansilpa, Y. eP527 Chanthawong, S. eP004, eP293 Charalambous, A. eP499 Charames, G. eP046, eP053, eP083, eP272, eP319, eP320, eP321, eP393, eP469, eP508, eP509, eP534, PS062 Charbonneau, F. eP036, eP278 CHASEN, M. eP227 Chatzichalepli, C. PS030 Chatzihalepli, C. eP042 Chaudhari, S. eP554 Chauffert, B. eP313 Chebolu, C. PS055 Cheifetz, O. eP486 Chen, C. eP405 Chen, C.C. eP064

Chen, Y. Chen, Y.J. Chen, Y.W. Cheng, H. Cheng, K. Cheng, K.F.K. Cheng, K.L. Cheng, S.e Cheng, T.C. Cheon, S. Cheong, I.Y. Cherkaoui, S. Cherny, N. Chessari, S. Chetrì, M.C. Cheung, W. Cheung, Y.T. Chiappini, D. Chin, L. Chisolm, S. Chiu, L.

Chiu, N.e Cho, J. Cho, J.Y. Cho, M. Cho, Y.H. Choi, I. Choi, M. Choi, M.K. Choi, S. Choi, Y. Chou, Y.J. Chow, E.

Chow, R.

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eP091 eP401 eP091 eP212, eP448 eP186, eP197 eP452 PS047 P091 eP435 eP092, eP342, eP343, eP008 eP476, eP477 eP228 eP359 PS049 eP298 eP437, PS019 eP323 eP185 eP033 eP136 eP005, eP006, eP007, eP008, eP052, eP277, eP443, PS048 P052, eP005, eP006, eP007, eP033, eP277, eP443, PS048 eP438, eP456 eP476 eP261 eP050 eP166 eP031, eP053, eP508, eP509, eP108 eP070 eP150 eP520 eP147 eP005, eP006, eP007, eP008, eP029, eP030, eP031, eP032, eP033, eP034, eP035, eP036, eP038, eP044, eP045, eP046, eP047, eP048, eP049, eP052, eP053, eP054, eP055, eP056, eP057, eP068, eP069, eP082, eP083, eP092, eP093, eP094, eP095, eP108, eP170, eP172, eP206, eP272, eP277, eP286, eP294, eP316, eP317, eP318, eP319, eP320, eP321, eP336, eP340, eP341, eP342, eP343, eP344, eP345, eP365, eP366, eP380, eP392, eP393, eP433, eP434, eP439, eP440, eP441, eP442, eP443, eP447, eP457, eP468, eP469, eP494, eP508, eP534, PS009, PS048, PS062, PS064, PS067 eP007, eP008, eP054, eP056, eP093, eP094, eP095, eP277, eP278, eP344, eP345, eP439, eP440, eP441, PS048, eP005, eP006, eP035, eP036, eP046, eP052, eP053, eP108, eP156, eP170, eP272, eP294, eP319, eP320, eP321, eP365, eP366, eP433, eP434, eP443, eP508, eP509, eP534, PS009

Chow, S.

eP055, eP057, eP156, PS009, eP108, eP170, eP294, eP365, eP366, PS048 Chowdhury, S. eP041, eP215 Christakis, M. eP032, eP036, eP316 Christakis, N. eP316 Christiansen, I. PS031 Christophe, A. eP308 Chu, K. PS034 Chu, K.P. eP131, eP350 Chufal, K. eP074 Chung, H. eP048, eP172 Chung, S.H. eP476 Chung, W.L. eP507 Chunhua, Y. eP425 Ciccone, G. eP347 Cinefra, M. eP298 Citak, E. eP411 Ciuleanu, T.E. eP010 Ciupek, A. eP526 Claire, G. eP308 Clark-Snow, R. eP017 Clark, K. eP346 Cleeland, C.S. eP424 Clegg, J. eP451 Clendeninn, N. eP003, PS056 Cloé, B. eP308 Co, J. eP188 cobos, J. eP339 Cohen, E. eP125 Cohn, R.J. eP528 Cole, C. eP135, eP067, eP145, eP164, eP456, eP521 Cole, S. eP271 Collura, N. eP240 Coloumbe, G. eP457 Cone, C. eP178 Congdon, M. PS042 Conlin, A. eP456 Conlon, M. PS005 Conte, P. eP555 Coolbrandt, A. eP466 Cooper, B. PS033 Copher, R. eP012, eP011, eP013 Cordero, H. eP448 Cormie, P. PS006, PS007 Cornely, O. eP462 Correia, P. eP489 CORTAREDONA, S. eP065 Cortes, J.E. eP424 Cotogni, P. eP347 Coulombe, G. eP055, eP057, eP069 Cox, K. eP014 Coyle, V. eP220, eP221 Cravets, M. PS056 Crawford, J. eP448, PS053 Crovella, S. eP071 Cruz, L.A.P.D. eP279 Crvenkova, S. eP219 Cuffe, S. eP143, PS068 Cui, Y. eP463 Culakova, E. eP164, eP521 Curi, D. eP194 Currow, D. eP348, eP236, PS050 Curry, C. eP220 Curtis, L. eP261

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Curtis, T. eP360 Custer, A. eP154 Cykert, S. eP305 Cymbaluk-Ploska, A. eP510 D'Abrew, N. PS063 D'amico, M. eP298 D'Souza, D. eP014 Dae Ho, L. eP543 Dahhil, S.R. PS011 Dahl, A.A. eP531 Dal Lago, L. eP122 Daliani, D. PS002 Daly, B. eP137 Damatopoulou, A. PS030 Danielson, B. eP131, eP350, PS034 Danjoux, C. eP049, eP172, eP340, eP341, eP433, eP434, eP440, eP441, eP494, PS009 Dantzer, R. eP141 Dar, A.R. eP055, eP057, eP069, eP457 Darbes, L. eP269 Dardoufas, K. PS030 Dargan, S. eP122 Darmani, N. PS055 Das, D. eP016 Datta, A. eP402 David, E. eP392, eP047, eP048 Davis, A. eP482 Davis, M. eP066 Dawson, L.A. eP374 Dayan, M. eP518 De Abreu Lourenco, R. PS063 de Castro Hillman, E. eP157 De La Cruz, M.G. eP357 De LaCruz, C. eP183 de Lange, J. eP187, eP264, eP552 De Luca, A. eP347 De Oliveira Brandao, C. eP449 de Oliveira Gozzo, T. eP280, eP511 de Rooij, B.H. eP512, PS044 de Soet, J.J. eP187 De Souza, G. eP180 deAndrés-Galiana, E.J. eP310 DeAngelis, C. eP005, eP006, eP007, eP008, eP035, eP036, eP046, eP049, eP052, eP053, eP055, eP057, eP069, eP083, eP156, eP170, eP172, eP272, eP277, eP278, eP286, eP317, eP318, eP319, eP320, eP321, eP340, eP341, eP344, eP345, eP393, eP439, eP440, eP441, eP442, eP443, eP447, eP457, eP468, eP469, eP508, eP534, PS009, PS048, PS062, PS064, PS067 DeAngelis, L. eP513 Debenham, B. eP131, eP350 Dechaphunkul, A. PS049 Dede, M. PS002 Del Fabbro, E. eP081, eP171, eP329, eP338 Delgado Guay, M.O. eP352, eP357 Delgado-Guay, M. eP281 Delille MSN- FNP-BC, E.M. PS032 DeLonghi, C. eP365 Demas, W.F. eP054, eP056

Dennis, K.

eP282, eP055, eP057, eP069, eP345, eP457 Dent, R. eP052 Deo, S. eP453 DePasquale, S.E. eP449 Deray, G. eP287 Desjardins, A. eP178, PS060 Dev, R. PS004 Dewani, S.J. eP310 Dhaliwal, V. eP244 Dhillon, A. eP033 Dhillon, H. eP548, eP547 Di Cristo, C. eP158 Di Lenarda, R. eP071, PS025 Di Mattei, V.E. eP431 Di Palma, M. eP283, eP250 Di Pede, P. eP133, eP158, eP304 Di Prospero, L. eP286 di Tomasso, J. eP039 Di, M. eP122 Diaz Paniagua, L. eP208, eP339 Diaz Puente, M.T. eP208, eP339 Diaz, M. eP129 Diaz, P. eP318 Dibaj, S.S. eP357 Dickman, A. eP009, eP349 Diedrich, C. eP233 Diefenbach, M. eP421 Diego, E. eP183 Diep, P.P. eP267 Dietrich, M.S. eP538 DiGiovanni, J. eP342 Dimitrijevic, J. eP058, eP028 Dimitrovska, A. eP219 Ding, K. eP054, eP055, eP056, eP057, eP069, eP083, eP393, eP457, eP469, PS062 Diniz dos Reis, P.E. eP096, eP138, PS016 Dinney, C. PS035 Dionne-Odom, J.N. eP335 Djordjevic, F. eP028, eP058 Dmochowska, N. PS023 Dodge, J. eP261 Doering, P. eP282 Dolwani, S. eP309 Domen, K. eP484, eP485 Domingues Pereira, A. eP200 DOMINGUEZ OCADIO, G. eP387, eP390 Donaldson, G. eP472 Dong-Youn, L. PS046 Dong, F. PS055 Donini, O. PS028 Donovan, K. eP061, eP062 Donovan, K.A. eP228, eP314 Donovan, M. eP247 Doroff- B.A., R. PS020, PS021 Dourado Gaia, B.K. eP138 Dreyer, J. eP100 Driga, A. eP444 Drill, E. eP040 Drost, L. eP032, eP442, eP443, eP035, eP172, PS064 Duarte, E. eP281 Dudek, A. eP041, eP215 Duggleby, W. eP072 Duimering, A. PS034, eP350

Dullea, A. Dunn, R. Dunne, R. Dunphy, C. Dupuis, L.L. Durand, M.J. Durant, L.C. Dutta, P. Dwivedi, S. Dy, S. Dybkær, K. E. Enblom, A. Eadie, T. Ecclestone, C. Eche-Gass, A. Edo, M. Edwards, B. Edwards, D. Eerdekens, M.H. Ehrler, A. Ekaphop, S. EL AZZAZY, S. El Betagi, N. Elad, S. Elaidi, R. Elalamy, I. Elazzazy, S. Eliason, R. Ellershaw, J. Elliott, S. Ellis, J. Ellis, K. Elswick, R.K. Eltahir, H. Enami, T. Endo, M. Eng, E. Eng, L. ENIU, A. Enrech Francés, S. Enting, D. Eo, W. Epner, D. Erdeljac, H.P. Eric, W. Eriyando, T. Erler, D. Erten, B. Eryando, T. Escalante, C. Eskind, A.C. Esparaz, B. Esparaz, B.T. Estevinho, F. Estilo, C. Eufemia Stefania, L. Eum, Y.J. Evangelista, A. Evans, W.K. Everett, B. Eversole, E. Ewa, P.S. Ezendam, N. Ezendam, N.P.M. Fadipe, B. Fadipe, Y.

eP369 eP135 eP456 eP482 eP019, eP020, eP324 eP504 eP511 eP016 PS003 eP362, eP364 PS031 PS008 eP514, eP505 eP439 eP287 eP252 eP163, PS035 eP306 eP059, eP060 PS045 eP209 eP540 eP241 eP248, eP197 eP023 eP542 eP450 eP451 eP349 eP518 eP439 eP305, eP306 eP537 eP063 eP226 eP169 eP305, eP306 eP503, eP515 eP415, eP502 eP208, eP339 eP041, eP215 eP050 eP357 eP154 eP296 eP088 eP033 eP411 eP132 eP136, eP141 eP323 eP521 PS011 eP545 eP249, eP040 eP298 eP070 eP347 eP533 eP399 eP400 eP510 eP516 eP512, PS044 eP403, eP097 eP097

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Fagbule, F. Fairchild, A.

eP288, eP289, eP290 eP350, eP444, eP055, eP057, eP069, eP072, eP131, eP457, eP535, PS034 Fakhoury, K. eP098 Falcone, A. eP224, eP229, eP300, eP417, eP420 FALLAI, C. eP500 Fang, C.K. eP064 Fann- MD- MPH, J. eP423 Fardell, J.E. eP528 Farid, M. eP506, eP507 Farnesi, A. eP229, eP404, eP224, eP300, eP417, eP420 Farsi, F. eP090, eP273, eP274 Farzanfar, D. eP503, eP515 Fatima, A. eP230, eP445, PS037, eP322, eP539 Fatiregun, O. eP403 Fauvet, R. eP313 Fedunenko, V. eP398 Feige, M. eP271 Feldman, J.L. eP180 Fen, Z. eP463 Fenech, A. eP061, eP062 Feng, J. PS049 Feng, Y. eP405 Fennell, K. eP406, eP517 Fergusson, D. eP536 Ferman, H. eP100 Fernandes, L. PS043 Fernández-Martínez, J.L. eP310 Ferrara, M.L. eP158, eP304 Ferrara, P. eP298 Ferreira Cunha, N. eP148 Ferreira, E.B. PS016 Ferreira, F. eP211 Ferri, A. eP184 ferrua, M. eP250 Feyer, P. PS059 Ficorella, C. eP351 Filippini, C. eP347 Finkelstein, J. eP032, eP043 Finkelstein, S. eP033, eP043 Fisher, J. eP478 Fitch, M. eP284, eP446 Fleury, M. eP285 FLEURY, P. eP110 Floore, M. eP400 Florain, S. eP308 Flowers, E. eP139 Fok, R. eP506, eP507 Follmann, M. PS059 Fonseca, O. eP299 Font-Gonzalez, A. eP324 Foo, K.M. eP134, PS047 Ford, M. eP032, eP043 Forde, C. eP220, eP221, eP220, eP221 Foreman, T. eP528 Forjaz, V. PS066 Forrest, C. eP451 Fosså, S.D. eP531 Fourcade, A. eP250 Fowler, D. eP261 Franzmann, E. eP247 Frederickson, D. eP360

Freire, I. eP299 Friedlander, M. PS010 Friedman, H. PS060 Friedman, H.S. eP178 Friend, J. eP348 Frikha, A. eP287 Frisbee-Hume, S. eP357, eP358 Frowen, J. PS052 Fu, G. eP343 Fu, W. eP008, eP092, eP342, eP343 Fujii, M. PS027 Fujii, T. PS027 Fujimoto, Y. PS027 Fujita, M. eP265 Fukaya, M. eP226 Fukuda, H. eP237 Fung, C. eP135, eP164, eP456 Furfari, A. eP083, eP393, PS062, eP046, eP053, eP272, eP319, eP320, eP321, eP469, eP508, eP509, eP534 Furukawa, N. eP018 Furze, G. eP478 Futreal, A. eP142 Fyffe, M. eP467 Gabos, Z. eP131, PS034 Gale, N. eP394 Galiti, D. eP042 Galitis, D. PS002 Galitis, E. PS002, PS030 GALLARDO DE LAS PEÑAS, M. eP390 Galli, L. eP224, eP229, eP300, eP417, eP420 Gallo-Hershberg, D. eP052 Galvao, D. PS006, PS007 Gan, Y. eP134 Gan, Y.X. PS047, PS061 Gandhi, A. eP074 Ganesh, V. eP034, eP035, eP082, eP172, eP286, eP447, PS067, eP032, eP047, eP206, eP317, eP318, eP442, eP443, eP468, PS009, PS048, PS064 García García, B. eP208, eP339 Garcia-Manero, G. eP136, eP424 Garming Legert, K. eP245, eP246 Garming-Legert, K. eP203 Gaspe Mudiyanselage, N. eP448 Gaudet, M. eP282 Gautheron, L. PS012 Gavina, C. eP545 Gee, P. eP309 Geleijn, E. eP384 Geller, R. eP003 Genzler, R. eP448 Gevirtz, R. PS040 Ghilardi, M. eP223 Ghosh, S. eP072, eP131, eP350, PS034 GHOSHAL, S. eP416 Giacca, M. PS025 Gibson, L.eP286 Gibson, R. eP051, PS023, PS024, PS026 Giguere, J. eP456 Giguere, J.K. PS011 Gil-Gil, M. eP555 Gildersleeve, J. eP448 Gillham, C. eP241

S27

Gilliland, S. PS052 Giordano, S. PS036 Giorgino, R. eP348 Giotis, A. eP052 Giuliani, M.E. eP503, eP515 Giusti, R. eP351 Glare, P. eP359 Gobbo, M. PS022, eP071, PS025 Godoy Cabral, R. eP148 Goel, A. PS003 Gogia, A. eP152 goksel, F. eP217 Goldenberg, L. eP518 Goldstein, D.P. eP503, eP515 Gomes, B. eP489 Gondry, J. eP313 González-Fernández, R. eP523 Gonzalez, I. eP109 Goodall, H. eP014 Goodall, S. eP036, eP170 Gordillo BS, C.A. PS032 GORPELIOGLU, S. eP409 Gosh, N. eP099 Goto, H. eP231 Gough, K. eP546 Gozzo, T.D.O. eP279 Graham-Douglas, A. eP553 Gralla, R. eP448 Granata, R. eP133 Granfortuna, J. eP449 Granot, T. eP100 Grant, C. eP530 Granville, T. eP360 Greenlee, H. eP513 Greil, R. eP037 Gress, R. eP261 Grez, M. eP281 Griggs, J. eP269 Grimes, G. eP261 Groen, A. eP202, PS029 Groen, W.G. eP384 Groenvold, M. eP354 Grov, E.K. eP315 Gueiros, L. eP251 Guerrab, F. eP306 Guglielmo, M. eP158, eP133, eP304 Guha Choudhuri, P. eP402 Guido, J. PS040 Guliyev, E. eP427 Gunn, B. eP141 Guo, X. PS014 Guo, Y. eP232 Gupta, P. eP259 Gurumurthy, P. eP118 Guth, D. eP177 GUVENC, G. PS058 Guzzo, M. eP133 Ha, J.Y. PS001 Habbous, S. eP515 Habeebu, M. eP403 HABOLD, D. eP090, eP273, eP274, eP155 Haddad, P. eP450 Hagmann, C. eP369 Haider, A. eP352 Hakim, F. eP261 Hales, S. PS013

S28

Halkett, G. eP101, PS007 Hall, R. eP234, eP448 Hall, S. eP357 Hamauchi, S. eP001 Hamer, J. eP439 Han, D.H. eP268 Han, H.S. eP106 Hannon, B. eP353, eP541, eP385 Hannum, S. eP364 Hanrahan, E. eP143 Hans, S. eP307 Haque, M. eP533 Harder, S. eP354 Harmsen, H. eP202, PS029 Harper, C. eP503 Hart, L. eP555 Harthoorn, L. eP202 Hartmann, B. eP190 Hartog, A. eP202 Hartsell, W.F. eP054, eP056 Hasani, A. PS007 Hasegawa, S. eP485 Hasegawa, Y. PS027 Hashemi, S. eP310 Hashimoto, H. eP001 Hashimoto, M. eP485 Haslbauer, F. eP037 Hassan, A. eP063, eP450 Hassan, A.A.I. eP051 Hasseus, B. eP245, eP246 Hata, H. eP252 Hattori, S. eP051 Hauken, M. eP407, eP479 Hausner, D. eP355 Haverman, T.M. eP187 Havinga, R. eP202, PS029 Hayashi, T. eP024 Healy, P. eP178, PS060 Heckler, C. eP067, eP145, eP271, eP521, PS011, PS040 Hedden, L. eP518 Heijnen, C. eP141, eP142 Heilmann, V. eP177 Heimgartner, J. eP233 Helen, G. PS050 Helmers, R. eP552 Hembree, T.N. eP314 Henry, B. eP356, eP092, eP108, eP294, eP336, eP365, eP380 Herlofoson, B.B. eP267 Herndon II, J.E. eP178 Herndon- II, J. PS060 Herrmann, N. eP156 Herrstedt, J. eP354 Herve, C. eP307 Hesketh, P.J. eP026 Hess, K.R. eP150, eP357 Heung-Moon, C. eP543 Hicks, J. eP335 Higano, C. eP518 Higgins, S. eP214, eP238 HIguchi, T. eP253 Hilden, P. eP249 Hill, A. eP432 Hirano, S. PS027 Hiranuma, A. eP213

Support Care Cancer (2017) 25 (Suppl 2):S21–S266

Hirashima, Y. eP001 Ho-Nguyen, V.T. eP360 Ho, H.K. PS047 Höbel, N. eP085 Hochberg, U. eP080 Hodges, J. eP243, eP244, eP256 Hofto, S. eP173 Hogan, W. eP233 Hohri, H. eP475 Holland, C. eP102 Hollen, P. eP448 Hollenberg, D. eP156, eP344, eP345 Höller, U. PS059 Holmes, H. PS035 Holmskov, U. eP198 Holst, J.J. eP190 Homes, H. PS036 Hong, M.Y. eP413 Hope, A.J. eP503, eP515 Hoppel, C. eP137 Horak, D.eP397 Horevoorts, N.J.E. eP512 Hoskin, P. eP035, eP054, eP056, eP344, eP345 Hosoya, K. PS054 Hovan, A. eP245, eP246 Howell, D. eP503, eP515 Howell, S.L. eP335 Hsiao, C.P. eP137 Huang, B.W.Y. eP064 Huang, F. eP350, PS034 Huang, I.C. eP451 Huang, S. eP335 Huang, Z. eP452 Hudson, M. eP451 Hudson, M.M. eP323 Hughes, O. eP444 Hughes, P. PS023, PS066 Hui, D. eP357, eP358, eP359, eP360, PS004 Hullihen, B. eP239 Hung, C.T. eP413 Hunnangkul, S. eP527 Hunt, K.K. eP179 Hunter, R. eP130 Hurtado, K. eP462 Huryn, J. eP040, eP249 Husain, A. eP374 Husby, S. eP198 Husson, O. eP512, eP516 Hutchison, A. eP432 Huyghe, E. eP090, eP274 Huysmans, M.C. eP245, eP246 Huzikawa, K. eP169 Hwang, I.G. eP382 Hwang, J.H. eP476, eP477 Hwang, M. eP038, eP494, eP044, eP131, eP433, eP434, eP535 Hwang, S.W. eP361 Hytting-Andreasen, R. eP190 Iacono, D. eP351 IACOVELLI, N.A. eP133, eP500 Ibrahim Exstara, N.Z. PS065 Ikeda, A. eP325 Ikeda, T. eP226 Ikegame, K. eP484 Im-Ryung, K. PS046

Imamachi, K. eP252 Imataki, O. eP226 Inaba, H. eP323 Inano, T. eP162 Infante, G. eP133 Inha, J. eP496 Inocêncio Vasques, C. eP138, PS016, eP096 IREN AKBIYIK, D. eP409 IREN AKBIYIK, D. eP408 Isaacs, J. eP513 Isabel, P. eP201 Isayev, I. eP427 Isenberg, S. eP362 Isenberg, S.R. eP364 Isenring, E. eP173, eP432 Isenring, L. eP235 Ishida, M. eP410 Ishide, K. eP226 Ishii, T. eP162, eP237, eP487 Ishikawa, H. eP103, eP001, eP237 Isogai, Y. eP160 Issarachai, S.S. eP293 Itani, Y. eP484 Ito, S. eP530 Iturbide, A. eP244 Iwae, S. PS027 Iwasa, S. eP001 Iwayama, S. eP205 Jacinto, J.K. eP188 Jackson, J. eP173 Jacquot, F. eP283 Jae-Lyun, L. eP543 Jaeger, C. eP037 Jager-Wittenaar, H. eP233 Jahn, F. PS059 JANAH, A. eP065 Janelsins, M. eP067, eP135, eP164, eP271, eP521, PS040, PS041 Janelsins, M.C. PS011 Janeslins, M. eP145 Jang, G. eP050 Jang, R. eP165 Janni, W. eP555, eP429 Janusz, M. eP510 Javaloyes, N. eP418 Javier, M.T. eP201 Jefford, M. eP101 Jehangir, W. eP066 Jensen-, B. eP525 Jensen, J. eP525 Jess, L.R. PS008 Jhang, S.Y. eP413 Jho, H.J. eP378 Jiang, S. PS047 Jiayi Tao, M. eP038 Jihye, P. PS046 Jiménez-López, A.J. eP381 Jin Seok, A. PS046 Jin, R. eP153 Jin, S. eP170 Jo, B. PS041 Jobran, S. eP063 Joffily Parahyba, C. eP200 Johansson, J.E. eP245, eP246 Johns, D. eP104, eP495, PS039 Johnsen, H.E. PS031

Support Care Cancer (2017) 25 (Suppl 2):S21–S266

Johnson, M. PS036 Johnson, M.P. eP178 Johnson, R. eP183 Johnston, M. PS053 Jones, A. eP553 Jones, C. eP451 Jones, D. eP154 Jones, J. eP482 Jones, J.M. eP503, eP515 Jones, N. eP306 Jontell, M. eP203 Jordan, K. eP026, PS049, PS059 Jordi, G. eP201 Jordi, M. eP201 Jordi, R. eP201 Joseph, D. PS006 Joseph, K. eP131 Joshi, R. PS065 Joyce, D. eP144 JR, V.K. eP453 Juergens, R.A. eP486 Juhee, C. PS046 Julian, T.B. eP179 Julio, A. eP523 Jun Ho, J. eP382 Jung, P. eP159 Junying, L. eP425 Kaasa, S. eP359 Kadoya, K. eP213 Kaduri, S. eP392 Kagaya, H. eP492 Kaida, K. eP484 Kajizono, M. eP253 Kale, R. eP174 Kalfarentzos, E. eP042 Kalinin, D. eP037 Kallidil, R. eP143 Kamal, A.H. eP364 Kamath, J. eP105 Kamdar, J. eP553 Kamen, C. PS041, eP135, eP164, eP269, eP271 KAMEO, S. eP550, eP551 Kamisako, M. eP475 Kamoshida, T. eP103 Kanakry, C. eP261 Kandagatla, A. eP465 KANDIAH, N. PS061 Kane, J. eP225 Kane, R. eP101 Kaneko, M. eP103, eP160 Kanellopoulos, P. PS030 Kang, D. PS046 Kang, J.H. eP070, eP070, eP382 Kang, S.H. eP291 Kanmodi, K. eP290, eP363, eP288, eP289 Kantilal, K. eP107 Kao, S. eP547, eP548 Kapanadze, S. eP059, eP060 Kaplan, S. eP462 Kapsner-Smith, M. eP514 Karaaslan Eser, A. eP411 Karak, F. eP555 Karen, M. eP456 Karen, R. eP362 Karine, L. eP308

Karthaus, M. Karuturi, M. Kataoka, T. Katoh, R. Katsumata, N. Kattan, J. Kav, S. Kavelaars, A. Kawai, Y. Kawakami, J. Kawamitsu, K. Keefe, D. Keenleyside, M. Keesey, R. Keller, M.R. Kelly, J. Kelly, L. Kenmotsu, H. Kenmuir, C. Kennedy, M.J. Kenny, P. Kesler, S. Kevork, N. Khattri, S. Kikuchi, Y. Kilgore, K. Kilgour, R. Kim, B.S. Kim, C.R. Kim, D.Y. Kim, E. Kim, H.J. Kim, H.S. Kim, J. Kim, J.H. Kim, J.Y. Kim, M. Kim, M.K. Kim, S.T. Kim, W. Kim, Y.J. Kim, Y.S. Kimani, G. King, G. King, J. Kinsey, E. Kirk, J. Kiss, N. Kissow, H. Kitagawa, Y. Kitahara, T. Kitajima, M. Kitetere, E. Kjerland, L.E. Klagholz, S. Kleckner, I. Knoth, R. Ko, A.R. Ko, H. Kobayashi, H. Kober, K. Koch, E.D. Koeller, J. Kogawa, T. Koh, S.J. Kojima, H.

S29

eP010, eP177 PS036 eP254 eP213 eP226 eP555 eP411 eP142 PS054 eP492 eP213 eP051, PS024 eP444 eP451 PS056 eP235 eP329, PS065 eP162 eP444 PS068 PS063 eP067, PS040 eP355 PS003 eP222 eP358 eP039 eP050 eP520 eP291 eP268 PS001 eP050 eP520 eP268, eP520 eP178 eP011 eP292, eP454 eP106 PS055 PS004 eP382 eP115, eP161 PS068 eP526 PS053 eP189 PS052 eP190 eP252 eP213 eP483 eP107 eP315 eP419 eP067, eP135, eP521 eP011, eP013, eP012 eP412 eP519 eP162 eP139 eP059, eP060 eP140 eP024 eP520, eP382 PS027

Koklanaris, E. eP530 Kollie, J. eP305, eP306 Komatsu, Y. eP018 Koneru, R. eP112 Kongsuphon, N. eP209 konishi, T. eP255 Konmun, J. eP209 Konstantina-Eleni, A. PS002 Kontoyiannis, D. eP142 Koo, D.H. eP496 Koo, V. eP170 Koppelmans, R. eP245 Kornelsen, E. PS019 Kosaka, Y. eP018 Kotey, A. eP306 Kouloulias, V. PS030 Kouri, M. PS030, eP042, PS002 Kouvaris, I. PS030 Kralidis, G. eP059, eP060 Krassas, G. eP014 Kraychete, D.C. eP051 Kremer, L.C.M. eP324 Kremoser, C. PS029 Krendyukov, A. eP085 Krishnan, M. eP277 Krishnasamy, M. eP546 Kruitwagen, R.F.P.M. PS044 Krull, K. eP451 Krull, K.R. eP323 Krylov, V. eP480 Krys, O. eP503, eP515 Krzyzanowska, M. eP541 Kuban, D.A. eP150 Kuchinad, K. eP364 Kuchonthara, N. eP293 Kuhl, D. eP518 Kuhlman, S. eP400 Kuiken, N. PS029, eP202 Kuipers, F. PS029 Kuk, J. eP055, eP069, eP457 Kumaralingam, N. PS066 Kumaresa Pandian, N. eP549 Kume, T. eP226 Kunde, M. eP233 Kunitomo, K. eP160 Kuo-Bonde, L. eP234 Kurata, M. PS054 Kuruvilla, J. eP481 Kutomi, G. PS054 Kuznecova, G. eP501, eP210 Kuznecovs, S. eP210, eP501 Kvale, E. eP335 Kwok, C. eP399 Kwok, J.B. PS010 Kwon, J.H. eP050 Kwon, M.J. eP292, eP454 Kwon, S. eP181, eP182 Kyrodimos, E. PS030 Kyrtsonis, M.C. PS002 Kyu-Pyo, K. eP543 L’Italien, M.F. eP532 La Carpia, D. eP158 Labbe, E. eP400 Labrosse-canat, H. PS012 Lacaze, M. eP250, eP283 Lacey, J. eP547, eP548

S30

Lacorte, M. eP229 Lacourt, T. eP141, eP142 Lahav Prof., M. eP100 Laheij, A.M.G.A. eP264, eP187 Lai, Y.H.eP401, eP413 Lai, Y.L. eP064 Lalla, R. eP256, eP243 Lalloue, B. eP250 Lam, H. eP294, eP005, eP007, eP008, eP035, eP045, eP046, eP049, eP052, eP108, eP108, eP156, eP170, eP272, eP277, eP317, eP318, eP319, eP320, eP321, eP340, eP341, eP342, eP344, eP345, eP365, eP366, eP366, eP442, eP447, eP468, eP509, eP534, PS048, PS064, PS067 Lam, M. eP108, eP365, eP366, eP156, eP170, eP294, eP319, eP320, eP321, eP336, eP342, eP345, eP380, eP534 Lam, T. eP136 Lamb, S. PS006 Lanctot, J. eP451 Landaverde, D.U. eP109 Lang, C. eP033 Lanzarotti, C. eP026, PS049 Lao, N. PS064, eP443 Laocharoenkeat, A. eP527 Larocque, G. eP536 Launay-Vacher, V. eP287 Laura, O. eP298 Lawrence, D.C. eP122 LE FEL, J. eP110, eP295 Le, L.W. eP075, eP355, eP374 Le, Q. eP195 Leahey, A. eP439 Leão, J. eP251 Lechner, B. eP006, eP172, eP342, eP343, PS009 Lee, A. eP014 Lee, C.K. PS010 Lee, D.H. eP051 Lee, D.S. eP084 Lee, H.J. eP268 Lee, H.R. eP291 Lee, H.W. eP106 Lee, H.Y. eP050 Lee, J. eP443, eP506, PS042, PS061 Lee, J.H. eP186 Lee, J.T. eP111 Lee, J.W. eP476 Lee, K.H. eP070, eP106 Lee, N. eP249 Lee, S.C. eP106 Lee, S.S. eP496 Lee, Y.G. eP496 Lee, Y.H. eP413, eP436 Lee, Y.J. eP378 Leeder, J.S. eP019 Legeay, K. eP307 Legouffe, E. eP287 Lehane, L. PS063 Lei, X. PS036 Leighl, N.B. eP515 Lelimo, M. eP467

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Lemonde, M. eP112 Leroy, P. eP307 Lesser, M. eP448 Letal, J. eP060 Leuleu, X. eP287 Leung, C. eP094 Leung, K. eP212 Levasseur, S. eP039 Levesque, L. eP532 Levsque, J. eP399 Levy, D.C. eP547, eP548 Lew, C. eP134 Lewington, V. eP041 Li, P. eP350 Li, Y. eP212 Liakouli, Z. PS030 Liang, S.Y. eP414, eP455 Lightfoot, A. eP305 Likhitsakuochai, N. eP209 Lim, C. eP291 Lim, K.H. eP151, eP396 Lim, M.Y. eP068, eP113, eP367 Lim, S.Y. eP506 Lim, T. eP050 Lim, V. eP040 Lim, Y.H. eP004 Lin, C.C. eP368 Lin, P.J. eP521, eP067, eP135, eP145, eP456 Linden, K. eP282 Lingyan, Z. eP463 Liou, Y.T. eP147 Lipp, E. PS060 Lipp, E.S. eP178 Liska, C. eP536 Liu, C.Y. eP367 Liu, D. eP326, eP358 Liu, D.D. eP357 Liu, G. eP503, eP515 Liu, M. eP475 Liu, S. eP296, eP503 Liu, S.L. eP015 Livingston, P. eP517 Lo, C. eP370, PS013 Lo, S.H. eP094, eP095 Loeffen, E.A.H. eP324, PS018 Loh, K. eP135, eP506, eP507 Loh, K.P. eP456 Loh, S.Y. eP452 Loiselle, C. PS045 Lomax, A.J. eP547, eP548 Lonati, V. eP223 Long-Simpson, L. eP243 Long, J. eP271 Lonshteyn- Ph.D., A. PS021 loparco, D. eP298 Lopes, M. eP283 Lopes, N. eP199 López-Alarcón, M.D. eP381 Lopez, V. eP212 Loppinet, E. eP287 Lorenz, K. eP364 Lorraine, W. eP308 Lorton, C. eP238 Loscalzo, M.J. eP397 Loucks, A. eP153 Løyland, B. eP315

Loyola, E.A.C.D. eP280 Lu, L. eP503 Lu, S. PS049 Lu, Z.e P150, eP396 Lubrano di Ciccone, B. eP121 Luctkar-Flude, M. eP522 Lueftner, D. eP122 Lui, L.C.Y. eP094, eP095 Luis, G. eP201 Lujic, S. PS042 Lukkahatai, N. eP325 Luque, L. eP114 Lustberg, M. eP310 Lutz, K. eP518 Lutz, S. eP345 Lv Lin eP474 Ma, D. eP350 Ma, J. eP369 Mac DONALD, N. eP227 MªCarmen, R. eP418 Macchi, F. eP257 Macchi, G. eP347 MacDonald, K. eP218 MacDonald, W. eP282 MACÊDO, L.E. eP550, eP551 Madden, K. eP326 Mady, N. eP039 Mafwimbo, J. eP330 Magalhães, P.A.P.D. eP280 Magee, G. eP011, eP012, eP013 Magnuson, A. PS011 Mahmud, A. eP055, eP057, eP069, eP457 Maina, F. eP115 Majorana, A. eP185, eP184 Malfitano, C. eP370, PS013 Malheiro, M. PS043 Mamzer, M.F. eP307 Manalo, M.F. eP371 Mancarella, G.A. eP335 Mandhani, A .PS003 Mandrell, B. eP451 Mang, O. eP094 Manhard, K. PS056 Manikantan, K. eP464 Mann, M. eP309 Manson, S. eP429 Manuel, S. eP418 Manuela, L. eP201 Manzullo, E. eP141 Mapara MD, M. PS032 Maravelis, G. PS030 Marchetti, P. eP351 Marcussen, M. PS031 Margolies, L. eP269 Maria Pia, Z. eP417 Mariana, M. eP211 MARINHO, P. eP550, eP551 Marino, A. eP298 Markham, M.J. eP175 Markicevic, M. eP143 Marko, P. eP340 Marmar, C. eP370 Maropoulos, G. PS030 Marques, J. eP211 Marshall, A. eP478 MARSHALL, E. eP422

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Marthick, M. eP547, eP548 Martin Martínez, J.M. eP208, eP339 Martinelli, V. PS025 Martino, R. eP482 Martins Mourão, A. PS043 Marx, W. eP235 Masalu, N. eP330 Mason, S. eP349 Mastick, J. eP139 Masuda, Y. eP162, eP487 Masujima, H. eP103 MATEI, R. eP415, eP502 Matsui, R. eP024 Matsuo, K. eP262, eP265 Matsuoka, J. PS054 Matsuura, K. PS027 Mattina, K. eP503 Mauricio, F.S. eP068 Mavrangelos, C. PS023 Mayanagi, S. eP237 Mayeur, D. eP542 Mayo, B. PS051 Mayo, S.J. eP481 Mays, J. eP261 Mazzetti, M. eP431 Mazzoni, E. eP298 Mbah, O. eP306 Mc Auliffe, P. eP183 McBride, A. eP011, eP218 McCall, L. eP179 McCarty, C. eP335 McCLish, D. eP338 McColl, M.A. eP522 McCollom, S. eP281 McCullough, R. eP192 McDonald, R. eP031, eP069, eP457, eP030, eP033, eP036, eP046, eP047, eP048, eP049, eP053, eP108, eP170, eP172, eP206, eP272, eP319, eP320, eP321, eP340, eP341, eP433, eP434, eP439, eP441, eP447, eP494, eP508, eP509, eP534, PS048 McEneaney, S. eP176 McEwen, S. eP482 McGill, B. eP528 McGrath, C. eP282 McGuire, D.B. eP537 McKee, D.K. eP360 McKiernan, S. PS006 McLoone, J.K. eP528 McMahon, M. eP233 McNeil, C. eP547, eP548 McSherry, F. eP178 Mehmood, T. eP372, eP373, eP458 Meigs, M. PS005 Meißner, W. eP059 Mejia, M.B. eP188 Melnik, M. eP145 Melo, T. eP251 Menang, J. eP459 Mendonça Mota, A.C. eP138 Meneses, A.G. PS016 Meneses, K. eP517 Meng, Y.C. eP359 Menon, M. eP174

Merchant, S. Merideth, M. Merlo, J. Mesci, A. Mesquita, A. Messino, M. Meyer, G. Meyer, R.

eP101 eP530 eP184, eP185 eP344, eP345 eP545 eP521 eP542 eP056, eP083, eP393, eP469, PS062 Meyer, R.M. eP054, eP055, eP057, eP069, eP457 Miaskowski, C. eP139, PS033 Miccinesi, G. eP404, eP417, eP420 Miceli, R. eP133 Michael, L. eP045 Michalopulos, M. eP328 Miglianico, L. eP287 Migliorati, C. PS002 Miguéns, M. eP211, PS043 Milakovic, M. eP005, eP008, eP342, eP343 Milanova, L. eP219 Miller, E. eP178 Miller, K. eP310 Miller, M. eP555 Mills, C. eP041 Milne, D. eP546 Milne, R. eP503, eP515 Milstein, D. eP552 Min-Hee, R. eP543 Minasian, L. eP271 Minasian, L.M. PS011 Minvielle, E. eP250 Miranda e Silva, W. eP200 Miranda, H. PS043 MIRIYALA, R. eP416 Misir, S. eP011, eP012, eP013 Misra, S. PS003 Mitani, D. eP397 Mitchell, S. eP146, eP438, eP471 Mitobe, Y. eP483 Mitsuhashi, N. eP162, eP487 Mitsunaga, S. eP193 Mittendorf, E.A. eP179 Miura, K. PS054 Mohamad, F. PS061 Mohamed, A. eP327, eP328 Mohammadi, K. eP243, eP256 Mohan, M. eP196 Mohile, N. eP067 Mohile, S. eP164, eP456 Mohile, S.G. PS011 Molassiotis, A. eP212 Mols, F. eP512 Monaco, M. eP429 Monden, N. PS027 MONREAL, E. eP387, eP389, eP390 Monteiro Benites, B. eP200 Moon, C.C. eP374 Mooney, K. eP471, eP472 Mooney, S. eP397 Moorin, R. eP101 Morales, M. eP523 Moras, R. eP299 Morash, R. eP536 Morgado, M. eP299 Morgado, S. eP299

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Mori, K.

eP160, eP162, eP226, eP237, eP487, eP492 Mori, M. eP226, eP359 Morikawa, A. eP160, eP487 Morin, S. eP307 Morishita, S. eP483, eP484, eP485 Morrow, G. eP271 Morrow, G.R. PS011 Morse, C. eP305 Mougeot, F. eP189 Mougeot, J.L. eP189 Mughal, T. eP099 Muircroft, W. eP236, PS050 Mukhapadhyay, A. eP402 Mukhopadhyay, S. eP016 Mukiri, E. eP161 Mulder, R.L. eP324 Mullane, K. eP462 Mulyowa, I. eP375 Mundluru, J. eP112 Murakami, H. eP001, eP160, eP162, eP487 Muriithi, E. eP376 Muro, M. eP253 Murphy, B. eP266 Murphy, B.A. eP538 Murphy, R.T. PS068 Musettini, G. eP300, eP417, eP224, eP229, eP404, eP420 Mustian, K. eP067, eP135, eP145, eP164, eP521, PS040, PS041 Mustian, K.M. PS011 Nabekura, T. eP213 Nabi, G. eP524, eP525 Nabid, A. eP054, eP055, eP056, eP057, eP069, eP457 Nacci, A. eP298 Nadalini, O. eP156 Nadler, M. eP486 Nagappa, A.N. eP460 NAGAR, P. eP416 Nagashima, M. eP213 Nagata, N. eP237 Nagy, C. eP017 NAIMO, S. eP500 Naito, T. eP162, eP160, eP487 Naito, Y. eP166 Nakagawa, K. eP262, eP265 Nakashima, K. eP001, eP162 Nakata, E. eP492 Nakata, H. eP262 Nam, E.J. eP378 Nam, S.H. eP050 Nam, S.J. eP438 Nanda, S. eP074 Nardi, K. eP229 Narlesky, M. PS055 Nascimento Silva, M.J. eP148 Naseem, A. PS025 Navari, R. eP017, eP005, eP007 Naydonova, T. eP325 Naylor, P. eP400 Neergaard, M.A. eP354 Negm, R. eP540 Nelson, A. eP394 Nelson, C. eP421 Ness, K. eP451

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Neus, B. Newman, L Newton, R. Ng, R. NG, T.

eP201 .eP143 PS006, PS007 eP134, PS047 PS061, eP134, eP212, eP506, eP507, PS047 Ngai, G.W. eP507 Ngamphaiboon, N. eP209 Ngan, R. eP094, eP095 Nguyen, B.L. eP157 Nguyen, N. eP025 Nguyen, T. eP025 Nguyen, T.T. eP357 Nichols, A.C. eP335 Nicolaije, K.A.H. PS044 Nicolatou-Galitis, O. eP042, PS002, PS030 Nielsen, S. PS031 Niepel, D. eP037 Nigel, S. PS006 Niihara, M. eP237 Nijjar, T. eP131, eP350 Nikolaidi, A. eP042, PS002 Nikolaou, C. eP041, eP215 Nikpay, S. eP276 Nishimura, J. eP024 Nishioka, K. eP222 Nissim, R. PS013 Niwa, T. eP222 Nixon, J. eP432 Njim, S. eP459 Noll, B. eP189 Noll, J. eP244 Noonan, A.M. eP310 Noramon, T. eP209 Noreika, D. eP329, eP081, eP338 Nowak, A. eP395, PS007 Nurachmah, E. eP088, eP132 Nuria, F. eP201 Nusch, A. eP555 O'Connor, B. eP143, eP214, eP238, eP144 O'Connor, M. eP101 O'Donoghue, N. eP239, eP241 O'Hearn, S. eP317, eP318, eP442, eP468, PS064, PS067 O'Higgins, C. eP143 O'Higgins, C.M. eP144 O'Leary, N. eP214, eP238 O'Mara, A.M. PS011 O'Neill, T. eP125 O'Rourke, T. eP072 O’Shaughnessy, J. eP429 Oakley, C. eP107 OBA, K. eP018 Oei, B. eP054 Oerlemans, S. eP512 Ogata, H. PS054 Ogawa, H. eP484 Ogawa, T. PS027 Ogburn, T. eP325 Oguma, Y. eP160 Oguri, S. eP193 Oh, D. eP438 Oh, E.H. PS001 Oh, H.S. eP070 Oh, S. eP496 Oh, S.Y. eP377

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Ojeyinka, A. eP097, eP403 Oka, A. eP475 Okada, Y. eP018 Okami, K. PS027 Okamoto, M. eP262, eP265 Okayama, T. eP487, eP160, eP162, eP237 Okazumi, S. eP213 Okita, K. eP018 Olagunju, A. eP097, eP403 Oldervoll, L. eP491 Olivari, S. eP026 Olver, I. eP406, eP517 Omae, K. eP160, eP162, eP226, eP487 Omori, S. eP162 Onishi, H. eP410, eP483 Onitilo, A. eP145 Onitilo., A. eP271 Ono, A. eP162 Onozawa, Y. eP237 Opie, R. eP235 Opoku, S. eP461 ORLANDI, E. eP133, eP500 Oshiro, T. eP213 Osisami, O. eP335 Ota, I. PS027 Ottaviani, G. eP071, PS025, PS022 Ottery, F. eP233 Ottesen, S.S. eP354, eP383 Ottevanger, N. eP516 Ottoboni, T. PS056, eP003 Oudard, S. eP023 Ouhadj, S. eP553 Ouma, P.O. eP116 Owen, R. eP478 Owens, R. eP154 Owosho, A. eP040, eP249 Ozencakir, H. eP411 Pablo, M.V. eP523 Packer, M. PS040 Padilla, N. eP305 Paikousis, L. eP499 Paiva Fonseca, F. eP200 pak, Y. eP217 Palekhov, A. eP391 Palesh, O. PS040, PS011, PS041 Palma, A. eP281 Palma, F. eP298 Palmore, J. eP335 Pandit, S. eP263 Pang, J. eP296 Pang, L. eP163, eP462 Panobianco, M.S. eP280 Pant, K.K. PS003 Panta, S. PS060 Pantarotto, J. eP282 Paolieri, F. eP224, eP229, eP300, eP404, eP417, eP420 Papadogeogakis, N. eP042 Papadopoulou, E. PS002, eP042, PS030 Park, H.J. eP070 Park, J. eP419 Park, J.H. eP117 Park, K. eP377 Park, M. eP352, eP358, PS004 Park, M.W. eP182, eP181 Park, S.B. PS010

Park, S.E. PS001 Park, S.J. eP378 Park, S.Y. eP476 Parmar Pharm.D- BCOP, S. PS032 PARMAR, B. eP416 Parrino, J. eP462 Pasetka, M. eP005, eP006, eP007, eP008, eP052, eP172, eP278 Passchier, E. PS057 Passik, S. eP007 Patel, H. eP118 Patel, P. eP019 Patel, S. eP350, PS034 Paterson, C. eP524, eP525 Pathare, N. eP120 Patterson, C. eP246 Patterson, C.G. eP245 Patton, L.eP243, eP256 Paul, S. eP139 Pauline, L. eP308 Pauls, M. eP015 Pavletic, S. eP261 Paw Cho Sing, E. eP020 Pawar, D. eP119, eP120, eP379, eP554 Pearcey, R. eP131 Pedersen, L. eP354 Pedro, G. eP201 Peixoto, P. eP545 PEÑA, C. eP387 Peoples, A. eP145, eP164, eP521 Pepper, L.A. eP467 Peppone, L. eP164, eP135, eP145, eP271, eP521, PS041 Peppone, L.J. PS011 Pereira, D. eP175 PERETTI-WATEL, P. eP065 Perinetti, G. PS025 Perl Dr., G. eP100 Perloff, T. eP526 Pessi, M.A. eP304 Peter, A. eP533 Peters, K. PS060 Peters, K.B. eP178 Peters, M. PS014 Peters, S. eP285 Petrelli, F. eP223 Petsinis, V. eP042 Petzer, A. eP037 Pfanner, E. eP300, eP404, eP417, eP420 Pham, V. eP025 Pienaar, C. eP395 Pietra, C. PS051 Pietro, R. eP298 PIGNOLI, E. eP500 Pijnenborg, J.M.A. PS044 Pilarski, R. eP310 Pileri, C. eP328 Pillay, T. eP467 Pinheiro Freitas Costa, M.C. eP301 Piquette-Miller, M. eP019 Pissara, A.J. PS043 Pittayapan, P. eP527 Pituskin, E. eP072 PMS Study Group, B. eP554 Pollock, P. eP518 Pon, D. eP021, eP194, eP195

Support Care Cancer (2017) 25 (Suppl 2):S21–S266

Ponte, S. eP207 Popat, S. eP490 Popat, U. PS035 Pope, A. eP353 Pophali, P. eP530 Popmihajlov, Z. eP462 Popovic, G. eP075 Popovic, I. eP028 Popovic, M. eP005, eP007, eP008, eP029, eP045, eP049, eP341, eP342, eP343, eP447 Porceddu, S. eP432 Portman, D. eP121, eP061, eP062, eP228, eP314 Porubska, M. eP037 Porzio, G. eP351 Pouillart, P. PS012 Pouptsis, A. eP041, eP215 Powers, D. eP017 Prado, M.A.S. eP511 Prakash, A. eP191 Prakash, C. eP074 Pratt, N. PS065 Primeau, C. eP524 Probyn, L. eP030, eP031, eP033, eP034, eP038, eP044, eP047, eP316 Prof. Levrini, L. eP257 PS, S. eP196 Psyrri, A. PS030 Pui, C.H. eP323 Pulenzas, N. eP006, eP172, eP277, eP342, eP343, eP439, eP440, eP441 Puopolo, M. eP380, eP336 Puts, M. eP153, eP159, eP165, eP167 Puzas, J.E. eP164 Quaranta, A. eP298 Quart, B. PS056 Quinn, B. eP122 Rabaiotti, E. eP431 Rabel, H. eP072 Raber-Durlacher, J. eP552 Raber-Durlacher, J.E. eP264 Raber, J. eP245, eP246 Raina, V. eP152 Rajasekhara, S. eP061 Rakovitch, E. eP439 Raman, S. eP033, eP035 RAMANJULU, R. eP078, eP073 Ramaswamy, B. eP310 Ramchandani, D. eP397 Ramon, B. eP201 Ramrup, N. eP176, eP302 Rancoita, P.M.V. eP431 Randazzo, D. PS060 Randazzo, D.M. eP178 Ranna, V. eP197 Rao, V. eP067 Rapoport, B.L. eP303, eP017, eP497 Raquel, R. eP310 Rasmussen, H.L. eP315 Rastogi, M. eP074 Rathe, M. eP198 Rauh, J.e P177 Ravagnani, F. eP158 Ray, S. eP441 Rayne, S. eP467

Razis, E. PS002 Recio, T. eP207 Reddy, A. PS004 Reddy, A.S. eP357 Reddy, P. eP456, eP521 Reed, V.K. eP150 Reich, R.R. eP314 Reilly, R. eP143 Reilly, R.B. eP144 Remwa, E. eP467 Renaud, J. eP282 Reschke, J. eP164 Reshef MD, R. PS032 Revta, C. eP369 Ribeiro Barros da Cunha, S. eP200 Ribeiro, C. eP489 Ribeiro, J. eP299 Ricard, M. eP201 Ricci, S. eP224, eP229, eP300, eP404, eP417, eP420 Rice, A. eP144 Richards, D. eP555 Richards, K. eP444 Richardson, M. eP136 Rieber, A. eP360 Riedel, E. eP040 Rietveld, M. eP516 RIGAL, O. eP110, eP295 Rigney, M. eP526 Rin, S. eP252 Ringash, J. eP482 Rings, E. eP202, PS029 Rios, J. eP482 Ripamonti, C. eP304, eP133 Ripamonti, C.I. eP158 Rithara, S. eP115, eP161, eP376 Ritter, L. eP123 Rizzi, G. eP010 Roa, W. eP131, eP350, PS034 Roberts, S. eP394 Robertson, L. eP305, eP306 Robison, L. eP451 Robison, L.L. eP323 Rodgers, B. eP537 Rodin, G. PS013, eP075, eP370, eP374 Rodrigues Alvares, J. eP148 Rodrigues Fregnani, E. eP200 Rodrigues-Aranda, C. eP315 Roe, J. eP490 Roeland, E. eP369 Roeniger, A. eP493 Rojas, C. eP022 Rong, P. eP463 Rønning, M. eP315 Roos, D. eP054, eP056 Roque Mazoni, S. eP138 Rosa, M. eP201 Rosario, C. eP165, eP159 Rose, J. eP261 Rosen, L. eP448 Rosenthall, L. eP039 Rosko, A. eP154 Ross, A. eP419 Rourke, S.B. eP481 Rousey, S. eP145 Rousseau, C. PS045

S33

Rowbottom, L. eP030, eP031, eP036, eP046, eP047, eP048, eP049, eP053, eP108, eP156, eP170, eP172, eP272, eP319, eP320, eP321, eP340, eP341, eP433, eP434, eP447, eP494, eP508, eP509, eP534 Rozario, H. eP124 Rozario, N. eP245, eP246 Rozema, F.R. eP187, eP264 Rubinovitch Dr., B. eP100 Rudman, S. eP041, eP215 Rumio, C. eP257 Rupel, K. eP071, PS022, PS025 Rustina, Y. eP088, eP132 Rutkowski, S. eP225 Ruud, E. eP267 Rydall, A. eP075, eP370, PS013 SA, O. eP199 Saadi, A. eP307 Saarto, T. eP359 Sabatschus, I. eP060 SACCO, J. eP422 Sachanas, S. PS002 Sadeghipour, F. eP285 Safanda, M. eP037 Sagawa, T. eP252 Saghal, A. eP392 Sahgal, A. eP033, eP440, eP441 Sahin, E. PS058 Saigí Morguí, M. eP041 Saito, M. PS054 Sakai, D. eP024 Sakai, R. eP166 Sakamoto, H. eP265 SakthiKumar, L. PS017 Sakurai, M. eP001 Salgado, M. eP545 Saligan, L. eP146, eP325 Salkeld, E. eP136 Salmeron, G. eP287 Samelis, G. eP042 Samuel, C. eP305, eP306 SANCHEZ DAVILA, N. eP389 Sanchez Peña, A.M. eP208, eP339 Sanderson, P. eP125 Sandmæl, J. eP491 Sandmæl, J.A. eP488 Sands, M.B. PS042 Sandsund, C. eP490 Sangha, A. PS066 Sangha, S. eP120 Sano, Y. eP475 Santi, S. PS005 Santos, J. eP211 Santos, R. eP489 Sanz-Yagüe, A. eP381 Sapkota, S. eP263 Sarakosol, N. eP293 Sardesai, S. eP310 Sarno, L. eP431 Sasaki, A. eP253 Sasaki, H. eP166 Sasaki, K. PS027 Sato, A. eP213 Sato, H. eP492

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Sattar, S. eP167 Sauder, C. eP514 Saunders, D. PS005 Saunders, K. eP093 Savani, B. eP530 Saverio, C. eP298 Savina, S. eP398 SAWADA, N. eP550, eP551 Sbrana, A. eP224, eP420, eP229, eP300, eP404, eP417 Scarmozzino, A. eP347 Schaal, J. eP305, eP306 Schaller, A. eP076 Schechter, T. eP020 Scheiber, C. PS040, PS041 Schiavone, P. eP298 Schiestel, M. eP085 Schilling, J. eP177 Schimmer, A. eP075, eP370 Schloms, A. eP176 Schlundt, D. eP538 Schmidt, B. eP243, eP256 Schofield, E. eP421 Schofield, P. eP101 Schroeder, K. eP330 Scott, J. PS017 Scotté, F. eP023, eP542, eP307, eP287 Scrimger, R. eP350 Scullin, P. eP220, eP221 Seah, V. eP186 Secombe, K. PS024 Segal, R. eP536 Sekine, R. eP492 Sela, N. eP100 Selby, P. eP503, eP515 Selland, B. PS040 Selle, F. PS010 Sen, S. eP174 Senderovich, H. eP168 Senneseth, M. eP407 Senra, T.U. PS016 Seo, K.S. eP181, eP182 Seo, S. eP106 SEVEN, M. PS058 Severaj, R. eP467 Severin, D. eP131, eP350, eP535, PS034 Seyoung, S. eP543 Shafer, D. eP171 Shaffer, K. eP421 Shah, N. eP189 Shanis, D. eP530 Shankar, R. eP549 Sharma, B. eP077 Sharma, P. PS003 Sharma, R. eP364 Sharma, S. PS042 Shaulov, A. eP075 Shaw, C. eP490 Shaw, E. eP317, eP318, eP442, eP468, PS064, PS067 Shayani, S. eP194, eP195 Shelburne, S. eP142 Shelton, B. eP225 Shen, H. PS041 Shepherd, F.A. eP515 Sheth, R. eP553

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Shiki, I. eP226 Shim, B.Y. eP070 Shim, H. eP106 Shimokawa, M. eP024 Shin, J. eP519 Shino, M. eP103 Shiozaki, H. eP162, eP226 Shiozaki, M. eP205 Shirren, J. PS051 Shnall, J. PS013 Shoffner, K. eP449 Shoji, J. eP475 Shriram, A. eP549 Shrotriya, S. eP239 Shumway, N. eP005 Shun, S.C. eP147 Shwe, M. eP134, PS047, PS061 Shyu, C.R. eP180 Sidhu, R. eP397 Signorelli, C. eP528 Silva, A.M. eP545 Silvestre, J. eP234 Sima, A. eP171 Singh, A. eP464 Singh, H. eP149 Siritanaratkul, N. eP527 Siu, S.W.K. eP094, eP095 Sixon, J. eP362 Skaare, A.B. eP267 Skipper, P. eP349 Skoro, N. eP081, eP329, eP338 Skripekova, A. eP028, eP058 Slatyer, S. eP395 Slaven, M. eP317, eP318, eP442, eP468, PS064, PS067 Sleight, A. eP529 Slief, R. eP264 Sloan, P. eP079, eP126 Slusher, B. eP022 Smit, C. eP467 Smit, T. eP303, eP497 Smith, B. eP305 Smith, D. eP266 Smith, J. eP061 Smith, K. eP364 Smith, K.M. eP180 Smith, P. eP400 Sneha M, L. eP549 Snow, S. eP015 Soares, G. eP251 Soga, Y. eP253 Soichi, F. eP386 Soler-López, B. eP381 Soliman, A. eP328 Soliman, H. eP206, eP440, eP441 Sollecito, T. eP243, eP256 Sønderkær, M. PS031 Song, E.K. eP106 Song, H.H. eP050 Song, H.N. eP382 Song, J. eP127, eP106, eP136, PS035 Song, Y. eP515 Song, Y.M. eP519 Sonis, S.T. eP310 Sook Ryun, P. eP543 Soong, I.S. eP094

Soong, Y.L. Sophie, M. Soran, A. Sorensen, G.L. Soria Tristán, M. Sota, K. Sottomayor, C. Sousa, P. Southerland, C. Sowunmi, A. Sparano, J. Spencer, K. Spielberger, R. Spillane, M. Spoelstra, S. Sponziello, F. Sridhar, M. Srimuninnimit, V. Sriram, Y. Srivastava, K. Srivastava, R. Stacey, E. Staerk, M. Starkweather, A. Stavas, M.J. Stavrinou, M. Steinberg, S. Steineck, G. Steiner, C. Stek, J. Stephanou, N. Stern, Y. Stevens, J. Stewart, B.R. Stinson, J. Stranks, S. Strasser, F. Stratton, P. Straube, R. Strauss, I. Stringer, A. Stuiver, M.M. Su, S. Subasri, M. Subongkot, S. Sugiyama, M. Sugiyama, Y. Sui, J. Sui, X. Suman, V. Sun, C. Sun, M. Sun, Y. Sundar, M. Sundar, R. Sung-Bae, K. Sung, L. Sunkavali, C. Surendra, Y. Suresh, A. Sussman, J. Sutanto, L.L.H. Sutradhar, S. SUVAK, O. Suzuki, H. Svanberg, A.

eP507 eP308 eP183 eP198 eP208, eP339 eP484 eP545 eP278 eP178 eP403 eP555 eP233 eP194, eP195 eP518 eP167 eP298 eP099 eP527 eP396 eP451 eP074 eP052 eP383 eP171 eP098 eP499 eP261 PS008 eP014 eP462 eP467 eP100 eP023 eP180 eP006, eP052 eP236 eP359 eP530 PS028 eP080 PS065 eP384 eP462 eP112 eP004 eP160 eP103 eP309 eP449 eP179 eP278 PS035 eP179 eP518 eP212 eP543 eP020 eP119, eP120, eP379 eP465 eP119, eP120, eP379 eP486 eP113 eP429, eP555 eP409 eP262 eP203

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Svendsen, M.N. eP383 Swami, N .eP353 Szabò, P. eP010 Szczylik, C. eP028, eP058 Taaffe, D. PS006 Tada, K. eP222 Taguchi, R. PS054 Tahara, M. PS027 Tahura, S. eP331 Takada Shinya, S. eP252 Takada, S. eP169 Takafumi, O. eP386 Takahashi, S. PS027 Takahashi, T. eP160, eP162, eP410, eP487 Takahashi, Y. eP169 Takamatsu, Y. eP166 Talla, V. eP465 Talley, N. eP346 Talwar, V. eP311 Tamaki, S. eP252 Tamura, K. eP024, eP051, eP166 Tan, W. eP128, eP129 Tanaka, H. eP213 Tanaka, K. PS027 Tanaka, R. eP103 Tanaka, T. eP485 Tanco, K. PS004 Tanco, K.C. eP357 Tandon, A. eP395 Tane, K. eP183 Tanem, K.E. eP267 Taniguchi, H. eP262, eP265 Tankel, K. eP131 Tanuma, A. eP160, eP162, eP237, eP487, eP492 Tao, M.J. eP030, eP044 Tarantino, G. eP223 Taranto, P. eP431 Tardif, L. PS045 Tarragó, C. eP201 Tatara, R. eP226 Teerada, S. eP209 Tejada, M. eP325 Teleni, L. eP235 Tellem, R. eP080 Temel, J. eP348 ten Tusscher, M.R. eP384 Terakado, H. eP001 Thaker, D.A. eP312 Thanyanan, R. eP209 Thavarajah, N. eP033 Théret, P. eP313 Thibault, C. eP023 Thirlwell, S. eP314, eP062, eP121, eP228 Thomas, A. eP022 Thompson, K. eP015 Thong, M.S.Y. eP512 Thorburn, A. eP039 Thorsen, L. eP488 Threatt, S. PS060 Tien, Y.W. eP147 Timmers, C.D. eP310 Tissing-Tan, C.J.A. eP054 Tissing, W. eP202, PS029 Tissing, W.J.E. eP324, PS018 Titus, A. eP360

Toh, C.K. eP452 Tohnai, I. eP193 Tomasone, J. eP486 Tomíška, M.eP028, eP058 Tomova, A. eP037 Tonolete, F. eP033 Toor, H.eP385 TOROK, T. eP415, eP502 Torstveit, A.H. eP531 Toscano de Campos, M.C. eP138 Toubasi, S. eP159 Tran, P. eP209 Tran, T. eP025, eP025 Tranmer, J. eP522 Treister, N. eP243, eP248, eP256 Tremblay, D. eP157, eP532, eP504 Trichas, M. PS030 Tripathy, D. PS035 Truscott, R. eP533 Tryfonopoulos, D. eP042, PS002 Tsai, C.J. eP249 Tsao, M. eP032, eP049, eP172, eP340, eP341, eP433, eP434, eP440, eP441, eP494, PS009 Tsiklakis, K. eP042 Tsimpidakis, A. PS002 Tsoi, D. PS007 Tsoukalas, N. eP041, eP215 Tsubaki, A. eP483 Tsubosa, Y. eP237 Tsuji, T. eP492, eP475, eP483 Tsukada, J. eP166 Tsukanov, J. eP081 Tsumaki, H. eP237 Tsuneizumi, M. PS054 Tucker, R. eP335 Tupper, L. eP281 Turkay, U. eP411 Turner, A. eP031, eP047, eP048, eP286 Turner, J. PS034 Tzaninis, D. PS002 Tzerbos, F. eP042 Uchitomi, Y. eP001 Udmuangpia, T. eP179 Ueda, M. eP252 Ueda, S.eP386, PS027 Ueda, T. PS027 Uehara, R. eP160, eP162 Ui Dhuibhir, P. eP240, eP241, eP143, eP214, eP238 Uomori, T. PS054 UPTON, J. eP422 Urita, T. eP213 Usama, M. eP150 Usmani, N. PS034 Utne, I. eP315, eP531 Vadalouca, A. PS030 Vail, L. eP478 Valentine, L. PS006 Valero, V. PS035 van Acht, M. eP056 Van de Poll-Franse, L. eP516 van de Poll-Franse, L.V. eP512, PS044 Van de Wetering, M.D. eP324 van den Hurk, C. eP466 van der Aa, S. eP202, PS029

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Van der Galiën, H.T. PS018 van der Linde, B. eP467 van der Linden, Y. eP056 van der Linden, Y.M. eP054 Van Der Meer, C. eP467 Van Der Velden, J. eP033 Van Deursen, R. eP394 van Draanen, J. eP052 Van Eeden, R. eP303, eP497 van Eenbergen, M. eP466 van Leeuwen, S. eP246 Van Patten, C. eP518 Van Sebille, Y. PS024, PS023, PS026 Van Straten, S. eP467 Vardas, E. eP042, PS002, PS030 Vardy, J. PS042 Vasile, E. eP224, eP229, eP300, eP404, eP417, eP420 Vennettilli, A. eP503, eP515 VERASTEGUI-AVILES, E. eP387, eP388, eP389, eP493 Verma, S. eP429, eP006, eP052, eP439 Verna, L. eP351 Vicent, V. eP201 vicente, M. eP339 Vichaya, E. eP141 Vidal, M. eP357 Vigano, A. eP039 Villegas-Estévez, F. eP381 Virgili, N. eP229, eP300, eP404, eP417, eP420 Vissers, P.A.J. eP512 Vitorino, R. eP481 Vlahovic, G. eP178, PS060 Vlooswijk, C. eP512 Voelker, H. eP243 Vogel, W. eP140 Voisin, D. eP010 Volkers, G. eP059 von Bültzingslöwen, I. eP244, eP245, eP246 Von Huth, S.L. eP198 Vos, C. eP516 Vos, M.C. PS044 Vourli, A. eP042, PS030 Vruwink, J. eP233 Vuong, S. eP005, eP008, eP034, eP047, eP082, eP172, eP206, eP277, eP439, eP440, eP441, eP447, PS009, PS048 Vvedenskaia, E. eP391 Vyas, N. eP530 Vyberg, M. PS031 Waechter, L. eP307 Wakasugi, T. eP484 Wakeda, T. eP222 Wakefield, C.E. eP528 Wakuda, K. eP162 Waldfogel, J. eP362 Walker, P.W. eP357 Wall, G.C. eP099 Wall, L. eP432 Walladbegi, J. eP203 Walling, A.M. eP364 Walsh, D. eP143, eP144, eP214, eP238, eP239, eP240, eP241, PS068

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S36

Wan, A.

eP319, eP320, eP321, eP469, eP534, eP031, eP032, eP034, eP036, eP038, eP043, eP047, eP053, eP082, eP083, eP092, eP108, eP170, eP286, eP294, eP316, eP317, eP318, eP342, eP343, eP365, eP366, eP380, eP392, eP393, eP447, eP468, eP494, eP508, eP509, PS009, PS062 Wan, B.A. eP029, eP030, eP035, eP044, eP045, eP046, eP048, eP049, eP172, eP272, eP340, eP341, eP433, eP434, eP442, eP443, PS064, PS067 Wanders, G. eP056 Wang, J.J. eP051 Wang, M.H. eP131, eP535 Wang, P. eP216 Wang, W. eP369 Wang, X. eP134, PS053 Ward, E. eP432 Wardill, H. PS023, PS026, PS024 Warwick, M. eP536 Wasley, D. eP394 Watanabe, R. eP262 Watanabe, S. eP359 Weant, M. eP178 Weaver, S.J. eP364 Weihua, Y. eP463 Weil, C. eP271 weitzman, T. eP423 Weller, S. eP518 Wen, M.C. PS061 Wendler, D. eP271 Were, P. eP332 Weru, J. eP470 Wesolowski, R. eP310 Weycker- Ph.D., D. PS020, PS021 Whetstone, V. eP302 Whisenant, M. eP471, eP472 White, K. PS063 Whitfield, A. eP009 Wiebe, E. PS034 Wignall, A. PS051 Wilberg, P. eP267 Wilkinson, A. eP395 William, B. eP357 Williams, A. PS011 Williams, J. eP326, eP352 Williams, J.L. eP151, eP357, eP396 Williams, L.A. eP424 Williams, N. eP310 Wilson, A. eP357, eP472 Wilson, C. eP083, eP393, eP406, eP469, eP517, PS062 Wilson, C.F. eP054, eP055, eP056, eP057, eP069, eP457 Wilson, C.M. eP537 Wilson, R. eP362 Winston, D. eP462 Wiseman, T. PS066, eP490 with Cancer Guideline Working Group, O.B.O.T.P.I.C. eP324 Wolf, J. eP323

Wolt, A.

eP317, eP318, eP442, eP468, PS064, PS067 Won, Y.K. eP084 Wong, A. eP083, eP393, eP469, PS062 Wong, B. eP471 Wong, K. eP212 Wong, K.H. eP094 Wong, K.Y. eP094, eP095, eP367 Wong, R. eP083, eP393, eP469, PS062 Wong, R.K. eP056, eP057, eP069 Wong, R.K.S. eP054, eP055, eP457 Wong, S.Y. eP094 Woodring, S. eP178 Woodward, A. eP309 Wörmann, B. PS059 Wray, C. eP360 Wu- Ph.D., H. PS020 WU, H.G. eP268 Wu, J. eP150 Wu, J.S. eP056, eP057 Wu, J.S.Y. eP054, eP055, eP069, eP457 Wu, K. eP176 Wu, W.W. eP455 WU, X. PS047 Wulff-Burchfield, E. eP538 Xavier Scott, J. eP549 Xianyong, L. eP463 Xiaolu, L. eP463 Xu, M. eP467 Xu, W. eP503, eP515 Ya, T. eP463 yadav, B. eP204 Yamada, H. eP160 Yamada, N. eP160 Yamaguchi, T. eP001 Yamamoto, K. eP027, eP103, eP160 Yamashita, A. eP237 Yamazaki, K. eP103 Yanai, T. eP001 Yardley, D. eP555 Yasui, M. eP024 Yates, P. PS033 Yatim, F. eP250 Yau, W. eP369 Yau, Y.S.H. eP094, eP095 Yazbek, R. eP236 Yazdanie, F. eP261 Yee, A. eP032, eP043, eP048, eP392 Yee, D. eP131, eP350, PS034 Yennu, S. eP150, eP151 Yeo, A. eP134, eP507 Yeo, H.L. eP506, PS047 Yeo, H.L.A. PS061 Yeon Hee, P. PS046 Yeung, R. eP094, eP095 Yo, T. eP134 Yoannidis, T. eP503, eP515 Yoeuns, D. eP101 Yokom, D. eP159, eP165 Yokota, T. PS027 Yokoyama dos Anjos, A.C. eP148 Yom, S. eP249 Yom, S.K. eP040 Yoneda, J. eP205 Yongue, C. eP305, eP306

Yoo, J.S. eP476 Yoon-Koo, K. eP543 Yoon, J. eP438 Yoon, S.Y. eP050 York, D. eP101 Yorke, J. eP212 Yorkston, K. eP514 Yoshida, Y. eP213 Yoshikawa, K. eP252 Yoshitsugu, K. eP226 Young Hyuck, I. PS046 Young, A. eP466, eP478 Yuddi, G. eP051 Yuen, K.K. eP094, eP095 Yuki, S. eP018 Yun, H.G. eP291 Yun, J. eP382 Yun, M.J. eP292, eP454 Zacchigna, S. eP071, PS025 Zachariah, F. eP397 Zaidi, S. eP230, PS037 Zaidi, S.S.A. eP322, eP473, eP539, eP445 Zaki, P. eP044, eP317, eP030, eP031, eP038, eP046, eP053, eP172, eP272, eP286, eP318, eP319, eP320, eP321, eP366, eP433, eP434, eP442, eP468, eP494, eP508, eP534, PS064, PS067 Zambrowski, J.J. eP287 Zandonà, L. PS025 Zankhana, M. eP066 Zarowski, C. eP518 Zaydiner, B. eP398 Zenda, S. eP001 Zhang Jun-ee P474 Zhang, A. eP362 Zhang, H. eP164 Zhang, L. PS049, eP006, eP052, eP094, eP172, eP317, eP318, eP340, eP341, eP433, eP434, eP439, eP440, eP441, eP442, eP443, eP468, eP494, PS009, PS064, PS067 Zhang, X. PS035, eP163 Zhao, N. eP296 Zhao, Y. eP015, eP462 Zheng Mei-chune P474 Zheng, R. eP425 Zhong, W. PS055 Zhu, J. eP364 Zhu, L. eP054, eP055, eP056, eP057, eP069, eP457 Zhukovsky, D.S. eP357 Zilic, A. eP028, eP058 Zimmermann, C.eP075, eP353, eP355, eP370, eP374, eP541, PS013 Zinchuk, K. eP248 Zlotogorski-Hurvitz Dr., A. eP100 Zopf, E. PS007 Zuccarone, M.P. eP404, eP420 Zuniga, C. eP109 Zupin, L. eP071 Zygogianni, A. PS030

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PS001 COMPARISON OF SERUM BONE MARKERS IN BREAST CANCER PATIENTS WITH BONE METASTASIS H.J. Kim1, S.E. Park1, J.Y. Ha1, E.H. Oh1 1 Chung-Ang University Hospital, Department of Internal Medicine, Seoul, Republic of Korea Introduction Bone is the most common site of metastatic recurrence in breast cancer and bone metastases are a major cause of morbidity for patients with metastatic breast cancer (MBC). The ability to predict breast cancer patients at ‘high risk’ for bone metastasis development could allow early selection of those most likely to benefit from interventions to prevent or delay bone metastasis. Objectives The purpose of this study was to assess the usefulness of these markers as predictors of progression related bone metastasis. Methods We prospectively observed bone metastasis and bone marker in 34 with breast cancer patients with bone-only metastasis from January 2014 to December 2015. Serum osteocalcin, carboxyterminal telopeptide of type I collagen (CTX), serum parathyroid hormone (PTH), 25-hydroxyvitamin, soluble RANKL (sRANKL), OPG and OPN were assessed at baseline, after every three month and at the time of progression of bone metastasis. Correlation of serum marker levels with progression of bone metastasis was assessed using receiver operating characteristics (ROC) analysis. Results During 24-months, 21 patients (61.7%) with breast cancer revealed the progression of bone metastasis. entered in this study. Serum OPG was significantly elevated in patients with progression of bone metastasis. ROC analyses showed that serum OPG levels were the most reliable predictor of bone metastasis (area under the curve = 0.71). Conclusions This study showed an OPG was reliable marker in detecting the progression of bone metastasis in breast cancer. A further study, which considered biologic subtypes, warranted.

PS002 LOCALIZED ALVEOLAR BONE DISEASE PRIOR TO DENTAL EXTRACTION IN CANCER PATIENTS TREATED WITH A N T I R E S O R P T I V E S : A N E A R LY S TA G E O F OSTEONECROSIS OF THE JAW (ONJ)? E. Papadopoulou1, O. Nicolatou-Galitis1, E. Razis2, E. Vardas1, I. Athanasiadis3, A. Konstantina-Eleni1, A. Ardavanis4, D. Galitis1, A. Nikolaidi3, M. Kouri1, A. Tsimpidakis2, S. Sachanas5, F. Antoniou6, D. Tryfonopoulos4, M.C. Kyrtsonis7, D. Tzaninis8, D. Daliani9, M. Dede4, E. Galitis1, C. Migliorati10 1 University of Athens, Dental School, Athens, Greece 2 Hygeia hospital, Third Medical Oncology Department, Athens, Greece 3 Mitera hospital-Hygeia, Oncology Department, Athens, Greece 4 Saint Savvas Hospital, Oncology Department, Athens, Greece 5 Athens Medical Center-Psychikon Branch, Department of Hematology, Athens, Greece 6 Elena Venizelou, Oncology Department, Athens, Greece 7 Laikon General Hospital, Hematology Department, Athens, Greece 8 Athens Medical Center, Department of Medical Oncology, Athens, Greece 9 Euromedica, 1st Oncology Clinic, Athens, Greece 10 University of Tennessee Health Science Center College of Dentistry, Department of Diagnostic Sciences and Oral Medicine, Memphis, USA Introduction Growing data, from animal experimental studies and clinical observations, have implicated periodontal infectious disease in the development of ONJ in patients, treated with antiresorptive agents.

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Objectives To assess the role of localized periodontal alveolar bone disease (LABD) in ONJ, prior to dental extraction in cancer patients. Pain, swelling, purulence and localized tooth mobility defined LABD. Methods Thirty-nine patients with cancer and bone disease, receiving antiresorptives, were included: 26 (Group A) were referred for LABD and 13 for management of hopeless teeth. Dental extractions were performed under antibiotics. Alveolar bone biopsies were obtained. Historical specimens from healthy subjects and from subjects with ONJ lesions were used as controls. Results Group A: Pain (20), mobility (14), swelling (9), purulence/fistula (8) and numbness (1) preceded the dental extractions. Periapical radiolucency (11), periodontal ligament widening (9), bone loss (6) and dense bone (1) were observed radiologically. Alveolar bone was necrotic in 16 specimens. Bacteria infiltrated six specimens. Nine patients developed ONJ. Group B: Carious teeth/roots and fracture (8) and mobility related to generalized periodontitis (5) led to dental extractions. Periodontal ligament widening (3), periapical radiolucency (3) and bone loss (1) were observed radiologically. No specimens showed necrotic bone. One patient developed ONJ. Conclusions In group A, with LABD, 9/26 patients, 8 with biopsy proven necrotic periodontal alveolar bone, progressed to ONJ, as opposed to 1/13 in Group B. LABD with necrotic alveolar bone in patients on antiresorptives may indicate early ONJ. Recognition may lead to early diagnosis and successful management of ONJ.

PS003 TOBACCO EXPOSURE BY VARIOUS MODES MODULATE PRO-(IL-12) AND ANTI-(IL-10) GENE EXPRESSION AND INFLUENCE THE MEDIAN SURVIVAL OF PROSTATE CARCINOMA PATIENTS S. Dwivedi1, A. Goel2, S. Khattri3, A. Mandhani4, P. Sharma1, S. Misra5, K.K. Pant3 1 All India Institute of Medical Sciences AIIMS- Jodhpur- RajasthanIndia-342005, Biochemistry, Jodhpur, India 2 King George Medical University KGMU- Lucknow- Uttar PradeshIndia-226003, Urology, Lucknow, India 3 King George Medical University KGMU- Lucknow- Uttar PradeshIndia-226003, Pharmacology and Therapeutics, Lucknow, India 4 Sanjay Gandhi Post Graduate Institute of Medical Sciences- Lucknow Uttar Pradesh- India-226010, Urology, Lucknow, India 5 All India Institute of Medical Sciences AIIMS- Jodhpur- RajasthanIndia-342005, Oncosurgery, Jodhpur, India Introduction Inflammation is an important hallmark of all cancers and net inflammatory response is determined by a delicate balance between pro-and antiinflammatory cytokines, which may be affected by various environment factors including tobacco exposure and may affect survival. Objectives The present study was designed to explore the effect of various modes of tobacco exposure on Interleukin-12 (IL-12) and Interleukin-10 (IL-10) inflammatory cytokine levels and survival in prostate carcinoma (PCa) patients. Methods 5ml blood samples of 285 cancer patients and 285 controls with 94 BPH were recruited after taking ethical clearance and their consent; baseline levels of serum IL-12 and IL-10 were measured by ELISA and mRNA expression of both genes were quantified by (Sybrgreen chemistry) real time PCR in various tobacco exposed groups. Relative inflammatory mRNA levels of both were

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calculated using [(1/2) ΔCt ],while fold change expression by 2-ΔΔCt (Livak and Schmittgen, 2001). Five year survivals were analyzed by Log-rank (Mantel-Cox) test. Results The serum pro-inflammatory (IL-12) among tobacco smokers groups showed unique trend i.e. the levels were highest in bidi’s smokers, followed by chillum, cigarette, hookah. Interleukins level were highest in smoker, chewer and alcohol users (combined users) have shown significantly higher levels (p<0.001) with significant low median survivals (27.1 months, standard error=2.86 and 95 % CI: 21.432.62;) than non users. Stage (III and IV) of tobacco addicted patients have also shown significantly increased levels of IL-12 and IL10. Conclusions IL-12 and IL-10 seems to be influenced by tobacco exposure and inflammation also affects median survival of cancer patients.

PS004 A S S O C I AT I O N B E T W E E N T O B A C C O U S E , PA I N EXPRESSION, AND MALADAPTIVE COPING AMONG ADVANCED CANCER PATIENTS R. Dev1, Y.J. Kim2, A. Reddy3, D. Hui3, K. Tanco3, M. Park4, C. Carmack3, E. Bruera3 1 University of Texas MD Anderson Cancer Center, Supportive Care and Palliative Medicine, Houston, USA 2 Seoul National University Bundang Hospital, Department of Internal Medicine Seongnam- Republic of Korea., Seongnam, Republic of Korea 3 University of Texas MD Anderson Cancer Center, Symptom Control & Palliative Medicine, Houston, USA 4 md anderson cancer center, Statistics, Houston, USA Introduction Cancer patients who smoke express higher pain and are at an increased risk for opioid abuse. Objectives To evaluate the association between tobacco use, symptom expression, and maladaptive coping in advanced cancer patients. Methods We prospectively enrolled cancer patients evaluated and collected data on demographics, cancer diagnosis, morphine equivalent daily dose (MEDD), smoking status using Behavioral Risk Factor Surveillance System, symptoms (Edmonton Symptom Assessment Scale), CAGE alcoholism questionnaire, Screener and Opioid Assessment for Patients with Pain (SOAP-SF) survey, and Brief COPE Questionnaire. Results Among 399 patients, 195 (49%) were never smokers, 158 (40%) former smokers, and 46 (11%) current smokers. The most common malignancies were gastrointestinal (21.1%) and breast (19.5%). Current smokers expressed significantly higher pain scores than former or never smokers [median 7 vs. 6 vs. 5, respectively (p=0.015)], increased MEDD (median 90 vs. 60 vs. 50, p=0.002), and more likely to screen CAGE positive (33% vs. 24% vs. 8.7%, p<0.0001). Compared with former and never smokers, current smokers were significantly more likely to cope with substance use (p=0.02), denial (p=0.007), and self-blame (<0.0001), while both current and former smokers significantly more likely to use venting (p=0.04). Also, current smokers compared with former and never smokers were significantly more likely screen positive (≥ 4) on the SOAP-SF survey (74% vs. 13% vs. 9.3%, p=<0.0001) and clinicians rated a higher risk for maladaptive coping (6.5% vs 2.5% vs. 1.5%, p= 0.003). Conclusions In advanced cancer, current and former smokers were significantly more likely to have higher pain expression, CAGE positivity, and increased opioid use.

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PS005 INTEREST IN SMOKING CESSATION AND QUIT RATES A S S O C I AT E D W I T H A C L I N I C A L T O B A C C O IN TERVENT ION (CT I) OFFERE D NEAR START OF TREATMENT IN HEAD AND NECK CANCER PATIENTS M. Conlon1, D. Saunders2, M. Meigs1, S. Santi1, J. Caswell1 1 Health Sciences North/Northeast Cancer Centre, Epidemiology, Sudbury, Canada 2 Health Sciences North/Northeast Cancer Centre, Dental Oncology, Sudbury, Canada Introduction Offering smoking cessation opportunities during cancer treatment is important and may improve patient quality of life and outcomes from care. Objectives This research study used a prospective cohort design set within a dental oncology program at a regional cancer centre in Sudbury, Ontario, Canada, to assess smoking characteristics, interest in, and outcomes associated with receiving a chairside Clinical Tobacco Intervention (CTI) near time of treatment for head and neck cancer. Quit rates, use of medications, and ongoing cravings and urges were assessed at 6 and 12 months. Methods Newly diagnosed patients were screened for a history of smoking, and ever-smokers were invited to participate, which involved: completing an interviewer administered questionnaire that assessed smoking-related behaviours, including nicotine dependence using the Fagerstrom Test for Nicotine Dependence (FTND) and related Time to First Cigarette (TTFC); providing a saliva sample for genetic analyses; and consenting to future contact for assessment of cessation and other health-related outcomes. All smokers were offered personalized counselling and cessation support, pharmacotherapy if appropriate, and received regular follow-up. Results 469 patients who self-reported as ever-smokers agreed to participate. About 36% (n=168) were current smokers and most (n=146; 86.9%) were interested in receiving the CTI. At 6 months, 33 (29.7%; 33/111) of the current smokers had quit smoking; at 12 months 32 of the current smokers had quit smoking (32%; 32/100). Conclusions Offering CTI near time of treatment is acceptable to patients, and provides an important opportunity to support patients in their cessation efforts.

PS006 ONE SIZE DOESN’T FIT ALL: RESPONDERS AND NONRESPONDERS TO EXERCISE INTERVENTIONS FOR CANCER PATIENTS AND SURVIVORS P. Cormie1, S. Lamb2, R. Newton3, L. Valentine2, S. McKiernan2, S. Nigel3, D. Joseph3, D. Taaffe3, D. Galvao3 1 Australian Catholic University, Institute for Health & Ageing, Melbourne, Australia 2 Cancer Council Western Australia, -, Perth, Australia 3 Edith Cowan University, Exercise Medicine Research Institute, Perth, Australia Introduction Research conducted in people without cancer demonstrates substantial inter-individual heterogeneity in response to exercise. Cancer introduces additional factors that may further influence the response. It is unclear which cancer patients do and don’t respond to exercise or what factors influence the magnitude of response. Objectives Explore whether there is heterogeneity of effect among people with cancer in response to exercise.

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Methods 600 people with cancer (70% female, 30% male; age 61±12 years; BMI: 27 ±5 kg.m-2; 2.1±3.2 years since diagnosis) within 2 years of treatment participated in this investigation. Participants had been diagnosed with one of ~40 different types of cancer, predominately breast (43%), prostate (13%) and bowel (9%). Participants self-enrolled in a 3-month community-based exercise program involving supervised moderate-intensity aerobic and resistance exercise. Assessment of physical function, fatigue, distress and quality of life (QOL) were conducted at baseline and post-intervention. Results Significant (p≤0.05) differences existed in the magnitude of change in all variables assessed (Table 1, Figure 1). Patients with the poorest baseline values had significantly greater change in all variables. The magnitude of change in all variables assessed did not vary between patients currently on vs. off treatment, <1-year vs. >1-year since diagnosis or common vs. rare cancer types (Figure 2).

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PS007 SAFETY AND FEASIBILITY OF SUPERVISED EXERCISE DURING ADJUVANT TREATMENT OF HIGH-GRADE GLIOMA P. Cormie1, E. Zopf1, G. Halkett2, D. Tsoi3, A. Hasani4, D. Galvao5, R. Newton5, A. Nowak4 1 Australian Catholic University, Institute for Health & Ageing, Melbourne, Australia 2 Curtin University, School of Nursing- Midwifery and Paramedicine, Perth, Australia 3 St John of God Hospital, Medical Oncology, Perth, Australia 4 Sir Charles Gairdner Hospital, Department of Medical Oncology, Perth, Australia 5 Edith Cowan University, Exercise Medicine Research Institute, Perth, Australia Introduction Patients with high-grade glioma (HGG) undergo aggressive treatments, experience significant adverse-effects and report high unmet needs. Exercise may be an effective intervention to aid management of HGG but no previous research has examined the potential impact of exercise among these patients. Objectives Evaluate if exercise is a feasible and safe therapy in patients with HGG undergoing chemoradiotherapy. Methods 29 patients (69% men; 52±12 years) with HGG scheduled to receive chemoradiotherapy participated in this pilot study. Patients self-selected to receive either usual care (n=5) or a supervised exercise intervention (n=24) throughout chemoradiotherapy. The intervention involved an individualised prescription of moderate-intensity aerobic and resistance exercise during twice weekly sessions delivered at the hospital. Assessment of quality of life (QOL), fatigue, distress, physical function and body composition were conducted ≤10 days prior to and following chemoradiotherapy. Results Four (14%) participants withdrew; baseline characteristics did not differ significantly from non-withdrawers (p≤0.05). Exercise session attendance was ~80±4% and one adverse event relating to the intervention was reported (Table 1). The intervention improved function but few other changes were observed (Table 2). The changes were influenced by whether participants were receiving dexamethasone (Table 3). Function significantly improved while QOL and symptoms did not worsen in exercising patients not receiving dexamethasone. Patients receiving dexamethasone significantly decreased QOL, increased fat mass and did not improve function despite exercising.

Conclusions Significant individual variability exists in the response to exercise among people with cancer. The greatest improvement in symptom severity and QOL is among patients with the worst symptoms. Thus, people with cancer who may be least likely to be referred to an exercise program are the patients who benefit the most.

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Objectives To investigate physical-activity and fear of physical-activity during chemoradiation therapy, and to study the relation between fear, common side-effects and physical-activity. Methods Patients during radiotherapy (100%), combined with tumor-surgery (61%), and chemotherapy (36%) at four Swedish oncology departments irrespective of tumor-diagnose answered Tampa-Scale for Kinesiophobia-Cancer (TSK-Cancer), and questions regarding physicalactivity, nausea, fatigue, and pain. Results Of 452 patients delivering TSK-Cancer data (99%), 324 did not experience fear of activity, while 128 (29%) experienced fear. Patients experiencing fear had compared to patients free from fear increased risk for nausea (40% versus 30%, Relative Risk (RR) 1.53, 95% Confidence Interval (CI) 1.18-1.97, fatigue (80% versus 68%, RR 1.21, CI 1.091.36), pain (70% versus 44%, RR 1.58, CI 1.33-1.87), and to not comply with physical-activity guidelines: >150 minutes physical-activity a week (17% versus 30% complied, RR 1.82, CI 1.19-2.79). Of 453 answering patients, 258 (57%) patients had received information regarding physicalactivity during their cancer therapy, while 195 (43%) had not received any information. Conclusions Over a fourth of patients experienced fear of physical-activity, and these patients experienced more side-effects and were less likely than other patients to follow physical-activity guidelines. Information regarding physical-activity during cancer therapy had been implemented in two thirds of patients within ordinary routine cancer care. Cancer care professionals may identifying patients experiencing kinesiophobia and low physical-activity during cancer therapy, to provide support in physicalactivity.

PS009 THE INCIDENCE OF NEUROPATHIC PAIN IN BONE METASTASES PATIENTS REFERRED FOR PALLIATIVE RADIOTHERAPY

Conclusions Supervised exercise is safe and well tolerated by HGG patients undergoing chemoradiotherapy. Outcomes following exercise were better in HGG patients not receiving dexamethasone. Randomised controlled trials are required to further explore these findings.

PS008 KINESIOPHOBIA AND PHYSICAL-ACTIVITY IN CANCER CARE AND REHABILITATION: THE RELATION BETWEEN F EA R OF A C T IV I T Y A N D SI D E - E FF E CT S D U RI N G CHEMORADIATION THERAPY A. E. Enblom1, L.R. Jess2, G. Steineck3, M. Bäck2 1 Linköping University, Department of Medical and Health Sciences, Linköping, Sweden 2 Linköping University, Department of Medical and Health Sciences, Linköping, Sweden 3 Gothenburg University, Department of Oncology- Division of Clinical Cancer Epidemiology, Gothenburg, Sweden Introduction Physical-activity has potential to reduce side-effects during cancer therapy and even increase survival. Kinesiophobia, in terms of “fear of physical-activity”, has not previously been studied during cancer therapy.

S. Chow1, B. Lechner1, R. Chow1, L. Zhang1, M. Tsao1, C. Danjoux1, E. Barnes1, C. DeAngelis1, S. Vuong1, V. Ganesh1, A. Wan1, A. Agarwal1, E. Chow1 1 Odette Cancer Centre - Sunnybrook Health Sciences Centre - University of Toronto, Department of Radiation Oncology, Toronto, Canada Introduction Bone metastases can be associated with neuropathic pain, which often leads to suffering, disability, and reduced health-related quality of life. Objectives To estimate the prevalence of neuropathic pain in patients with symptomatic bone metastases referred for palliative radiotherapy. Methods A prospective study of patients with symptomatic bone metastases was conducted. Patients referred for palliative radiotherapy completed the Self-Reported Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) questionnaire to assess neuropathic pain. Data regarding patient demographics, medication use, and radiotherapy prescribed was collected. Statistical analyses were conducted to identify relationships between the presence of neuropathic and other patient-related factors. Results Sixty-two patients completed the S-LANSS, 16 (25.8%) of whom had a score suggestive of neuropathic pain. Fifty-nine (95.2%) patients received radiotherapy to a total of 81 sites, with spine and pelvis being the most common sites. No statistical difference in fractionation was found between patients with and without neuropathic pain. Of the 16 patients with neuropathic pain, only

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2 (12.5%) were receiving a neuropathic specific analgesic. No significant differences were found between patients with and without neuropathic pain in terms of demographic characteristics, prescribed radiation therapy, or worst pain score. Conclusions Pain with neuropathic features remains prevalent in a population of patients referred for palliative radiotherapy. Although there are effective medications for bone pain from cancer, only 2 patients with S-LANSS scores indicating neuropathic pain were receiving pregabalin or gabapentin. More frequent prescription of pain medications targeting neuropathic pain may be warranted in this patient population.

PS010 PATIENT VERSUS CLINICIAN REPORTED INCIDENCE AND SEVERITY OF PACLITAXEL-INDUCED NEUROTOXICITY S.B. Park1, J.B. Kwok2, R. Asher3, C.K. Lee3, P. Beale4, F. Selle5, M. Friedlander6 1 University of Sydney, Brain and Mind Centre, Sydney, Australia 2 University of New South Wales, Neuroscience Research Australia, Sydney, Australia 3 University of Sydney, National Health and Medical Research Council Clinical Trials Centre, Sydney, Australia 4 Concord Repatriation General Hospital, Concord Cancer Centre, Sydney, Australia 5 Hôpital Tenon-, Department of Medical Oncology- Alliance For Cancer Research, Paris, France 6 University of New South Wales, Prince of Wales Clinical School, Sydney, Australia Introduction Chemotherapy-induced peripheral neuropathy (CIPN) is a dose limiting toxicity of paclitaxel, with no method to identify at-risk patients. Objectives To investigate incidence and risk factors for the development of CIPN as reported by clinicians and patients. Methods Risk factors for the development of CIPN were examined in 454 patients treated with paclitaxel/carboplatin from the ICON7 trial. Neuropathy was graded by clinicians by standard adverse event reporting and by patients utilising OV28 questionnaire. Genetic risk factors were examined by selecting six single nucleotide polymorphisms in genes associated with microtubule function. Risk factors were assessed via dose-to-event cox regression models. Results Grade >2 neuropathy was reported by clinicians in 28% of patients, while 68% of patients reported ‘quite a bit’ or ‘very much’ tingling or numbness. Agreement between clinicians and patients was poor (k=0.236, 95%CI 0.177 to 0.296, P<.001). Older age, bevacizumab treatment and bowel resection were associated with clinician reported CIPN, while older age and volume of residual disease were associated with patient-reported neuropathy. MAPT additive polymorphisms were associated with patient-reported neuropathy and GSK3B additive polymorphisms were associated with clinician reported CIPN in doseto-first event analyses. Conclusions There was significant discordance between patient and clinicianreported neurotoxicity. The lack of consensus regarding optimal outcome measures and whose opinion with regard to CIPN takes precedence is a limitation in the investigation of risk factors for CIPN. Care must be taken to select and include patient-reported outcome measures in CIPN assessment to enable accurate identification of genetic and other risk factors for neuropathy.

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PS011 CANCER-RELATED COGNITIVE IMPAIRMENT (CRCI) UP TO SIXMONTHS POST-CHEMOTHERAPY WITH MULTIPLE COGNITIVE TESTING METHODS IN A NATIONWIDE LONGITUDINAL STUDY OF BREAST CANCER (BC) PATIENTS AND CONTROLS M.C. Janelsins1, C. Heckler1, L.J. Peppone1, S.G. Mohile2, K.M. Mustian1, T. Ahles3, O. Palesh4, A.M. O'Mara5, L.M. Minasian5, A. Williams6, A. Magnuson2, S.R. Dahhil7, B.T. Esparaz8, J.K. Giguere9, G.R. Morrow1 1 University of Rochester, Surgery-Cancer Control, Rochester, USA 2 University of Rochester, Radiation Oncology, Rochester, USA 3 Memorial Sloan Kettering Cancer Center, Oncology, New York, USA 4 Stanford University, Stanford Cancer Institute Survivorship Research Program, Stanford, USA 5 National Institute of Health, National Cancer Institute, Bethesda, USA 6 University of Rochester, Department of Public Health Sciences, Rochester, USA 7 Wichita NCORP, Oncology, Wichita, USA 8 Heartland NCORP, Oncology, Decatur, USA 9 NCORP of the Carolinas, Greenville Health System, Greenville, USA Introduction CRCI is a clinically important problem. Objectives We conducted a nationwide longitudinal study to assess CRCI. Methods NCORPs recruited BC patients (N=580) and age-matched non-cancer controls (N=363). Computerized ((CANTAB Delayed Match to Sample (DMS), Rapid Visual Processing (RVP), Verbal Recognition Memory (VRM)), paper-based ((Controlled Oral Word Association (COWA), and Trail Making Test (TMT)), and phone-based (category fluency, word recall, backward counting and digits backward) cognitive assessments of memory, attention, and executive function at pre-chemotherapy, post-chemotherapy, and 6 months follow-up (or time-equivalent) were completed. Longitudinal mixed model (LMM)s included group, time, time*group, and relevant covariates. Results In all LMMs, there was a significant group*time interaction depicting lower scores in patients compared to controls (p <0.005) except for the TMT (p=0.09). For the DMS memory test, (primary aim), we observed no significant difference between groups from pre- to post-chemotherapy but did observe a significant difference from pre-chemotherapy to follow-up (p=0.017) where patients significantly declined (p=0.005) and controls did not change. We observed similar results for RVP. For VRM, there was a significant pre- to post-chemotherapy group difference (p=0.003). For COWA, patients significantly declined and controls significantly improved reflecting a significant between group difference (p<0.0001) from pre- to post-chemotherapy. For TMT, both groups significantly improved with patients improving less than controls reflected by a significant between group difference (p=0.04). On all phone tests, there were significant between group differences from both pre- to post-chemotherapy and at follow-up with patients doing less well than controls (all p<0.001). Conclusions CRCI in BC patients persists up to 6 months post-chemotherapy.

PS012 MANAGEMENT OF OLFACTORY, GUSTATORY AND SWALLOWING IMPAIRMENTS IN PATIENTS WITH HEAD AND NECK CANCER G. Buiret1, H. Labrosse-canat2, L. Gautheron2, P. Pouillart3 1 CH Valence, ENT, VALENCE cedex, France 2 Réseau Régional de Cancérologie, Projet médical et pôle Formation, Lyon, France 3 UniLaSalle, Pôle Nutrition- Santé- Longévité, Beauvais, France

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Introduction Malnutrition is particularly related with olfactory, gustatory and swallowing disorders in patients with head and neck cancer. Nutrition is often considered with a therapeutic and quantitative point of view (sum of calories, of protein, oral supplements, enteral feeding...). However, especially in France, eating is central in the social and familial dynamic and the cancer and its treatments can lead to a dramatic quality of life impairment. Objectives To formalize a national consensus about management of olfactory, gustatory and swallowing impairments at home and in care centers Methods A national call for project was performed to recruit multi-professionnal volunteers early 2016, anyone was accepted. Seven focus groups by phone-call were set during 2016. Bibliographic study and the main patients coping strategies were sake. Finally the project was presented and validated in "Guidelines and French Oncology Networks" congress in Nancy, France, in December 2016 and published on the web with either AFSOS (the French National Supportive Care in Cancer Association) and SFNEP (the French National Enteral and Parenteral Nutrition Society) approbation. Results Definitions, physiological and physiopathological notions about smell, taste and swallowing before, during and after cancer treatment were first recalled. The prevention and management strategies of each trouble were then presented with practical messages: ingrédients, cooking technics ans plating. Conclusions Finally this work has led to a national consensus on the management and coping strategies of eating disorders, at home and in care centers, that can be set in parallel with nutrition stratégies to improve quality of life impairment.

PS013 MANAGING CANCER AND LIVING MEANINGFULLY (CALM): AN RCT OF A PSYCHOLOGICAL INTERVENTION FOR PATIENTS WITH ADVANCED CANCER G. Rodin1, C. Lo1, A. Rydall1, R. Nissim1, C. Malfitano1, J. Shnall1, C. Zimmermann1, S. Hales1 1 Princess Margaret Cancer Centre- University Health Network, Supportive Care, Toronto, Canada Introduction Patients with advanced cancer experience substantial distress in response to the burden of disease and challenge of living in the face of impending mortality. We developed a novel psychotherapeutic intervention called CALM designed to alleviate distress and facilitate adjustment in this population. CALM consists of 3-6 individual sessions delivered over 3-6 months that support exploration in 4 domains: 1) symptom management and communication with health care providers; 2) changes in self and relations with close others; 3) sense of meaning and purpose; and 4) the future and mortality. Objectives To test the effectiveness of CALM. Methods Participants were recruited from outpatient clinics at a comprehensive cancer center and randomized to receive CALM or usual care (UC). Assessments of depressive symptoms (primary outcome), death-related distress and other secondary outcomes were conducted at baseline, 3 (primary endpoint) and 6 months. ANCOVA was used to test for outcome differences between groups at follow-up. Results Three hundred and five participants (see Table 1) were recruited and randomized to CALM (n=151) or UC (n=154). We found less severe depressive symptoms for CALM vs UC at 3 (ΔM1-M2 = 1.09, p<0.04; Cohen’s d=0.23) and 6 (ΔM1-M2 = 1.33, p<0.01; Cohen’s d=0.29) months. Other statistically significant findings in psychological well-

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being and preparation for the end-of-life at 3 and 6 months also favored CALM vs UC.

Conclusions CALM is an effective intervention that provides a systematic approach to alleviate distress in patients with advanced cancer and helps them to address the predictable challenges that they face.

PS014 EVIDENCE-INFORMED MANAGEMENT OF EGFRIASSOCIATED SKIN TOXICITY: CLINICAL PRACTICE AND PATIENT OUTCOME IMPROVEMENTS FROM A BEST PRACTICE IMPLEMENTATION PROJECT M. Peters1, X. Guo2 1 The University of Adelaide, the Joanna Briggs Institute, Adelaide, Australia 2 Shanghai Cancer Hospital, Chemotherapy Department, Shanghai, China Introduction Epidermal growth factor receptor inhibitors (EGFRIs) bind to, slow, and inhibit the growth and proliferation of cancer cells. This ‘targeted therapy’ has demonstrated therapeutic effects on solid tumors including colorectal, lung, and head and neck cancers. Skin toxicities associated with EGFRI therapy are an indicator of treatment response, but may also lead to dose modification or discontinuation due to pain, discomfort, and impaired quality of life. With adequate knowledge and skills, EGFRI-induced skin toxicity can be effectively managed collaboratively by clinicians and people affected by cancer. Objectives To improve management of EGFRI-induced skin toxicity by implementing evidence-informed practice within a chemotherapy department. Methods Based on the Joanna Briggs Institute (JBI) approach to evidence implementation, evidence-informed recommendations for practice and audit criteria were developed based upon a series of rapid reviews. Clinical practice was audited against these criteria. Barriers to adherence were identified and strategies to improve compliance, including use of MASCC tools, were implemented with 19 clinicians and 21 patients. Re-audit against the criteria was used to measure clinical practice changes. Quality of life, incidence, and severity of toxicity were measured at baseline and follow-up. Results Improved compliance across all audit criteria in comparison with baseline results was achieved, with all but one criterion achieving 100% compliance. Incidence of skin reactions were lower at follow-up; papulopustular rash (75% to 57.1%), paronychia rate (38% to 7.1%), fissures (62.5% to 35.7%). Conclusions Implementation of strategies to improve patient care and compliance with evidence-informed practice were effective and led to reduced incidence and severity of EGFRI-induced toxicities.

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PS015 DERMATOLOGIC CHALLENGES OF HEMATOPOETIC STEM CELL TRANSPLANT RECIPIENTS

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Conclusions Urea based cream 10% was effective to delay the development of the palmar-plantar erythrodysesthesia and to prevent the onset of higher degrees of this syndrome in patients undergoing chemotherapy.

M. Anadkat1 1 Washington University School of Medicine, Dermatology, St Louis, USA Introduction Patients undergoing hematopoetic stem cell transplantation face many potential challenges. These include myelosuppression, risk for infection, drug toxicity, potential for disease relapse, and graft versus host disease. Many of these complications initially present with cutaneous manifestations. Objectives 1. Describe the various dermatoses that plaque patients undergoing hematopoetic stem cell transplantation 2. Differentiate neoplastic, reactive, and infectious cutaneous morphologies 3. Learn diagnostic and management strategies for dermatologic complications of stem cell transplantion Methods Images and examples will draw from the 10 years of experience as an oncodermatologist at one of the busiest bone marrow transplantation centers in the world. Results There are many complications including infection, disease relapse, drug toxicity, and graft versus host disease. Conclusions This lecture will highlight the various forms of cutaneous complications that may be encountered, emphasizing that not all issues are graft versus host disease.

PS016 UREATO PREVENT PALMAR-PLANTAR ERYTHRODYSESTHESIA SYNDROME IN PATIENTS UNDERGOING CHEMOTHERAPY: A SYSTEMATIC REVIEW C. Inocencio Vasques1, T.U. Senra1, A.G. Meneses1, E.B. Ferreira1, P.E. Diniz dos Reis1 1 Univesity of Brasilia, Nursing Department, Brasília, Brazil Introduction Palmar-plantar erythrodysesthesia, also known as hand-foot syndrome (HFS), is a common skin toxicity related to antineoplastic chemotherapy, such as doxorubicin, cytarabine, capecitabine, docetaxel. The most common signs and symptoms are burning, tingling, painful sensation in the palms of the hands and soles of the feet. Objectives To evaluate the effectiveness of the use of urea in preventing palmarplantar erythrodysesthesia in patients undergoing chemotherapy Methods We developed a sytematic review and the searches were conducted on the following eletronic databases: CINAHL EBSCO, Cochrane Central Register of Controlled Trials (CENTRAL), LILACS, PubMed, SCOPUS, and Web of Science, with no restrictions. Only clinical trials were included. The primary outcome of interest was the prevention of palmar-plantar erythrodysesthesia through the use of urea. Results A total of 656 potentially relevant articles were identified in all databases. After removal of duplicates, 446 articles were identified and of these 22 met all inclusion and exclusion criteria and were eligible for full screening, although only 3 of them were included in the review. Urea based cream 10% was evaluated against mapisal, hydrocolloid dressing and best support care excluding all creams. When compared to the best support care, urea has delayed the development of the palmar-plantar erythrodysesthesia. Compared to mapisal and hydrocolloid dressing, urea has prevented the development of higher degrees of the syndrome.

PS017 CLINICAL IMPLICATIONS OF MALNUTRITION AT DIAGNOSIS, DURING TREATMENT AND ON OUTCOME IN PEDIATRIC ONCOLOGY: A DEVELOPING COUNTRY PERSPECTIVE L. SakthiKumar1, J. Scott2 1 Sri Ramachandra Medical College and Research Institute, Final Year MBBS Undergraduate Student, Chennai, India 2 Sri Ramachandra Medical College and Research Institute, Department of Paediatrics, Chennai, India Introduction Malnutrition is considered as a poor prognostic sign among children with cancer and is thought to increase infection rate. Malnutrition is a major problem in India and is of major concern to pediatric oncologist in developing countries. Objectives To assess if malnutrition at diagnosis and during treatment is a prognostic factor on other events and outcome among childhood cancer patients. Methods All children ≤18 years diagnosed with cancer between June 2009 to June 2016, treated at our institution were included in this retrospective cohort study. Anthropometric data from the medical records upon diagnosis, 3, 6, 12 and 24 months of treatment and relevant treatment data were collected. Nutrition was assessed by the BMI Z-scores calculated using WHO’s Anthro (<5 years) & Anthro-Plus Software (≥5 years). Those with a Z-score <-2S.D. were classified as undernourished. Weight loss more than 10% was considered significant. All events and outcomes were compared between the malnourished and well-nourished children. Results 306 patients were included in this study, 114 were undernourished at diagnosis. 102 of these 306 patients had significant weight loss. Malnutrition at diagnosis and significant weight loss was associated with increased febrile neutropenia with bacteraemia, anaemia, dosage interruptions, mucositis and blood transfusions. Significant Weight loss was also associated with pneumonia and platelet transfusions. Patients undernourished at diagnosis and those with significant weight loss showed a significantly worse outcome (death or relapse) (P<0.001).

Conclusions Patients with undernutrition at diagnosis and/or significant weight loss during treatment showed a significantly worse survival and increased events.

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PS018 PREDICTIVE VALUE OF PCT AND IL-6 FOR BACTERIAL INFECTION IN CHILDREN WITH CANCER AND FEBRILE NEUTROPENIA E.A.H. Loeffen1, H.T. Van der Galiën1, W.J.E. Tissing1 1 University of Groningen- Beatrix Children’s Hospital- University Medical Center Groningen, Department of Pediatric Oncology/ Hematology, Groningen, The Netherlands Introduction Only a third of children with cancer and febrile neutropenia have a bacterial infection, nevertheless standard care comprises hospitalization and intravenous antibiotics. Several biomarkers have been proposed as predictive markers for bacterial infection in this population. Objectives We aimed to evaluate the role of Interleukin-6 (IL-6) and Procalcitonin (PCT) in diagnosing bacterial infection in children with cancer and febrile neutropenia. Methods The study population was derived from a prospective database (2006-2013, IL-8 study) comprising children with cancer who presented with febrile neutropenia. From stored plasma samples (taken at admission and/or at 12-24 hours) we determined the PCT and IL-6 levels. Consequently, we explored their relation with presence of bacterial infection (positive blood culture, positive x-thorax or clinical bacterial focus). We predefined cut-off values, based on previous research, at 60 ng/L for IL-6 and 0.25 ng/mL for PCT. Results 77 febrile neutropenic episodes in 55 children with cancer were included, in 18 episodes (23.4%) a bacterial infection was documented. Both at presentation and after 12-24 hours, median values of IL-6 as well as PCT were significantly higher in patients with a bacterial infection compared to patients without a bacterial infection. With both biomarkers above cut-off values, sensitivity was 93% (with either one this was 100%). The identified low-risk group comprised 41% of the population. Conclusions PCT and IL-6 are promising markers in identifying bacterial infection in children with cancer and febrile neutropenia. In a subsequent project, we will incorporate these biomarkers in a risk assessment model that we will test prospectively in a clinical trial.

PS019 P O P U L AT I O N - B A S E D A N A LY S I S O F U S E O F GRANULOCYTE COLONY STIMULATING FACTOR (GCSF) IN PATIENTS RECEIVING HIGHLY MYELOSUPPRESSIVE CHEMOTHERAPY FOR BREAST CANCER E. Kornelsen1, W. Cheung1 1 Tom Baker Cancer Center, Oncology, Calgary, Canada Introduction GCSF use may be suboptimal despite prior research that shows GCSF prophylaxis can reduce neutropenic fevers and hospitalizations. Objectives We characterized GCSF use in a population-based cohort of breast cancer patients and described outcomes and predictors associated with GCSF prophylaxis. Methods Patients diagnosed with breast cancer from 2008-2012 in a Canadian province and received chemotherapy that posed >20% risk of neutropenic fever were reviewed. Associations between GCSF use and 1) patient and physician factors and 2) treatment outcomes were analyzed using regression. Results We included 805 women: median age 52 years, 40% smokers, 52% regular alcohol consumers, 64% ECOG 0, and 24% had private health insurance. In this cohort, 330 (41%) patients were given GCSF. Among

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those treated with GCSF, 132 (40%) and 198 (60%) individuals received GCSF as primary and secondary prophylaxis, respectively. Overall, neutropenia was noted in 467 (58%) cases while neutropenic fever was experienced by 161 (20%) patients. Compared to those who did not use GCSF, patients who used GCSF had lower rates of neutropenia (14% vs. 61%, p<0.01) and neutropenic fever (8% vs. 23%, p<0.01). In regression, patients lacking extended medical coverage (32% vs. 49%, p=0.02), poor ECOG (30% vs. 55%, p=0.03), and those evaluated at non-teaching institutions (25% vs. 69% p < 0.01) were less likely to receive GCSF. Patients seen at non-teaching institutions were also given primary GCSF prophylaxis less frequently (16% vs 59%, p < 0.01). Conclusions GCSF prophylaxis was associated with improved neutropenia-related outcomes. Despite evidence-based recommendations, use of GCSF remains suboptimal.

PS020 R I S K O F C H E M O T H E R A P Y- I N D U C E D F E B R I L E NEUTROPENIA (FN) WITH EARLY DISCONTINUATION OF PEGFILGRASTIM PROPHYLAXIS (PP) IN US CLINICAL PRACTICE FROM 2010-2015 D. Weycker- Ph.D.1, M. Bensink Ph.D.- M.Sc.- M.Ed.2, H. Wu- Ph.D.1, R. Doroff- B.A.1, D. Chandler- Ph.D.2 1 Policy Analysis Inc. PAI, HEOR, Brookline, USA 2 Amgen Inc., Global Health Economics, Thousand Oaks, USA Introduction Evidence suggests not all cancer chemotherapy patients who receive firstcycle PP continue to receive it in later cycles (especially the last cycle), and these patients may be subsequently at higher risk of FN. Evidence from current US clinical practice is warranted. Objectives To estimate odds of FN, beginning with second cycle, among cancer chemotherapy patients who received PP in that cycle and all previous cycles versus those who received PP in all previous cycles only. Methods Matched-cohort design and US healthcare claims data (2010-2015) were employed. Source population comprised cancer patients who received intermediate/high-risk regimens and first-cycle PP. From source population, beginning with second chemotherapy cycle, all patients who received PP in all previous cycles were identified. From this subset, patients who did not receive PP in cycle of interest (comparison patients) were matched on their characteristics to those who received PP (PP patients); same process was repeated for subsequent cycles. Odds ratios for FN during cycle were estimated using generalized estimating equations. Results Among 38,250 patients in source population, 8.8% did not receive second-cycle PP and were matched to those who did; cohorts were balanced on their characteristics (std. differences <0.1). FN odds in cycle 2 were significantly higher for comparison patients (vs. PP patients). Results were largely comparable across cycles.

Conclusions In this evaluation of cancer chemotherapy patients who received firstcycle PP in recent US clinical practice, FN risk was substantially higher among patients who did not receive PP in subsequent cycles versus those who continued PP.

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PS021 CHEMOTHERAPY-INDUCED FEBRILE NEUTROPENIA (FN) AMONG CANCER PATIENTS RECEIVING PEGFILGRASTIM PROPHYLAXIS (PP) IN US CLINICAL PRACTICE FROM 20102015: FN RISK BY DAY OF PP ADMINISTRATION D. Weycker- Ph.D.1, M. Bensink Ph.D.- M.Sc.- M.Ed.2, A. LonshteynPh.D.1, R. Doroff- B.A.1, D. Chandler- Ph.D.2 1 Policy Analysis Inc. PAI, HEOR, Brookline, USA 2 Amgen Inc., Global Health Economics, Thousand Oaks, USA Introduction PP is recommended for administration 1-3 days after the last administration of chemotherapy during the cycle. Some patients, however, receive PP before or after the recommended timing. While evidence suggests that FN risk may be lower when PP is administered per recommendation, such evidence is based on data that may not be reflective of current clinical practice. Objectives To estimate odds of FN among cancer chemotherapy patients who received PP on the last day of chemotherapy administration (“Day 0”) or 45 days following chemotherapy completion (“Days 4-5”), versus 1-3 days following chemotherapy completion (“Days 1-3”), using recent data from US clinical practice. Methods Retrospective cohort design and data from two US private healthcare claims repositories (2010-2015) were employed. Patients received intermediate/high-risk chemotherapy regimens for solid tumors or nonHodgkin’s lymphoma (NHL) and PP in ≥1 cycle; all cycles with PP were pooled for analyses. Adjusted odds ratios for FN during the cycle were estimated for patients who received PP on Day 0 or Days 4-5, vs. Days 13, using generalized estimating equations. Results 63,101 patients received PP in 217,273 cycles (Day 0, 8%; Days 1-3, 91%; Days 4-5, 1%). Odds of FN were significantly higher among patients receiving PP on Day 0 or Days 4-5, vs. Days 1-3.

Conclusions In this large-scale retrospective evaluation of cancer chemotherapy patients receiving PP in recent US clinical practice, PP was administered before or after the recommended timing in 9% of cycles, and FN incidence was significantly higher in these cycles.

PS022 M U LT I C E N T E R R A N D O M I Z E D D O U B L E - B L I N D CONTROLLED TRIAL TO EVALUATE THE EFFICACY OF LASER THERAPY FOR TREATMENT OF SEVERE ORAL MUCOSITIS INDUCED BY CHEMOTHERAPY IN CHILDREN. LAMPO RCT M. Gobbo1, G. Ottaviani1, K. Rupel1, M. Biasotto1 1 University of Trieste, Dental Science - Oral Medicine and Pathology, Trieste, Italy Introduction Class IV diode laser photobiomodulation (PBM) has proven efficacy in the treatment of severe oral mucositis (OM) in paediatric oncologic patients compared with placebo. Objectives Primary objective was reduction of OM grade (WHO scale) seven days after PBM. Secondary objectives were reduction of pain following a 0-to10 numeric pain rating (NRS) scale and need for analgesics.

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Methods A total of 101 eligible paediatrics suffering from a WHO grade >2 chemotherapy-induced OM were enrolled in 8 Italian hospitals. Patients were randomized into either PBM group or sham treatment group. PBM or sham treatment were performed for four consecutive days (days +1-+ 4). On days +4,+7 and +11 OM grade, pain and need for analgesics were evaluated by an operator blinded to treatment. Results 51 patients were randomized into PBM group and 50 in sham group according to WHO grade. 93.7% of PBM patients and 72% of sham patients had a WHO<3 on Day+7 (p=0.01). Significant (p<0.006) decreasing of NRS was registered between day 0 (NRS: 8[7-9] in both groups) and day 7 (NRS: 1[0-3] in PBM group and 2.5[1-5] in sham group). A reduced use of analgesics was reported in LT group (49%) if compared to sham group (62%) although not statistically significant. Neutrophil count was not significantly different between groups over time (NS). No significant adverse events attributable to treatment were recorded. Conclusions PBM is safe and effective and should be introduced as standard therapy for paediatrics patients affected by OM as it accelerates recovery from OM and reduces pain.

PS023 DYSBIOTIC FAECAL SUPERNATANTS DISRUPT COLONIC EPITHELIAL BARRIER FUNCTION AND INCREASE COLORECTAL AFFERENT NERVE EXCITATION: A NEW MECHANISTIC UNDERSTANDING FOR CHEMOTHERAPYINDUCED GUT TOXICITY H. Wardill 1 , R. Gibson 2 , Y. Van Sebille 1 , M. Campaniello 3 , N. Dmochowska1, C. Mavrangelos3, P. Hughes1, J. Bowen1 1 University of Adelaide, Adelaide Medical School, Adelaide, Australia 2 University of South Australia, Division of Health Sciences, Adelaide, Australia 3 South Australian Health and Medical Research Institute SAHMRI, Centre for Nutrition and Gastrointestinal Diseases, Adelaide, Australia Introduction Chemotherapy for cancer causes severe gut toxicity, manifesting as diarrhoea and pain. Symptoms are commonly reported to coincide with dysbiotic changes in the gut which can be measured in the stool; however the causal consequences remain poorly studied. Objectives To determine the impact of dysbiotic faecal supernatants (D-FSN) on epithelial barrier function and colo-rectal afferent nerve function for translation of mechanisms to chemotherapy-induced gut toxicity. Methods Faecal samples from 10 patients with functional gut disorders (with confirmed dysbiosis) and 8 sex-/aged-matched healthy controls (HC) were used to prepare FSNs. The composition of HC-/D-FSN was assessed using mass spectrometry. Segments of distal colon (from healthy mice) were mounted into Ussing chambers and exposed luminally to D-FSN/ HC-FSN+/-protease inhibitor cocktail (PIC). Resistance (RTE) and conductance were measured for 2h. D-FSN and HC-FSN were also applied to pelvic colonic extrinsic afferents for 5 min and changes in mechanosensitivity determined. Results Mass spectrometry analysis showed FSN composition clearly differs between D-FSN and HC-FSN. D-FSN caused a significant decrease in RTE with paralleled increase in conductance (p<0.001). Protease inhibition partially rescued D-FSN-induced changes in RTE (p=0.02) and conductance (p<0.0001). Electrophysiological analysis showed afferent firing, indicative of increased nerve excitability, in the presence of D-FSN but not HC-FSN.

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Conclusions Dysbiotic faecal samples impair epithelial barrier integrity and directly activate mucosal afferent nerves suggestive of a causative role. Translation of this mechanism holds promise for future studies into chemotherapy-induced gut toxicity, and places the gut microbiome at the centre of cancer therapy-induced gut dysfunction.

PS024 CROFELEMER FOR THE TREATMENT OF DACOMITINIBINDUCED DIARRHEA Y. Van Sebille1, R. Gibson2, H. Wardill3, K. Secombe3, I. Ball3, D. Keefe3, J. Bowen4 1 The University of Adelaide, Discipline of Physiology, Adelaide, Australia 2 The University of South Australia, Division of Health Sciences, Adelaide, Australia 3 Adelaide Medical School, Adelaide, Australia 4 Adelaide Medical Schol, Adelaide, Australia Introduction Crofelemer is an anti-secretory agent approved for the treatment of AIDS associated diarrhea. Recently it has been proposed for clinical prevention of targeted therapy-induced diarrhea. However, the mechanisms causing targeted therapy-induced diarrhea remain undefined. As such, it is unclear if crofelemer will be effective in this setting. Objectives Determine in a preclinical model, if crofelemer prevents dacomitinibinduced diarrhea Methods 48 Albino Wistar rats received 7.5 mg/kg dacomitinib and/or 25 mg/kg crofelemer and/or vehicle via daily oral gavage for 21 days. Diarrhea was graded twice daily. Electrogenic ion transport was measured in Ussing chamber mounted tissue. Intestinal barrier function was measured with 4kDa FITC-dextran, and tight junction proteins, ZO-1, claudin-1, and occludin were visualized with immunofluorescence and analysed. Architectural changes were assessed via H&E and immunohistochemistry markers. Results Diarrhea was significantly worse in rats treated with dacomitinib/ crofelemer combination, than rats treated with dacomitinib alone (92 vs 83%, p=0.0003). Crofelemer was unable to attenuate dacomitinibinduced weight loss, intestinal secretion, intestinal permeability alterations, tight junction disruption, or architectural damage. Conclusions This is the first study to investigate crofelemer in targeted therapyinduced diarrhea and found that it unexpectedly worsened dacomitinibinduced diarrhea, without any increase in tissue injury. As such, any clinical use of crofelemer in this setting should be approached with caution. More work is required to uncover the precise mechanisms leading to small molecule TKI-induced diarrhea as to propose rationally targeted and effective interventions.

PS025 LASER THERAPY AS SUPPORTIVE TREATMENT FOR ORAL MUCOSITIS IS A SAFETY PROCEDURE IN ONCOLOGICAL PATIENTS G. Ottaviani1, V. Martinelli2, K. Rupel1, N. Caronni3, A. Naseem3, L. Zandonà4, G. Perinetti4, M. Gobbo1, R. Di Lenarda4, R. Bussani4, F. Benvenuti3, M. Giacca2, M. Biasotto1, S. Zacchigna4 1 University of Trieste, Dental School - Oral Medicine and Pathology, Trieste, Italy 2 International Centre for Genetic Engineering and Biotechnology, Molecular Medicine, Trieste, Italy

Support Care Cancer (2017) 25 (Suppl 2):S21–S266 3 International Centre for Genetic Engineering and Biotechnology, Cellular Immunology, Trieste, Italy 4 University of Trieste, Department of Medical- Surgical and Health Sciences, Trieste, Italy

Introduction Laser therapy is emerging as a promising supportive treatment for oral mucositis induced by oncological therapies. However, its mechanisms of action and, more importantly, its safety in cancer patients, have never carefully investigated so far. Objectives The main purpose of the presented study is to analyse the behaviour of cancer cells in vitro and in vivo after laser exposure. Methods Cell metabolism was assessed in vitro on mouse B16F10 melanoma cells, on human skin fibroblasts, commercial human umbilical vein endothelial cells and primary bone marrow-dendritic cells by ATPlite Luminescence Assay at 24 and 48 hours after different laser protocols exposure. Both xenograft melanoma and ortotopic oral carcinogenesis mouse models were used to analyse tumour growth and invasiveness through a histological (haematoxylin and eosin stain) and immunohistochemistry characterization (CD4, CD8, DCIR2 and Melan-A ). The analysis of the tumor infiltration was performed using FACS technology. Results In vitro cell metabolism and proliferation increased after laser treatment. Interestingly, in vivo laser therapy reduced tumour growth and invasiveness, indicating a beneficial influence on tumor microenvironment. Lasertreated tumors were delimited and infiltrated by immune cells, in particular by lymphocytes and dendritic cells. A paralleled effect was the enhanced secretion of type I interferons. In contrast, the number of pro-angiogenic macrophages was reduced in response to photobiomodulation, with consequent normalization of the tumor vasculature. Conclusions Our results encourage to perform laser therapy safely also in potentially dysplastic or neoplastic areas in oncological patients, affected by mucosal or cutaneous lesions.

PS026 DIFFERENTIAL GUT MICROBIOME PROFILES PRODUCE ALTERED GASTROINTESTINAL SYMPTOMS FOLLOWING C H E M O T H E R A P Y: D O E S T H I S P O I N T T O A N E W PREDICTIVE MARKER? H. Wardill1, R. Gibson2, Y. Van Sebille1, J. Bowen1 1 University of Adelaide, Adelaide Medical School, Adelaide, Australia 2 University of South Australia, Division of Health Sciences, Adelaide, Australia Introduction Recent research indicates that the unique composition of an individual’s gut microbiome is critical in shaping their immune system and susceptibility to disease. In support of these data, research has suggested pretreatment gut microbiome profiles drive GI toxicity following anticancer treatment, and hence may present as a novel predictive tool. Objectives To determine the impact of gut microbiome composition of symptom generation in a preclinical model of irinotecan-induced GI toxicity. Methods Two populations of BALB/c mice were sourced from two different locations (BALB/c-A and BALB/c-B) and were housed in separate cages. 16S pyrosequencing was used to determine the composition of their gut microbiome. Mice were then treated with 270 mg/kg irinotecan (i.p.) and 0.03 mg/kg atropine (s.c.). At 24 h (peak injury time point), weight loss and diarrhoea severity were assessed. Serum FITC-dextran concentration (4 kDa) was used as a measure of intestinal barrier function.

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Results 16S sequencing revealed significant differences in the gut microbiome in the two BALB/c cohorts. BALB/c-A had increased proteobacteria and decreased bacteroidetes phyla (relative abundance) compared to BALB/c-B. BALB/c-A had lost significantly more weight at 24 h. Serum FITC-dextran concentration was higher in BALB/c-A compared to BALB/c-B, indicating worsened intestinal barrier dysfunction. Diarrhoea severity was not significantly different between groups. Conclusions Differential gut microbiome composition is associated with altered GI toxicity profiles following irinotecan. The gut microbiome therefore presents as a novel strategy to predict severe GI toxicity to promote tailored cancer treatment and better directed delivery of supportive care measures. Further investigation in patient cohorts is now required.

PS027 A MULTICENTER PHASE II STUDY OF REBAMIPIDE LIQUID FOR CHEMORADIOTHERAPY-INDUCED ORAL MUCOSITIS IN HEAD AND NECK CANCER PATIENTS T. Ogawa1, T. Yokota2, T. Fujii3, S. Ueda4, S. Iwae5, K. Tanaka6, I. Ota7, K. Matsuura8, Y. Fujimoto9, T. Beppu10, Y. Hasegawa11, S. Takahashi12, N. Monden13, K. Okami14, H. Kojima15, T. Ueda16, K. Sasaki17, S. Hirano18, M. Fujii19, M. Tahara20 1 Tohoku University Hospital, Otolaryngology-Head and Neck Surgery, Sendai, Japan 2 Shizuoka Cancer Center, Division of Gastrointestinal Oncology, Shizuoka, Japan 3 Osaka Medical Center for Cancer and Cardiovascular Diseases, Department of Otolaryngology- Head and Neck Surgery, Osaka, Japan 4 Nara Hospital- Kindai University School of Medicine, Medical Oncology, Nara, Japan 5 Hyogo Cancer Center, Department of Head and Neck Surgery, Hyogo, Japan 6 Kindai University Faculty of Medicine, Department of Medical Oncology, Osaka, Japan 7 Nara Medical University, Department of Otolaryngology-Head and Neck Surgery, Nara, Japan 8 Miyagi Cancer Center, Division of Head and Neck Surgery, Miyagi, Japan 9 Nagoya University- Graduate School of Medicine, Department of Otorhinolaryngology, Aichi, Japan 10 Saitama Cancer Center, Division of Head and Neck Surgery, Saitama, Japan 11 Aichi Cancer Center Hospital and Research Institute, Department of Head and Neck Surgery, Aichi, Japan 12 The Cancer Institute Hospital of JFCR, Department of Medical Oncology, Tokyo, Japan 13 Shikoku Cancer Center, Department of Head and Neck Surgery, Ehime, Japan 14 Center of Head and Neck Surgery- Tokai University, Department of Otolaryngology, Kanagawa, Japan 15 Jikei University School of Medicine, Department of Otorhinolaryngology, Tokyo, Japan 16 Hiroshima University Hospital, Department of OtorhinolaryngologyHead and Neck Surgery, Hiroshima, Japan 17 Chiba Cancer Center, Head and Neck, Chiba, Japan 18 Kyoto University Hospital, Department of Otolaryngology-Head and Neck Surgery, Kyoto, Japan 19 Eiju General Hospital, Department of Otolaryngology, Tokyo, Japan 20 National Cancer Center Hospital East, Department of Head and Neck Medical Oncology, Chiba, Japan Introduction Preclinical and pilot study results suggest that rebamipide can decrease chemoradiotherapy-induced oral mucositis.

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Objectives This phase II study assessed the efficacy and safety of rebamipide liquid for chemoradiotherapy-induced oral mucositis in patients with head and neck cancer (HNC) and determined the optimal dose of rebamipide liquid. Methods Ninety-four patients aged 20-75 years with HNC were randomized to receive rebamipide 2% and 4% liquids, or placebo. Treatment started 3 days prior to the initiation of chemoradiotherapy (Day -3) and continued until 4 weeks after radiotherapy ended (Day 77). Treatment comprised mouth washing and swallowing with the study drug 6 times/day. The primary endpoint was the incidence of grade ≥3 oral mucositis determined by clinical examination and assessed by central review according to the Common Terminology Criteria of Adverse Events version 3.0. Secondary endpoints were time to onset of grade ≥3 oral mucositis. Results The incidence of grade ≥3 oral mucositis was 39%, 29%, and 25% in the placebo, rebamipide 2% and rebamipide 4% groups, respectively. In the rebamipide groups, there was a trend towards a prolongation in the time to onset of grade ≥3 oral mucositis compared with the placebo group. Among the three groups, there was no difference in the incidence of potentially drug-related adverse events. Conclusions Mouth washing with rebamipide may be effective and safe for chemoradiotherapy-induced oral mucositis in HNC patients. The efficacy and safety profiles suggest that the 4% liquid is the optimal rebamipide dose.

PS028 SGX942 IS A SAFE AND EFFECTIVE TREATMENT FOR REDUCING THE DURATION OF SEVERE ORAL MUCOSITIS (SOM) IN HEAD AND NECK CANCER (HNC) PATIENTS O. Donini1, R. Straube2 1 Soligenix- Inc., Research and Development, Princeton, USA 2 Soligenix- Inc., Clinical Development, Princeton, USA Introduction SGX942 is a first-in-class drug with a novel mechanism of action, modulating the innate immune system to decrease inflammation while enhancing bacterial clearance and tissue healing. Chemoradiation therapy (CRT) associated OM has been linked to dysfunctional inflammation stimulated by the innate immune system. SGX942 has been previously reported to reduce the duration of SOM by 50% in HNC patients receiving CRT. Long term follow-up evaluations have now been completed and further demonstrated the safety and potential ancillary benefits of SGX942 treatment. Objectives To assess the efficacy and long-term safety of SGX942 compared to placebo. Methods This Phase 2 trial enrolled 111 patients who were treated twice per week during radiation therapy and were followed for 12 months after CRT completion. Results Use of daily opioid pain medication was found to decrease in the 1.5 mg/ kg SGX942 treatment group. The incidence of “complete RECIST response” was increased at the initial follow-up visit, and this lack of impact on underlying tumor progression was maintained throughout the 12month follow-up period. 1-year mortality in the placebo group in this study was 19% compared to 7% in the SGX942 treatment group. Conclusions SGX942 appears to be a promising treatment for SOM in HNC patients undergoing CRT and may offer ancillary benefits. Taken together, the previously reported reduced infection rate, coupled with the potential for accelerated tumor clearance and the trend towards reduced mortality, indicate that further studies are warranted. A Phase 3 clinical trial in HNC patients is anticipated to begin in 2017.

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PS029 FARNESOID X RECEPTOR ACTIVATION AMELIORATES M E T H O T R E X AT E - I N D U C E D G A S T R O I N T E S T I N A L MUCOSITIS N. Kuiken1, S. van der Aa1,2, E. Rings3,4, R. Havinga1, H. Harmsen5, C. Kremoser6, F. Kuipers1, A. Groen1,7, W. Tissing1 1 Beatrix Children’s Hospital- University of Groningen- University Medical Center Groningen, Pediatrics, Groningen, The Netherlands 2 Nutricia Advanced Medical Nutrition, Nutricia Research, Utrecht, The Netherlands 3 Leiden University Medical Center- Leiden University- Leiden, Pediatrics, Leiden, The Netherlands 4 Erasmus Medical Center- Erasmus University Rotterdam, Pediatriccs, Rotterdam, The Netherlands 5 University of Groningen- University Medical Center Groningen, Microbiology, Groningen, The Netherlands 6 Phenex Pharmaceuticals AG- Heidelberg, Phenex pharmaceuticals, Heidelberg, Germany 7 Academic Medical Center- Amsterdam, Amsterdam Diabetes Center, Amsterdam, The Netherlands Introduction Gastrointestinal mucositis is a severe side effect of chemotherapy. Bile salts (which may contribute to diarrhea, inflammation and bacterial overgrowth) are endogenous detergents that signal via Farnesoid X Receptor (NR1H4, FXR). Objectives We aimed to determine the effect of a synthetic FXR-agonist on the severity of methotrexate (MTX)-induced mucositis in rats. Methods Male Wistar rats received 45 mg/kg, 60 mg/kg MTX or saline as single intravenous injection. The FXR-agonist PX20606 was administered daily starting seven days prior to MTX injection until termination at days 6 or 12 after MTX. Bodyweight, food intake, diarrhea and plasma citrulline levels were determined continuously. At day 6 or day 12, biliary parameters, caecal microbiota, villus length and MTX plasma levels were determined. Results In contrast to our expectation, FXR activation aggravated the severity of mucositis, with steeper decreases in bodyweight and food intake, more diarrhea and lower survival rates, despite a markedly increased hydrophilicity of the bile salt pool. However, FXR activation led to elevated plasma citrulline levels and increased villus length in control rats as well as in MTX-treated rats during their recovery phase, indicating trophic actions of FXR in the intestine. The diversity of the microbiome was reduced by MTX, whereas the FXR-agonist did not significantly affect microbiome composition. Conclusions Our data indicate that FXR activation worsens MTX-induced mucositis in rats; a less detergent bile salt pool does not provide protection. Since PX20606 treatment promotes intestinal growth, FXR activation might be useful in clinical situations that benefit from stimulation of intestinal repair.

PS030 SALIVARY Α-AMYLASE AS A MARKER FOR SALIVARY G L A N D TO X I C I T Y I N H E A D A N D N E C K C A N C E R PAT I E N T S R E C E I V I N G R A D I O T H E R A P Y O R CHEMORADIOTHERAPY: A PRELIMINARY REPORT M. Kouri1, O. Nicolatou-Galitis1, A. Vadalouca2, V. Kouloulias3, G. Maropoulos 4 , P. Kanellopoulos 4 , E. Kyrodimos 5 , A. Vourli 1 , E. Papadopoulou 1 , E. Vardas 1 , C. Chatzichalepli 1 , E. Galitis 6 , M. Trichas7, A. Zygogianni8, Z. Liakouli8, A. Psyrri9, A. Damatopoulou10, G. Maravelis11, K. Dardoufas12, I. Kouvaris8 1 School of Dentistry- National and Kapodistiran University of Athens, Clinic of Hospital Dentistry, Athens, Greece

“Athens Medical Center”, Pain Clinic, Athens, Greece Medical School- National and Kapodistrian University of Athens, 2nd Radiology Department- Radiotherapy Unit, Athens, Greece 4 “Laiko” General Hospital of Athens, Department of Biochemistry, Athens, Greece 5 “Hippokrateio” Hospital- Medical School- National and Kapodistrian University of Athens, ENT Clinic, Athens, Greece 6 School of Dentistry- National and Kapodistiran University of Athens, Clinic of Orofacial Pain, Athens, Greece 7 “Iaso” Hospital, Radiotherapy Department, Athens, Greece 8 Medical School- National and Kapodistrian University of Athens, 1st Radiology Department- Radiotherapy Unit- “Aretaieion” University Hospital, Athens, Greece 9 Medical School- National and Kapodistrian University of Athens, Oncology Department- “Attikon” University Hospital, Athens, Greece 10 “Alexandra” Hospital, Radiotherapy Department, Athens, Greece 11 “Metropolitan” Hospital, Department of Radiation Oncology, Piraeus, Greece 12 “Hygeia” Hospital, Radiation Oncology Center, Athens, Greece 2 3

Introduction Salivary gland radiation-related toxicity, dysfunction and xerostomia are significant complications in head and neck cancer patients. Salivary αamylase is a good indicator for salivary gland function. Objectives To assess the salivary α-amylase changes in head and neck radiotherapy or chemoradiotherapy. Methods Forty-four patients (mean age 63.16) were included in the study; 16 had oral/oropharyngeal, 14 laryngeal, 5 parotid and 9 other carcinomas. Whole saliva was collected and α-amylase was assessed before radiotherapy, at 2nd-4th weeks and at 5th-7th weeks. A-amylase was measured using the 2-Chloro-NPG3-Substrate-Photometric method. Xerostomia and oral mucositis were recorded. Results Twenty patients received chemoradiotherapy and seven radiotherapy alone. Mean total dose (27/44 patients) was 63.64Gy. Seven patients were not assessed due to administrative reasons, 1 was hospitalized, and 9 were lost of follow up. Between 5th-7th week: 22 patients were assessed. Amylase was reduced in 18 patients from 173.96U/ml to 43.75U/ml; fourteen patients had moderate-severe oral mucositis and 12 had moderate-severe xerostomia. Amylase was increased in 4 patients from 263.15U/ml to 420.94U/ml; those 4 patients had mild to moderate oral mucositis (RTOG:I-II) and 0 to mild xerostomia (VAS:0-4). Between 2nd-4th week: 7 patients were assessed. Amylase was reduced in 5 patients from 209.42U/ml to 46.92U/ml and was increased in 2 patients from 86.63U/ml to 94.13U/ml. Conclusions The reduction of α-amylase in most assessments (23/29) after 2-7 weeks of radiotherapy was considered related to salivary gland dysfunction and radiation toxicity. Α-amylase may serve as a marker for the radiationinduced salivary gland toxicity. The study is ongoing.

PS031 GENE EXPRESSIONS SIGNATURE OF CONSECUTIVE ORAL MUCOSA BIOPSIES BEFORE, DURING AND AFTER RADIATION THERAPY IN PATIENTS WITH TONSIL CANCER M. Marcussen1, J.S. Bødker2, M. Sønderkær2, M. Andersen3, S. Nielsen4, I. Christiansen5, O.J. Bergmann6, M. Bøgsted7, K. Dybkær7, M. Vyberg4, H.E. Johnsen8 1 Aalborg University, Department of Clical Medicine, Aalborg, Denmark 2 Aalborg University Hospital, Clinical Cancer Research Center, Aalborg, Denmark

Support Care Cancer (2017) 25 (Suppl 2):S21–S266 3 Aalborg University Hospital, Department of Oncology, Aalborg, Denmark 4 Aalborg University Hospital, Department of Pathology, Aalborg, Denmark 5 Aalborg University Hospital, Department of Hematology, Aalborg, Denmark 6 Aarhus University, School of Dentistry- Faculty of Health Science, Aalborg, Denmark 7 Aalborg University, Department of Clinical Medicine, Aalborg, Denmark 8 Aalborg University Hospital, Department of Hematology and Clinical Cancer Research Center, Aalborg, Denmark

Introduction Radio-chemotherapy induced oral mucositis is a clinical challenge with few documented prophylactic interventions or predictive test Objectives The aim of this study was to outline a gene expression signature of human oral mucosa and peripheral blood before, during and after chemoradiation to find a target for future preventive initiative or predictive tests Methods Eight patients with squamous tonsil cancer (TON) each had consecutive buccal biopsies and blood tests taken before, at day7 and at day20 following chemo-radiotherapy, on which we applied global gene expression and immune histochemical stain for LY6G6C, KRT16 and SCIN, and monitored clinical mucositis. One biopsy and blood test each from ten healthy individuals served as control Results We found LY6G6C (encoding a surface immunoregulatory protein expressed on mucosal dendritic cells) upregulated before treatment in non-mucositis patients. Compared to normal controls, we found a specific gene signature of TON buccal mucosa before treatment (downregulation of LIFR, FKBP5, MS4A4E, PDGFRA, SPARCL), and recognized several differently expressed non-coding RNA´s in the peripheral blood (e.g. RNU6-620P). In response to therapy, we found both short and long-term change in the expression of SCIN (down-regulation), encoding a protein involved in exocytosis of secretory cells; and of KRT16 (up-regulation) encoding an epithelial cytokeratin. Finally, we found a comparable change in gene expression among patients receiving high-dose melphalan and chemo-radiation Conclusions Among TON patients a specific pre-treatment gene signature of the mucosa and the blood was found. In addition, SCIN and KRT16 were altered both short and long term. LY6G6C may serve as predictor of mucositis

PS032 GASTROINTESTINALTOXICITY OF HIGH-DOSE MELPHALAN IN AUTOLOGOUS STEM CELL TRANSPLANTATION: IDENTIFICATION OF RISK FACTORS AND A BENCHMARK FOR EXPERIMENTAL THERAPIES C.A. Gordillo BS1, S. Parmar Pharm.D- BCOP2, E.M. Delille MSNFNP-BC1, A. Assal MD1, M. Mapara MD1, R. Reshef MD1 1 Columbia University Medical Center, Medicine, New York, USA 2 New York Presbyterian Columbia, Pharmacy, New York, USA Introduction Melphalan is the most commonly administered chemotherapy in autologous stem-cell transplantation. There are limited contemporary data on gastrointestinal toxicity associated with it. Objectives To characterize the gastrointestinal toxicity of high-dose melphalan and identify risk factors for severe toxicity. Methods We retrospectively studied 100 consecutive patients who received highdose melphalan between 2014-2016.

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Results Patients (mean age 53 years, range 20-73) had myeloma (42%), lymphoma (42%) or amyloidosis (16%). Melphalan dose was 200 (40%), 140 (59%), or 100 mg/m2 (1%). Ninety-seven percent of patients experienced diarrhea ranging 1-18 daily bowel movements (Figure 1). Sixty-two percent developed grade≥2 diarrhea, while grade≥2 nausea and vomiting was observed in 39% and 24%, respectively. The mean total number of bowel movements during 14 days after transplant was 31 (maximum 61). Rescue loperamide was given 12 times on average (range 0-43). Eighteen percent had a decrease in more than 10% of their weight and 38% dropped albumin level by at least 1g/dL. Patients with grade≥2 diarrhea had higher incidence of hypokalemia, hypomagnesemia and hypoalbuminemia, used more rescue medications and had more prolonged diarrhea (8.7 v. 5 days, p<0.0001) than patients with milder diarrhea. Grade≥2 diarrhea was independently associated with age>55 (p=0.04), creatinine clearance <60 (p=0.05) and female sex (p=0.04). Melphalan dose and underlying disease were not significantly associated with diarrhea.

Conclusions Diarrhea continues to be the main dose-limiting toxicity of high dose melphalan, with female sex, older age and abnormal renal function causing high risk. Novel therapies for melphalan-induced diarrhea in stem-cell transplantation are critically needed.

PS033 DEMOGRAPHIC, CLINICAL, AND GENETIC PREDICTORS OF QUALITY OF LIFE OF WOMEN UND ERGOING SURGERY FOR BREAST CANCER K. Alexander1, C. Miaskowski2, P. Yates1, B. Cooper2 1 Queensland University of Technology, School of Nursing, Brisbane, Australia 2 University of California, Department of Physiological Nursing, San Francisco, USA Introduction The variability in findings from quality of life (QOL) studies of breast cancer patients following surgery suggests that not all women are affected to the same extent. Objectives The purposes of this study were to identify latent classes with distinct trajectories of QOL in women from prior to through six months following breast cancer surgery and to evaluate for differences in demographic and clinical characteristics, as well as for variations (single nucleotide polymorphisms (SNPs) and their haplotypes) in 15 candidate cytokine genes, between the identified classes.

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Methods Growth mixture modelling (GMM) was used to identify latent classes of women (n = 398) based on Quality of Life-Scale-Patient Version (QOLPV) scores obtained prior to surgery then monthly for 6 months. Chisquare tests were employed to evaluate for demographic, clinical, and genetic differences between the latent classes identified. Results Groups of women who report distinct physical well-being, social wellbeing, and total QOL trajectories prior to and after breast cancer surgery were identified. The phenotypic characteristics associated with membership in the lower physical well-being, social well-being, and total QOL groups included: younger age, lower functional status, and having received adjuvant chemotherapy. Higher BMI was a predictor of lower physical well-being. SNPs in five cytokine genes (i.e., CXCL8, NFKB2, TNFA, IL1B, and NFKB1) were associated with group differences in physical well-being, social well-being and total QOL classes. Conclusions Identification of breast cancer patients at risk for poorer QOL outcomes prior to the initiation of treatment may help to inform treatment and supportive care planning for these women.

PS034 INFORMAL CAREGIVER QUALITY OF LIFE IN A PALLIATIVE ONCOLOGY POPULATION A. Duimering1, J. Turner2, K. Chu1, F. Huang1, D. Severin1, S. Ghosh3, D. Yee1, E. Wiebe1, N. Usmani1, Z. Gabos1, S. Patel1, B. Danielson1, J. Amanie1, W. Roa1, A. Fairchild1 1 Cross Cancer Institute, Radiation Oncology, Edmonton, Canada 2 Cross Cancer Institute, Clinical Psychology, Edmonton, Canada 3 Cross Cancer Institute, Experimental Oncology, Edmonton, Canada Introduction Many patients with advanced cancer are supported primarily by informal caregivers (IC), who assume increasing responsibility as a patient’s condition deteriorates, often precipitating distress. Objectives We sought to characterize the quality of life of IC of patients referred to a palliative radiotherapy (PRT) program. Methods IC accompanying patients to a dedicated PRT clinic (03/2016-01/2017) were invited to complete a survey based on the validated Caregiver Quality of Life Index – Cancer (CQOLC). Demographics, burden, and engagement in support services were assessed for association with lower CQOLC scores by a generalized linear model. Results 201 surveys were analyzed representing 197 unique patients; mean age 68.3 years, 25.0% lung primaries, ECOG performance status 0-2 (49.5%) to 3-4 (50.5%). IC were 60.8% female, mean age 58.7 years, and 60.6% the patient’s spouse. 69.5% lived with the patient and 38.3% were additionally employed. IC spent a daily mean of 6.6 hours (range 0-24) assisting with instrumental (72.5%) and basic (37.5%) activities of daily living and medical tasks (20.5%). Mean CQOLC score was 82.1/140 (range 33-129). 63.8% of IC had previously accessed support service(s), most commonly home care (37.2%), and 52.2% indicated interest in additional services. Multivariate analysis revealed lower socioeconomic status, additional employment, cohabitation with the patient, poor patient performance status, and expression of interest in more support services to significantly correlate with lower CQOLC score (i.e. more distress). Conclusions Employing the CQOLC to screen IC of patients referred to a PRT program permits early identification of vulnerable IC to facilitate provision of appropriate support.

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PS035 MAJOR DEPRESSION AND SURVIVAL IN OLDER CANCER PATIENTS X. Zhang1, M. Sun1, J. Song2, C. Dinney3, U. Popat4, R. Champlin4, V. Valero5, D. Tripathy5, H. Holmes6, B. Edwards1 1 The University of Texas- MD Anderson Cancer Center, General Internal Medicine, Houston- TX, USA 2 The University of Texas- MD Anderson Cancer Center, Biostatistics, Houston- TX, USA 3 The University of Texas- MD Anderson Cancer Center, Urology, Houston- TX, USA 4 The University of Texas- MD Anderson Cancer Center, Stem cell transplantation, Houston- TX, USA 5 The University of Texas- MD Anderson Cancer Center, Breast Medical Oncology, Houston- TX, USA 6 University of Texas Houston McGovern Medical School, Geriatric and Palliative Medicine, Houston, USA Introduction More than 60% of cancer patients are older adults. Major depression is regularly seen in older cancer patients. Objectives To assess the prevalence of depression and evaluate its effect on mortality in older cancer patients. Methods Single site retrospective study. Patients 65 years of age and older with hematologic or solid tumors in active cancer care underwent a comprehensive geriatric assessment, including cognitive, functional, mood, nutritional, physical, and co-morbidity assessment in the Program for Healthy Aging. Patients were assessed using the Patient Health Questionnaire 9 (PHQ-9) [PHQ 9 >10, sensitivity is 88%, specificity is 88% for major depression]. Anti-depressant treatment was initiated, follow up visits were scheduled. Analysis: Descriptive statistics, and multivariable survival analysis. Results Among 304 eligible patients, the median follow-up was 12.7 months, 98 (32%) died, the median overall survival (OS) was 25.4 months. Median age at enrollment was 78 years. A number of geriatric syndromes and comorbidity were identified, major depression was diagnosed in 85 (28.2%) of individuals. Patients' follow up in the program was sub-optimal (<30%). A final multivariable model included age group, cancer stage, functional impairment, and major depression. Risk factors for OS include major depression (HR =1.88 (95% C.I. 1.12, 3.15), p-value=0.02), functional impairment (HR =2.47 (95% C.I. 1.28, 4.74), p=0.007), and metastatic disease (HR= 2.2 (95% C.I. 1.30, 3.97), p=0.004). Conclusions Major depression is common and impacts mortality in a cohort of older cancer patients. Early detection, initiation of antidepressant therapy and continuity of care for depression may potentially improve clinical outcomes. Prospective studies are recommended. PS036 USE OF STOPP CRITERIA MEDICATIONS IN OLDER BREAST AND COLORECTAL CANCER PATIENTS M. Karuturi1, S. Giordano2, H. Homes3, X. Lei2, M. Johnson4 1 MD Anderson Cancer Center, Breast Medical Oncology, Houston, USA 2 MD Anderson Cancer Center, Health Services Research, Houston, USA 3 University of Texas Health Science Center at Houston, Geriatrics and Palliative Medicine, Houston, USA 4 University of Houston College of Pharmacy, Clinical Sciences and Administration, Houston, USA Introduction Screening for potentially inappropriate medication use (PIM) is recommended in elderly cancer patients receiving chemotherapy.

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Objectives To determine predictors and impact of PIM on outcomes in breast and colorectal cancer patients receiving chemotherapy. Methods We used data from the SEER-Medicare database. Our study included patients ≥66 years with a diagnosis of Stage II/III breast and colorectal cancer made between 7/1/2007-12/31/2009. We used modified STOPP criteria to define baseline PIM as a dichotomous variable in the 4 months prior to diagnosis. Outcome measures included ER visits, hospitalization, death within 6 months of diagnosis, and a composite of the three. We used Chi-square or Fisher’s exact test to determine associations of PIM with covariates and outcomes, multivariable logistic regression to determine predictors of PIM, and a Cox proportional hazards (PH) model for the time-to-event analysis.

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Inclusion criteria were made and One Hundred and fifty participants were enrolled in the study. Socio demographic characteristics were evaluated using Beck Depression Inventory and socio demographic form. Severity of depression was estimated by using Hamilton D (HAM-D). Various variables were analysed including parent’s age, level of education, socioeconomic status of family and gender and number of children. Results 68% of the participants exhibited severe range of depression. 27% showed moderate depression where as 5% participants were showing the mild range of depression. An inverse co relation was found between educational status, occupational status (paid or unpaid), their marital status, socioeconomic family status and depression. Mothers 71% were found be more depressed than fathers. Conclusions We concluded that majority of mothers suffer from psychosocial symptoms particularly depression and it is mainly associated with some factors. There is need to incorporate parents especially mothers into the diagnosis and treatment process so that we can over come the effects of parental depression on the health outcomes of children diagnosed with cancer.

PS038 REDUCED RISK OF RECURRENCE IN BREAST CANCER PATIENTS WITH DEPRESSIVE DISORDERS IS ASSOCIATED WITH SELECTIVE SEROTONIN REUPTAKE INHIBITORS : A NATIONWIDE POPULATION-BASED COHORT STUDY Results Final analysis included 1595 breast and 1528 colorectal cancer patients. Frequency of baseline PIM by STOPP was 31.5% in the breast and 30.9% in the colorectal cohorts. In breast, associations with PIM in the multivariable analysis included higher co-morbidity and more medications. Associations in colorectal included older age at diagnosis, higher co-morbidity, and more medications. Associations with the composite in the Cox PH mode for breast included stage, co-morbidity, medication number and ER visits/hospitalization. Age, gender, race, co-morbidity and ER visits/ hospitalization were predictors amongst the colorectal. PIM was not associated with outcomes in either cohort, aside from hospitalization in breast. Conclusions We found no consistent association between pre-chemotherapy PIM defined by STOPP and outcomes.

PS037 IDENTIFYING THE SEVERITY OF PSYCHOSOCIAL SYMPTOMS AMONG PARENTS OF CHILDREN DIAGNOSED WITH CANCER A. Fatima1, S. Zaidi2 1 Lahore, Pakistan 2 wecare, Research, Lahore, Pakistan Introduction Each year almost 18,000 children are diagnosed with cancer in Pakistan. Majority of these children are underprivileged and hence the cancer become the leading cause of death. The diagnosis and treatment of childhood cancer is a continuous emotional distress for both parents particularly mothers. Objectives We aim to identify the severity of depression, emotional distress, stress and mental fatigue among parents of children diagnosed with cancer. Methods A cross sectional study was conducted in Shaukat Khanum Hospital, Lahore from March 2014 to April 2015. Exclusion and

C.H. Chang1 1 China Medical University Hopsital, Psychiatry, Taichung, Taiwan R.O.C. Introduction Previous studies have reported that decreasing depressive symptoms are associated with longer subsequent survival in women with metastatic breast cancer. However, the recurrence of breast cancer patients receiving antidepressants or psychotherapy for depression remains unclear. Objectives To investigate the association between antidepressants and risk of tumor recurrence in patients with breast cancer after curative surgery. Methods We enrolled a breast cancer cohort between January 2001 and December 2007 from the Taiwan National Health Insurance Research Database (NHIRD). Among 30,659 newly diagnosed breast cancer patients, we identified 1,147 breast cancer patients with depressive disorders and 2,294 matched breast cancer patients without depressive disorders, who both received curative breast surgery between January 2003 and December 2007. Results The depressive disorder cohort had a higher rate of recurrence when compared with the matched non-depressive disorder cohort (17.1% vs 12.5%; p <.001). The hazard ratio for subsequent recurrence among the depressive disorder cohort was 1.373 (95% confidence interval, 1.0981.716; p =0.005). The Cox univariate proportional hazards analysis showed that patients with depressive disorders receiving antidepressants (SSRIs, SNRIs, NDRIs, SARIs, and TCAs), or psychotherapy had lower risks of cancer recurrence. In the Cox multivariate proportional hazards analysis, depressed patients with SSRI treatment had the significantly lowest risk of recurrence (adjusted HR (aHR) 0.581, 95% CI 0.395 to 0.856, p = 0.006). Conclusions Depressive disorders were associated with a higher risk of breast cancer recurrence following curative breast surgery. However, depressed patients who received SSRIs treatment may have reduced risk of recurrence.

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PS039 RANDOMIS ED CONTROL LED T RIAL COMPARI NG VA R E N I C L I N E P L U S C O U N S E L L I N G A N D B R I E F COUNSELLING ALONE ON SMOKING CESSATION IN PATIENTS PRONE TO LUNG CANCER USING CARBON MONOXIDE MONITER D. Johns1 DM Wayanad Institute Of Medical Science, Dentistry, Trikakara-kochi, India 1

Introduction Lung cancer patients may benefit from combining pharmacological and non-pharmacological methods Objectives Efficacy of Varenicline and counselling on smoking cessation. Methods Group 1-Councelling alone Group 2-Councelling for 3 weeks + Varenicline(1mg twice/day) for 6 weeks Group 3- Councelling for 6 weeks + Varenicline(1 mg twice/day) for 6 weeks One hundred patients were enrolled in each group Inclusion Criteria-Previous lung disease, a family history of lung cancer, Past cancer treatment, Lowered immunity, Previous smoking related cancers, Exposure to certain chemicals and radon gas. Continuous and point prevalence abstinence from smoking (validated by exhaled carbon monoxide <10 ppm) was measured and self-reported reduction in cigarette consumption in smokers was assessed at 3 and 12 months. A post hoc exploratory analysis was conducted to assess if the effect of treatment was related to cigarette consumption Results Abstinence was higher in the group 3 than in the than in group 2 and 1. The difference between the groups was significant for validated point prevalence abstinence at 3 months (42%,38%, 20% respectively, p=0.045) and at 12 months (37%, 32%, 14%, p=0.03. A non-significant interaction was detected among participants by the level of nicotine dependence (P = 0.06 at 3months and P = 0.1 at 12 months) between group 3 and 2. When comparing the mean scores of the Minnesota Nicotine Withdrawal Scale (MNWS) between the study groups at month 12, the intervention group showed lower withdrawal than did the control group. The most common adverse event with varenicline was nausea. Conclusions Varenicline given with prolonged counselling was effective modality compared to counselling alone.

PS040 PHASE II RCT OF BRIEF BEHAVIORAL THERAPY FOR CANCER-RELATED INSOMNIA (BBT-CI): EFFECTS ON QUALITY OF LIFE (QOL) AND HEART RATE VARIABILITY (HRV) O. Palesh1, C. Scheiber1, B. Selland1, M. Packer1, S. Kesler2, M. Janelsins3, R. Gevirtz4, J. Guido3, C. Heckler3, K. Mustian3 1 Stanford University, Psychiatry and Behavioral Medicine, Stanford, USA 2 MD Anderson Cancer Center, MD Anderson Cancer Center, Houston, USA 3 University of Rochester, University of Rochester, Rochester, USA 4 Alliant International University- San Diego, Alliant International University- San Diego, San Diego, USA Introduction Approximately 80% of cancer patients struggle with insomnia. Insomnia has been associated with decreased HRV and QOL. There is a

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bidirectional relationship in that diminished QOL exacerbates physiological symptoms and, conversely, reduced HRV influences QOL. Objectives There are no effective interventions deliverable in infusion centers that address these side effects. Our aim is to evaluate the efficacy of BBT-CI for improving QOL and HRV in BC patients with insomnia undergoing chemotherapy. Methods 71 BC patients (mean age=52.5) with insomnia were randomized to either BBT-CI or a healthy eating control group (HEAL) in our phase II, RCT. BBT-CI and HEAL were delivered over 6 weeks (2 face-toface sessions + 4 phone calls) by trained nurses or clinical research staff at 5 NCI-funded Community Oncology Research Program clinics. We measured QOL with the Functional Assessment of Cancer Therapy (FACT-G and FACT-B), and HRV was measured with the Firstbeat® device. Results Results indicated excellent feasibility and acceptability of conducting BBT-CI in the infusion clinic based on a recruitment rate of over 75% and an intervention adherence of 74%, with 75% of intervention components successfully delivered. ANCOVA revealed significant improvements in QOL for BBT-CI at 6 weeks (FACT-G, p=.009; FACT-B, p=.016) and HRV measures (SDNN, p=.047; rMSSD, p=.040; HF, p=.018). Conclusions BBT-CI showed improvements in QOL and HRV in BC patients while demonstrating efficacy in the community oncology setting. BBT-CI is a novel intervention which has shown psychological and physiological benefits. Even further, it can be delivered directly in oncology clinics by nurses or research staff.

PS041 EFFECTS OF CHILDHOOD TRAUMA EXPOSURE AND CORTISOL LEVELS ON COGNITIVE FUNCTIONING AMONG BREAST CANCER SURVIVORS C. Kamen1, C. Scheiber2, M. Janelsins3, K. Mustian3, L. Peppone3, M. Asare3, B. Jo2, H. Shen2, O. Palesh2 1 University of Rochester School of Medicine, Surgery, Rochester, USA 2 Stanford University, Psychiatry, Stanford, USA 3 University of Rochester Medical Center, Surgery, Rochester, USA Introduction Cognitive functioning difficulties are common among breast cancer patients, but not all women experience difficulties equally. Childhood trauma exposure is associated with hypothalamic-pituitary-adrenal (HPA) axis dysregulation and changes in cortisol response, which are associated with cognitive functioning among women in general. Objectives To evaluate associations between trauma, cortisol dysregulation, and cognition among breast cancer survivors. Methods 56 women with breast cancer (any stage, off active treatment) completed measures of trauma exposure (the Traumatic Events Survey) and selfreported cognitive functioning (the Functional Assessment of Cancer Therapy – Cognitive); their salivary cortisol was measured 3x day/2 days. We examined associations between childhood trauma exposure and cognitive functioning, controlling for factors associated with cognition (age, education, time since chemotherapy, depression, anxiety, insomnia), and used the MacArthur approach to test whether cortisol dysregulation mediated the relationship between trauma and cognitive functioning. Results 57.1% of the sample had experienced 1+ traumatic event in childhood. Childhood trauma exposure was significantly associated with poorer cognitive functioning (r=-0.29, p=0.03). This association remained

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significant even after controlling for factors associated with cognition. Women with childhood trauma exposure had significantly higher waking cortisol (p=.01) and steeper diurnal cortisol slopes (p=.02) than those without trauma. The association between childhood trauma and poor cognitive functioning was mediated by steeper cortisol slopes (partial r=0.35, p=.02). Conclusions This is among the first studies finding associations between childhood trauma exposure, cortisol dysregulation, and self-reported cognitive functioning among breast cancer survivors. Early trauma and adversity should be considered, among other factors, in research aiming to address cognition in this population.

PS042 THE SINGLE QUESTION IN DELIRIUM (SQID); HOW HELPFUL IS A SINGLE QUESTION IN IDENTIFYING DELIRIUM IN CANCER PATIENTS? M.B. Sands1, S. Sharma2, L. Carpenter2, S. Lujic3, J. Lee4, M. Congdon5, A.M. Buchanan6, M. Agar7, J. Vardy8 1 UNSW Australia, Medicine- Prince of Wales Clinical School, Sydney, Australia 2 UNSW Australia, Psychiatry - Prince of Wales Clinical School, Sydney, Australia 3 UNSW Australia, Centre for Big Data Research in Health-, Sydney, Australia 4 University of Sydney, Medicine- Concord Clinical School, Sydney, Australia 5 The Prince of Wales Hospital, Medical, Syndey, Australia 6 Gosford Hospital, Medical, Gosford, Australia 7 University of Technology, Centre for Cardiovascular and Chronic Care, Sydney, Australia 8 University of Sydney, Medicine - Concord Clinical School, Sydney, Australia Introduction Delirium carries serious risks. Prevention is the mainstay of management; where prevention fails, early detection is crucial. Objectives To test a Single Question in Delirium (SQiD) in hospitalised, cancer patients Methods Setting: inpatient oncology wards of two comprehensive cancer centres, in Sydney, Australia. Prospective screening, excluded admissions of <24 hours, chemotherapy or radiotherapy only. The SQiD “Do you feel that [patient’s name] has been more confused lately?” was tested against interview by consultant psychiatrist (CPI), using DMS criteria. Primary endpoint was negative predictive value (NPV) of the SQiD v CPI; secondary endpoints included NPV of SQiD versus Confusion Assessment Method (CAM). Results A total of 120 patients were recruited: mean age 66.5 years (range 22-89), n=120, 43% female, cancer types: lung 21%; breast 12%, and prostate: 10%. 73% had stage 4 cancer. Delirium on CPI in was (n=71) was 35% (4/71 hyperactive, 17/71 hypoactive, 6/71 mixed). Primary endpoint: The NPV of SQiD was 72.2 (95%CI58.36 - 83.54); NPV of CAM was 71.2 (95%CI 57.92 - 82.24). Secondary endpoint, NPVof SQiD vs CAM, was 97.6 (95%CI 91.57 - 99.71). Delirium prevalence was 9.2% on CAM v 23.1% on SQiD. CAM identified 1 of 16 cases of hypo-active delirium versus 6 using SQiD. Conclusions The SQiD performed well against both comparators. Unlike the CAM, the SQiD required minimal training, and administration was feasible in busy inpatient oncology settings. This single question in delirium screening has potential to set a new standard of care.

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PS043 "PRE-CACHEXIA" AND INFLAMMATION IN THE ELDERLY WITH METASTASTIC GASTROINTESTINAL CANCER PROGNOSTIC PREDICTORS? D. Cardoso1, L. Fernandes1, A.J. Pissara1, M. Miguéns1, M. Malheiro1, H. Miranda1, A. Martins Mourão1 1 Hospital São Francisco Xavier, Serviço de Oncologia Médica, Lisbon, Portugal Introduction More than 50% of advanced stage cancer patients experience cachexia and >10% die of this cause. Systemic inflammation plays a crucial role in cachexia. The modified Glasgow Prognostic Score (mGPS) is a combined index of malnutrition and inflammation, with validated prognostic value, establishing three scores(0, 1 and 2-better, intermediate and worse prognosis). Objectives To evaluate and relate mGPS and overall survival (OS) in elderly patients(≥65 years) with metastatic Gastrointestinal Cancer (mGIC). Methods Retrospective, observational study of a random sample of elderly patients with mGIC established in 2014. Data was collected from clinical files and Student's t test(p) were used as statistical tests. Results We present our sample characterization in table 1. Within the mGPS subgroups, mean OS was different (table 2), being practically twofold in patients with mGPS=0(p<0,01). OS was compared between the 3 subgroups and it was confirmed that in patients with mGPS of 0, it was significantly higher than in those with mGPS of 1 and 2 (p=0.01 and p=0.001, respectively, vs. p=0,3 when mGPS 1 was compared with 2 p=0,05).

Conclusions A correlation was found between the mGPS and OS. This relationship evidences the contribution of systemic inflammation as a major prognostic factor and worse OS. The mGPS is important in the identification of patients at higher risk of developing cachexia, as emphasized by European recommendations. It may be a useful tool in signaling the pre-cachexia group of patients allowing an earlier intervention.

PS044 THE INDIRECT EFFECTS OF SURVIVORSHIP CARE PLANS ON QUALITY OF LIFE, ANXIETY AND DEPRESSION – THE ROGY CARE TRIAL B.H. de Rooij1,2, N.P.M. Ezendam2, K.A.H. Nicolaije1,2, M.C. Vos3, J.M.A. Pijnenborg3, D. Boll4, R.F.P.M. Kruitwagen5, L.V. van de PollFranse1,2,6

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Tilburg University, Medical and Clinical Psychology, Tilburg, The Netherlands 2 The Netherlands Comprehensive Cancer Organisation, Research, Utrecht, The Netherlands 3 Elisabeth-TweeSteden Hospital, Obstetrics and Gynecology, Tilburg and Waalwijk, The Netherlands 4 Catharina Hospital, Gynecology, Eindhoven, The Netherlands 5 Maastricht University Medical Center, Gynecology and GROW - School for Oncology and Developmental Biology, Maastricht, The Netherlands 6 The Netherlands Cancer Institute, Division of Psychosocial Research and Epidemiology, Amsterdam, The Netherlands Introduction Prior results from the ROGY care trial showed that Survivorship Care Plans (SCPs) did not increase satisfaction with information provision and care, but increased threatening illness perceptions among both endometrial and ovarian cancer survivors. Objectives The aim of the current study is to assess the indirect effects of SCPs on health-related quality of life (HRQoL) and anxiety and depression, through illness perceptions (figure 1).

Methods Twelve hospitals in the South of the Netherlands were randomized to providing ‘SCP care’ or ‘usual care’. Endometrial and ovarian cancer patients newly diagnosed between 2011 and 2015 completed questionnaires after initial treatment (endometrial, 221 [75%]; ovarian, 174 [71%]) and after 6 months (endometrial, 158 [54%]; ovarian 124 [50%]). SCPs were automatically generated after initial treatment by the oncology providers through the web-based Registrationsystem Oncological GYnecology (ROGY). Illness perceptions (B-IPQ) were measured after treatment and HRQoL (EORTC-QLQ-C30) and anxiety and depression (HADS) after 6 months. Results Structural equation models showed that in endometrial cancer patients, SCPs indirectly decreased physical functioning and cognitive functioning (β: -0.14; -0.15; p<0.05) and indirectly increased fatigue, insomnia and financial difficulties (β: 0.15, 0.05, 0.05; p<0.05), through increased experienced symptoms. In ovarian cancer patients, SCPs indirectly decreased emotional functioning through lower treatment trust (β=-0.17, p=0.03). Conclusions Current results suggest that SCPs have negative effects on HRQoL in patients who experience more threatening illness perceptions due to the SCP. We should be aware of the potential negative consequences of SCPs.

PS045 PATIENTS' APPRECIATION OF THE NURSE NAVIGATOR IS LINKED TO ENHANCED CANCER CARE EXPERIENCE AND SATISFACTION C. Loiselle1,2, A. Ehrler2, M. Allard3, L. Tardif4, C. Rousseau5 1 McGill University, Oncology & Ingram School of Nursing, Montreal, Canada 2 Segal Cancer Centre- Jewish General Hospital, Oncology, Montreal, Canada 3 St. Mary's Hospital, Oncology, Montreal, Canada 4 McGill University Health Centre, Oncology, Montreal, Canada 5 Rossy Cancer Network, Oncology, Montreal, Canada

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Introduction Growing evidence suggests that the presence of nurse navigators (NN) in cancer care is a promising means to meet patients’ needs and improve quality of care. However, few studies have examined relationships between patients’ cancer care experience and access to NN. Three academic cancer centers in Montreal, Quebec rolled out the Ambulatory Outpatient Patient Satisfaction Survey (AOPSS) to measure patients’ experience with cancer care and whether patients who were assigned a NN reported higher satisfaction with care. Objectives To examine the relationships between being assigned a NN and patients’ satisfaction with their cancer care and other indicators of an enhanced patient experience. Methods The AOPSS was completed by 2,438 patients who received treatment within the last six months at one of the three participating centres. AOPSS items were grouped rationally into themes, and correlated with health care satisfaction. Results Of the 1,521 patients assigned a NN, 71.3% found their NN to be very to extremely useful. Participants who were satisfied with their navigator were also significantly more satisfied with the information (r=.162; p<.01), quality of care (r=.219; p<.01), and emotional support they received (r=.404; p<.01). However, those who were dissatisfied with their NN rated quality of care as worse than those without a navigator. Significant differential levels of satisfaction (according to NN assignment) were also found across various quality indicators (e.g., treatment plan, support, contact and services, information provision, etc.). Conclusions Our findings add to the mounting evidence that nurse navigators can enhance the patient experience and satisfaction with cancer care.

PS046 INCIDENCE OF PERMANENT CHEMOTHERAPY-INDUCED ALOPECIA AMONG BREAST CANCER PATIENTS: A FIVEYEAR PROSPECTIVE COHORT STUDY D. Kang1, K. Im-Ryung2, A. Jin Seok3, I. Young Hyuck3, P. Yeon Hee3, P. Jihye4, L. Dong-Youn4, C. Juhee5 1 Samsung Medical Center, Center for Clinical Epidemiology, Seoul, Republic of Korea 2 Comprehensive Cancer Center- Samsung Medical Center, Cancer Education Center, Seoul, Republic of Korea 3 Samsung Medical Center, Division of Hematology/OncologyDepartment of Medicine, Seoul, Republic of Korea 4 Samsung Medical Center, Department of Dermatology, Seoul, Republic of Korea 5 Sungkyunkwan University, Department of Clinical Research Design & Evaluation- SAIHST, Seoul, Republic of Korea Introduction While chemotherapy-induced alopecia is considered temporary and usually reversible within 1-6 months after chemotherapy, some patients report persistent alopecia several years after chemotherapy. The frequency of long-term permanent chemotherapy-induced alopecia (PCIA) and hair related changes is unknown. Objectives This study aimed to assess the incidence of PCIA among breast cancer patients by quantifying changes in hair density and thickness before chemotherapy, after two cycles of chemotherapy, and one, three, six, and 36 months after completion of chemotherapy. Methods This was a prospective cohort study of 61 patients 18 years of age or older with a postoperative diagnosis of stage I to III breast cancer who received adjuvant chemotherapy between February and September 2012 at an

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outpatient breast cancer clinic in Korea. Objective hair density and thickness were measured using a noninvasive bioengineering device. Results At 6 months after completion of chemotherapy, 11.5% and 30.8% of patients experienced PCIA in terms of hair density and thickness, which did not recovered until after 36 months after completion of chemotherapy. Patients who received a combination of doxorubicin and cyclophosphamide followed by four additional cycles of paclitaxel were more likely to experience PCIA compared to patients with other type of chemotherapy. Conclusions Permanent and severe alopecia is a common side effect of breast cancer adjuvant chemotherapy. Additional research is necessary to translate these findings into interventions for improving distress due to permanent alopecia in breast cancer patients after completion of chemotherapy.

PS047 REDUCTION OF CHEMOTHERAPY CONCENTRATIONS IN HAIR FOLLICLES AFTER SCALP COOLING FOR PREVENTION OF CHEMOTHERAPY-INDUCED ALOPECIA J.W. Chae1, X. WU1, T. NG1, H.L. Yeo1, M. Shwe1, Y.X. Gan2, K.M. Foo3, S. Jiang4, K.L. Cheng5, R. Ng6, H.K. Ho1, A. Chan1 1 National University of Singapore, Department of Pharmacy, Singapore, Singapore 2 National Cancer Centre Singapore, Department of Pharmacy, Singapore, Singapore 3 K.K. Women’s and Children’s Hospital, Department of Pharmacy, Singapore, Singapore 4 K.K. Women’s and Children’s Hospital, Women Day Therapy Centre, Singapore, Singapore 5 Global Healthcare Singapore, Management department, Singapore, Singapore 6 National Cancer Centre Singapore, Division of Medical Oncology, Singapore, Singapore Introduction Scalp cooling (SC) is hypothesized to reduce the severity of chemotherapyinduced alopecia (CIA) via vasoconstriction, limiting the drug uptake to the hair follicle matrix cells. However, no formal studies have evaluated whether chemotherapy concentrations in the hair follicles are reduced after SC. Objectives This study was designed to compare drug concentrations in the hair follicles with or without SC among breast cancer patients receiving doxorubicin and/or cyclophosphamide. Methods This was a prospective, open-label study. Two groups of patients were recruited (with SC vs. without SC). In the SC arm, patients were provided SC (CarbonCoolTM) for 30 minutes prior to chemotherapy infusion and continued until 1-hour post treatment. The scalp surface temperature was kept ≤19oC to ensure consistent cooling. CIA was assessed using Dean’s score by photographic documentations. Hair follicles were taken 5 days after the first cycle of chemotherapy, and samples were analyzed using liquid chromatography-tandem mass spectrometry. Results Hair follicles of 10 patients (7 SC and 3 without SC) were analyzed. Patients receiving SC had lower mean (± SD) concentrations of cyclophosphamide (2100±1059 vs. 2816±2207 pg/5cm) and doxorubicin (1123±617 vs. 3147 ±2017 pg/5cm) in the hair follicles, comparing to those without receiving SC. Low concentration of cyclophosphamide was also associated with the prevention of CIA among those receiving SC (P = 0.045 for trend). Conclusions This is the first study to show that chemotherapy concentrations in hair follicles are reduced among those receiving SC. Hair follicle chemotherapeutic concentrations could be used as a surrogate marker for effectiveness of SC devices in future clinical trials.

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PS048 ENTERAL AND PARENTERAL NUTRITION IN CANCER PATIENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS R. Chow1, E. Bruera2, L. Chiu1, S. Chow1, N. Chiu1, H. Lam1, R. McDonald1, C. DeAngelis1, S. Vuong1, V. Ganesh1, E. Chow1 1 Odette Cancer Centre - Sunnybrook Health Sciences Centre - University of Toronto, Institute of Evaluative Clinical Sciences, Toronto, Canada 2 The University of Texas MD Anderson Cancer Center, Department of Palliative Care and Rehabilitation Medicine, Houston, USA Introduction In cancer patients, weight loss is an ominous sign suggesting disease progression and shortened survival time. As a result, providing nutrition support for cancer patients has been proposed as a logical approach for improving clinical outcomes. Nutrition support can be given to patients through enteral nutrition (EN) or parenteral nutrition (PN). Objectives The purpose of the review was to compare the outcomes of PN and EN in cancer patients. Methods A literature search was conducted in Ovid MEDLINE and OLDMEDLINE, Embase Classic and Embase, and Cochrane Central Register of Controlled Trials. Studies were included if over half of the patient population had cancer and reported on any of the following endpoints: the percentage of patients that experienced no infection, nutrition support complications, major complications or mortality. Risk ratios (RR) and 95% confidence intervals (CIs) using Review Manager Version 5.3 were calculated. Primary endpoints were stratified according to type of EN for subgroup analysis, grouping studies into either tube feeding (TF) or standard care (SC). Additionally, another subgroup analysis was conducted comparing studies with protein-energy malnutrition (PEM) patients and studies without PEM patients. Results The literature search yielded 674 articles of which 36 were included for the meta-analysis. There were no difference in the endpoints between the two study interventions except that PN resulted in more infection when compared with EN (RR =1.09, 95% CI: 1.01–1.18; P=0.03). Conclusions Other than increased incidence of infection, PN has not resulted in prolonging survival, increasing nutrition support complications, or major complications when compared with EN in cancer patients.

PS049 P H A S E 3 S T U D Y O F N E PA V E R S U S 3 - D AY O R A L A P R E P I TA N T R E G I M E N F O R P R E V E N T I O N O F CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING (CINV) IN HIGHLY EMETOGENIC CHEMOTHERAPY (HEC) SETTING L. Zhang1, S. Lu2, J. Feng3, A. Dechaphunkul4, S. Chessari5, C. Lanzarotti6, K. Jordan7, M. Aapro8 1 Sun Yat-sen University Cancer Center, Medical Oncology, Guangzhou, China 2 Shanghai Chest Hospital- Shanghai Jiao Tong University, Shanghai Lung Cancer Center, Shanghai, China 3 Jiangsu Cancer Hospital, Medical Oncology, Nanjing, China 4 Prince of Songkla University, Internal Medicine- Division of Medical Oncology, Hat-Yai, Thailand 5 Helsinn Healthcare, Corporate Clinical Development, Lugano, Switzerland 6 Helsinn Healthcare, Statistics and Data Management, Lugano, Switzerland 7 University of Heidelberg, Department of Medicine V, Heidelberg, Germany 8 Clinique de Genolier, Cancer Center, Genolier, Switzerland

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Introduction Co-administration of antiemetics that inhibit multiple molecular pathways is required to optimize CINV control in patients receiving HEC. NEPA, a fixed combination of the NK1 receptor antagonist (RA), netupitant (300 mg), and the 5-HT3RA, palonosetron (PALO, 0.50 mg), has shown superior CINV prevention compared to PALO. Objectives To demonstrate non-inferiority in preventing CINV with NEPA versus an aprepitant (APR)/granisetron (GRAN) regimen. Methods This randomized, double-blind, Phase 3 study conducted in 828 chemotherapy-naïve Asian patients receiving cisplatin-based HEC was designed to compare efficacy/safety of a single oral dose of NEPA with a 3-day oral APR/GRAN regimen. All patients received oral dexamethasone days 1-4. The primary efficacy endpoint was complete response (CR: no emesis/ rescue medication) during the overall (0-120h) phase. Non-inferiority was defined as a lower 95% CI greater than the non-inferiority margin set at 10%. Secondary endpoints included no emesis and no significant nausea (NSN: <25mm on 100mm VAS). Results Treatment groups were comparable: male (71%); mean age 54.5 years; lung cancer (58%). NEPA demonstrated non-inferiority to APR/GRAN for CR; no emesis/NSN rates favored NEPA.

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Results There were 4 major themes arising from the study: 1) Patients reported symptoms indicative of pancreatic exocrine insufficiency that are more diverse than is traditionally associated with pancreatic cancer. 2) There were factors that promoted successful treatment with pancreatic enzymes. 3) Patients and carers described treatment failure with pancreatic enzymes and new findings gave explanations for this. 4) Carer distress and frustration with the complications of pancreatic exocrine insufficiency and its treatment were common. Conclusions The results from this study suggest that pancreatic exocrine insufficiency in pancreatic cancer is undertreated, and that the traditional clinical model to assess the presence of exocrine insufficiency in pancreatic cancer needs to be re-described in order to increase the accuracy of clinical diagnosis, treatment accessibility and therapeutic monitoring.

PS051 ALTERATIONS OF GUT MICROBIOME ASSOCIATED WITH TYROSINE KINASE INHIBITOR-INDUCED DIARRHOEA AND THE EFFECT OF THE GLP-2 AGONIST ELSIGLUTIDE B. Mayo1, A. Wignall2, E. Bateman2, I. Ball2, J. Shirren2, C. Pietra3, J. Bowen2 1 University of South Australia, School of Pharmacy and Medical Sciences, Adelaide, Australia 2 University of Adelaide, Adelaide Medical School, Adelaide, Australia 3 Helsinn Healthcare, Research Innovation, 6915 Lugano, Switzerland

The type/incidence/severity of AEs were similar for both groups. Conclusions In this first head-to-head study comparing NK1RA regimens (and 4 days of dexamethasone), NEPA administered only on day 1 was non-inferior to a 3-day oral APR/GRAN regimen in preventing CINV associated with HEC.

PS050 THE IMPACT OF CANCER CACHEXIA UPON THE QUALITY OF LIFE OF PATIENTS AND CARERS IN ADVANCED PANCREATIC CANCER - A QUALITATIVE STUDY W. Muircroft1, G. Helen2, S. Carey3, D. Currow4 1 Southern Adelaide Local Health Network, Southern Adelaide Palliative Service, Adelaide, Australia 2 University of Sydney, Department of Nursing, Sydney, Australia 3 Royal Prince Alfred Hospital, Department of Dietetics, Sydney, Australia 4 Flinders University, Department of Supportive and Palliative Care, Adelaide, Australia Introduction Pancreatic exocrine insufficiency is a condition that commonly occurs due to pancreatic cancer and causes weight loss and decreases quality of life. Objectives The purpose of this qualitative study is to explore the patient experience of pancreatic exocrine insufficiency in pancreatic cancer and to understand the limitations and effectiveness of pancreatic enzyme replacement therapy from both patient and carer perspectives. Methods Semi-structured interviews were conducted with 14 patients and 9 carers recruited from palliative care and medical oncology services in the Adelaide region. Sampling continued until saturation of key themes. A critical thematic analysis was conducted.

Introduction With the advent of EGFR-targeted cancer therapies, like the Tyrosine Kinase Inhibitor (TKI) lapatinib, a shift towards chronic mucocutaneous toxicity has arisen, characterised by extensive diarrhoea in the clinical setting. No clear mechanism of this toxicity has yet been elucidated, and no effective treatment had been found. Objectives This study aimed to determine the underlying mechanism of lapatinibinduced diarrhoea, which elsiglutide uses to effectively protect against this toxicity. Methods 96 male Albino Wistar rats were gavaged 500mg/kg lapatinib (or vehicle) each day for up to 28 days. Elsiglutide (or vehicle), was given concurrently over the 28 days, as either; 0.9mg/kg s.c. given 4 days/week or 0.45mg/kg s.c. daily. Throughout treatment rats were monitored for diarrhoea and markers of distress. Rats were killed at either 14 or 28 days, caecal samples were taken for bacterial sequencing analysis. Results Lapatinib treatment was associated with mild-moderate diarrhoea (88%), which was mitigated (P<0.0001) by addition of elsiglutide at 0.9mg/kg (31% mild diarrhoea) and 0.45mg/kg (38% mild-moderate diarrhoea). Caecal microbiome showed a significant shift in microbial population in lapatinib treated animals. Proteobacteria significantly increased (P<0.001), whilst Bacteriodetes decreased (P<0.001). Shannon diversity index showed a significant decrease (P<0.001) in microbial diversity of animals treated with lapatinib alone. Elsiglutide did not prevent phyla level shift in the microbiome but maintained imperative species diversity. Conclusions These findings indicate that alterations to the gut microbiome may play a role in the progression of lapatinib-induced diarrhoea. Elsiglutide effectively inhibits lapatinib-induced diarrhoea and may provide protection against harmful microbial alterations in the GI tract.

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PS052 IMPROVED EFFICIENCY AND PATIENT SATISFACTION FOLLOWING INTRODUCTION OF A NUTRITION ASSISTANT ROLE IN A HEAD AND NECK CANCER CLINIC

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We performed a secondary analysis using a proportional odds model and stepwise selection to determine which baseline characteristics predicted a loss of LBM or SCP in the placebo group. Results

N. Kiss1, S. Gilliland2, J. Black2, L. Atkins2, J. Frowen2 1 Peter MacCallum Cancer Centre, Department of Cancer Experiences Research, Melbourne, Australia 2 Peter MacCallum Cancer Centre, Nutrition and Speech Pathology, Melbourne, Australia Introduction Patients with head and neck cancers receiving (chemo)radiation develop acute toxicities affecting nutritional intake. Nutrition is routinely managed by dietitians, however there is limited time to manage patients with complex nutritional issues. Objectives This study aimed to evaluate the effectiveness of implementing a nutrition assistant (NA) role for screening and intervention of lower nutrition risk patients in a multidisciplinary head and neck clinic. Methods A training module and model of care were established to upskill the NA and guide the screening and interventions to be undertaken. A pre-test post-test design was utilised comparing outcomes including proportion of dietitian time spent with high risk patients, weight change during and post-radiotherapy, time to commencement of enteral feeding and patient satisfaction assessed at six weeks post-treatment. Results Forty-three patients were included pre-implementation and 48 patients post-implementation with 21 (44%) of patients identified for NA screening/intervention. Mean weight change was similar between the groups during radiotherapy (-5.6% vs. -4.7%, p=0.3) and up to 4 weeks postradiotherapy (-6.6% vs. -6.49%, p=0.9). Time to commencement of enteral feeding did not differ between groups. Significant improvement in overall patient satisfaction (4.0 + 1.1 vs 4.6 + 0.61, p=.03), patient perceived benefit (3.8 + 0.69 vs 4.4 + 0.62, p<.01) and dietitian interpersonal skills (3.91 + 1.1 vs 4.6 + 0.55, p=.02) were observed post-implementation. Conclusions Nutrition assistants are an effective workforce to manage low risk patients in a multidisciplinary head and neck treatment clinic demonstrating maintenance of clinical outcomes and increased patient satisfaction.

PS053 PREDICTORS OF PHYSICAL AND FUNCTIONAL LOSS IN LUNG CANCER PATIENTS RECEIVING CHEMOTHERAPY E. Kinsey1, E. Ajazi2, M. Johnston3, X. Wang4, J. Crawford1 1 Duke University, Department of Medicine, Durham, USA 2 University of North Carolina, Department of Biostatistics, Chapel Hill, USA 3 GTx, Department of Clnical Development, Memphis, USA 4 Duke University, Department of Biostatistics, Durham, USA Introduction Muscle wasting has detrimental effects including increased mortality. Identifying patients at risk can guide treatment efforts. Objectives Identify predictive factors associated with developing cancer cachexia. Methods POWER 1 and 2 were randomized, double blind, placebo-controlled, multicenter, multinational Phase III trials of 600 lung cancer patients initiating chemotherapy to assess the efficacy of an experimental drug for the prevention and treatment of muscle loss. Primary endpoints included no change in lean body mass (LBM) and improvement in physical function (stair climb power/SCP) by 10% at day 84 of treatment.

Of the 322 placebo patients, 266 were eligible for LBM analysis and 301 were eligible for SCP analysis. Higher stage disease predicted physical loss (OR 1.656, CI 1.020-2.687) and functional loss (OR 1.840, CI 1.130-2.997). Five factors predicted only functional loss as measured by SCP including use of taxane chemotherapy (OR 1.526, CI 0.988-2.357), tobacco use before (OR 2.483, CI 1.237-4.985), ongoing tobacco use (OR 1.276, CI 0.704-2.312), SCP at baseline (OR 1.008, CI 1.004-1.011), and higher ECOG (OR 1.784, CI 1.121-2.838). Taxane and ongoing tobacco use were not statistically significant. Conclusions Advanced stage predicted physical and functional loss. Tobacco use and higher ECOG performance status predicted functional loss. Higher SCP at baseline was predictive of functional loss, possibly due to the wide variation of baseline SCP values.

PS054 COMPARISON BETWEEN 1ST AND 2ND GENERATION SEROTONIN RECEPTOR ANTAGONISTS IN TRIPLET ANTIEMETIC THERAPY IN BREAST CANCER PATIENTS – ACCORDING TO RECENT MULTI-INSTITUTIONAL DOUBLE-BLIND RANDOMIZED STUDY M. Saito1, T. Uomori 1 , K. Miura1 , R. Taguchi 1, M. Kurata1 , M. Tsuneizumi 2 , H. Ogata 3, G. Kutomi4 , K. Hosoya5, Y. Kawai 6, J. Matsuoka7 1 Juntendo University, Breast Oncology, Tokyo, Japan 2 Shizuoka General Hospital, Breast Surgery, Shizuoka, Japan 3 Toho University, Breast and Endocrine Surgery, Tokyo, Japan 4 Sapporo Medical University, Surgery, Sapporo, Japan 5 Tottori University, Surgery, Yonago, Japan 6 Tokyo Medical University, Breast Oncology, Tokyo, Japan 7 Juntendo University, Clinical Research Support Center, Tokyo, Japan Introduction Whether a 2nd generation serotonin receptor antagonist (5-HT3ra) would be superior to 1st generation 5-HT3ra when administering triplet antiemetic therapy for the prevention of chemotherapy induced nausea &

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vomiting (CINV) induced by anthracycline and cyclophosphamide containing regimens (AC) has been one of our main clinical questions. Objectives In this study, we assessed the efficacies of 1st and 2nd generation 5HT3ra agents for use as triplet antiemetic therapy for AC, by monitoring CINV, appetite and Quality of Life (QOL). Methods Between 2012 and 2015, 491 women with breast cancer receiving AC were recruited from 11 institutions, and randomly assigned to either single-dose palonosetron (0.75mg) or granisetron (40μg/kg) prior to chemotherapy on day 1, both with dexamethasone (9.9 mg) and aprepitant (125mg) on day 1 followed by additional doses (80mg) on days 2 and 3. Age, institution and habitual alcohol intake were used as stratification factors. The primary endpoint was a complete response (CR). The secondary endpoints were daily appetite according to patient’s diary and QOL measured by QOL-ACD Results 491 patients were included: 246 patients in the palonosetron group and 245 in the granisetron group. The difference in day-to-day CR in the palonosetron group was significantly higher than that in the granisetron group between 48 and 72 hours (p<0.02), however, there were no differences in daily appetite and QOL between two groups. Conclusions Although palonosetron showed significantly better efficacy in controlling CINV between 48 to 72 hours after AC than granisetron, appetite and QOL were not influenced by the difference on CINV between two groups.

PS055 PRANLUKAST SUPPRESSES DELAYED CISPLATIN-EVOKED VOMITING AND POTENTIATES THE ANTIEMETIC EFFICACY OF 5-HT3 RECEPTOR ANTAGONISTS AGAINST BOTH EARLY AND DELAYED EMESIS N. Darmani1, C. Chebolu1, W. Zhong1, W. Kim1, M. Narlesky1, J. Adams1, F. Dong1 1 Basic Medical Sciences, COMP/WesternU, Pomona, USA Introduction The leukotriene CysLT1 receptor antagonist pranlukast as a new antiemetic against delayed vomiting. Objectives The antimetic profile of pranlukast relative to a first (tropisetron) and a second generation (palonosetron) 5-HT3R antagonist and their effects against cisplatin-evoked vomiting and changes in phosphorylation levels of brainstem kinases (ERK1/2, PKCα/β and PKA) were investigated. Methods Behavioral and Western blot techniques were employed in in least shrews. Pranlukast (10 mg/kg), palonosetron (0.1 mg/kg) and tropisetron (10 mg/kg) or corresponding vehicles were administered 30 min prior to cisplatin (10 mg/kg). Results Pranlukast significantly reduced the mean frequency of vomits (70%) and fully protected shrews from vomiting (46%) during the delayed-phase. Although, pranlukast tended to reduce the mean frequency of vomits and the number of shrews vomiting during early-phase, these reductions failed to attain significance. When pranlukast was combined with either tropisetron or palonosetron, it potentiated their antiemetic efficacy during both phases of vomiting. In addition, pranlukast by itself prevented several intracellular signals of cisplatin-evoked delayed-vomiting including phosphorylation of ERK1/2 and PKA. When pranlukast was combined with either palonosetron or tropiseton, these combinations prevented enhanced phosphorylation levels of i) ERK1/2 during both acute- and delayed-phases, ii) PKCα/β at the peak acute-phase, and iii) PKA at the peak delayed-phase. The current and our published findings suggest that behavioral and signaling effects of pranlucast via blockade of CysLT1 receptors generally appear to be similar to the NK1R antagonist netupitant with some differences. The discussed effects of pranlukast helps to further understand the intracellular basis of cisplatin-induced vomiting.

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PS056 BIOEQUIVALENCE AND SAFETY OF HTX-019 (SURFACTANTFREE APREPITANT IV) AND FOSAPREPITANT IN HEALTHY SUBJECTS T. Ottoboni1, G. Boccia2, K. Manhard3, M.R. Keller2, M. Cravets4, N. Clendeninn5, B. Quart6 1 Heron Therapeutics- Inc., Pharmaceutical & PreClinical Research and Development, San Diego, USA 2 Heron Therapeutics- Inc., Clinical Operations, San Diego, USA 3 Heron Therapeutics- Inc., Drug Development, San Diego, USA 4 Heron Therapeutics- Inc., Biometrics, San Diego, USA 5 Heron Therapeutics- Inc., Clinical, San Diego, USA 6 Heron Therapeutics- Inc., Chief Executive Officer, San Diego, USA Introduction Fosaprepitant (aprepitant IV prodrug), is associated with hypersensitivity reactions primarily attributed to its surfactant, polysorbate 80. HTX-019 is a surfactant-free aprepitant IV formulation. Objectives To present pharmacokinetics and safety of HTX-019 and fosaprepitant from a phase 1 open-label, randomized, 2-way crossover bioequivalence study in healthy subjects. Methods Subjects received single-dose HTX-019 (130 mg) or fosaprepitant (150 mg) IV over 30 minutes (day 1; periods 1, 2), with ≥7-day washout between doses. Blood samples were collected before and 0.5-72 hours (aprepitant) and 0.5-1.5 hours (fosaprepitant) after infusion start. Bioequivalence evaluation (mixed-effects model) was based on aprepitant AUC0‑t, AUC0‑inf, and postequilibrium plasma aprepitant concentrations (C12h). Bioequivalence was declared if 90% CI was within 80%-125%. Safety evaluation included treatment-emergent AEs (TEAEs) and serious AEs. Results 97/100 subjects completed the study. Demographics and baseline characteristics were comparable between crossover periods. Figure 1 shows mean plasma aprepitant concentrations over time. Table 1 shows mean (%CV) AUC0‑t, AUC0‑inf, and C12h. 90% CIs for these parameters were within bioequivalence bounds (94.186-101.354). Within 30 minutes following infusion start, no HTX-019 recipients and 17% of fosaprepitant recipients had ≥1 TEAE. During the entire study period, fewer subjects had ≥1 TEAE with HTX-019 (21%) than with fosaprepitant (28%). No severe TEAEs, deaths, or serious AEs occurred. All TEAEs resolved by study end.

Conclusions HTX-019 IV was bioequivalent to fosaprepitant IV. HTX-019 IV was well tolerated, without the infusion-site reactions associated with fosaprepitant IV.

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PS057 MEETING PATIENTS’ NEEDS FOR SUPPORTIVE CANCER CARE USING PATIENT NAVIGATION A. Berezowska1, E. Bleiker1, E. Passchier1 1 Netherlands Cancer Institute, Psychosocial research and epidemiology, Amsterdam, The Netherlands Introduction Supportive care such as physical therapy and psychosocial counseling facilitates recovery and improves the quality of life of many cancer patients. Unfortunately, not all patients know how to access supportive cancer care. Hence, timely and systematic guidance provided by a patient navigator (PN) is likely to further increase the positive effect of supportive care on patients’ wellbeing. Little is, however, known about patient navigation in a supportive cancer care setting. Objectives To propose and evaluate a patient navigation intervention (i.e. specially trained oncology nurse who monitors, advises and (if needed) refers patients to supportive cancer care) in terms of patient satisfaction, consumption of supportive cancer care and self-management. Methods An online questionnaire was distributed among 224 breast and/or skin cancer patients who consulted a PN prior to, during, and after treatment. Results Respondents (N=120, response rate 54%) perceived the PN as a valuable extension of the cancer care continuum (92%). Furthermore, the PN was seen as accessible (92%), reliable (95%), an expert (92%), and someone who thinks along (87%). About 80% of the respondents who needed advice regarding nutrition (n=67), exercise (n=93), fatigue (n=98), emotions (n=106), work (n=79) and/or online information (n=91) mentioned they were properly informed by the PN. Especially advice on fatigue and work stimulated respondents’ self-management. Following consultations with the PN, 49% of the respondents used some form of supportive cancer care. Conclusions The PN is an appreciated and competent professional who may improve the accessibility of supportive cancer care as well as stimulate self-management.

PS058 WHAT ARE TURKISH NURSING STUDENTS THOUGHTS ABOUT PALLIATIVE CARE? E. Sahin1, G. GUVENC2, G. Bagcivan3, M. SEVEN4, M. Bakitas5 1 Giresun University, Faculty of Health Sciences – Nursing, Giresun, Turkey 2 Heath Science University, Nursing School, Ankara, Turkey 3 Gulhane Training and Research, Bakim Hizmetleri Mudurlugu, Ankara, Turkey 4 Koc University, Faculty of Health Sciences – Nursing, Istanbul, Turkey 5 University of Alabama at Birmingham, School of Nursing, Birmingham/ AL, USA Introduction Although there are many developments in improving palliative care (PC), an important barrier to progress is health professionals’ lack of PC knowledge and training opportunities. Objectives The purpose of this study was to determine Turkish nursing students’ knowledge and attitudes about PC. Methods This descriptive study was an investigator-developed survey of third and fourth year Turkish nursing students during the 2015-2016 academic year in an Ankara school of nursing school. Socio-demographic characteristics and PC knowledge and attitudes were collected by face to face interview.

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Results 136 students responded. Most practiced in general medicine/surgical department and ICU. Most described PC as a multidisciplinary health service (91.2%) for terminally ill patients (63%) with cancer (62%). Although 89.7% of students had some sort of PC training (education as part of courses?) more than half of them (66.2%) stated that this training was insufficient. PC topics that students desired to be included in the curriculum were basic concepts of PC (94.9%), communication (91.9%), legal and ethical topics (89.7%), loss and bereavement (89%), and symptom management (86%). Three quarters of the students (77.976.5%) stated that PC should be a mandatory university-degree program. Conclusions Nursing students find PC content and education lacking in their programs of study and prefer that this specialty content be expanded including as part of a specialty degree program.

PS059 EVIDENCE-BASED GERMAN GUIDELINES FOR SUPPORTIVE CARE IN CANCER PATIENTS F. Jahn1, P. Feyer2, U. Höller3, B. Wörmann4, M. Follmann5, K. Jordan6 1 Martin- Luther- University of Halle- Wittenberg, Department of Internal Medicine IV- Hematology and Oncology, Halle, Germany 2 Vivantes Clinics Neukoelln, Department of Radiation Oncology, Berlin, Germany 3 Charité University Medicine, Department of Radiation Oncology, Berlin, Germany 4 Charité University Medicine- Campus Virchow, Department of Hematology- Oncology and Tumor Immunology, Berlin, Germany 5 German Guideline Program in Oncology, Program Management, Berlin, Germany 6 Heidelberg University Hospital, Department Internal Medicine V, Heidelberg, Germany Introduction The German national cancer plan defines the improvement in Health Care by implementation of current evidence-based guidelines as a prioritized objective. December 2016 the guideline for supportive care in cancer patients, funded by the German Guideline Program in Oncology, was published. 88 experts from 45 associations / working- and patient advocacy groups from Germany, Austria and Switzerland were involved, led by the working group Supportive Care in Oncology (ASORS), the German Society of Hematology and Oncology (DGHO) and the German Society of Radiooncology (DEGRO). Objectives The German Supportive Care Guideline aims to provide the basis for evidencebased decisions for all professional groups involved in cancer treatment. Methods For ten topics selected key questions were defined. Best available evidence was collected based on systematic literature review (Medline, Cochrane Library) and adapting international high quality guidelines. The recommendations were endorsed in a moderated, formalized consensus-process, with each recommendation requiring at least 75% agreement. After a public consultation phase, comments received were discussed and necessary changes included. Results 337 recommendations have been adopted, relying on the systematic reviews (SR), adapted high-quality international guidelines (GA), and expert consensus (EC): anaemia (SR, EC), nausea/emesis (GA), neutropenia (GA), dermal toxicities (SR), mucositis (GA), diarrhea (SR), peripheral neurotoxicity (SR), bone complications (SR, extravasation injury (SR, EC) and supportive care in radiation therapy (GA, EC). Conclusions For the first time a German evidence based guideline for supportive care in cancer patients was developed supporting decisions in daily practice. Guideline and methodological report are available for download; an English translation is in preparation.

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PS060 PERCEIVED COGNITIVE DYSFUNCTION AT DIAGNOSIS AND BEYOND DISEASE PROGRESSION IN NEWLY DIAGNOSED GLIOBLASTOMA PATIENTS K. Peters1, S. Threatt1, P. Healy1, J. Herndon- II1, E. Lipp1, S. Panta1, D. Randazzo1, G. Vlahovic1, H. Friedman1, A. Desjardins1 1 Duke University Medical Center, Medicine, Durham, USA Introduction Newly diagnosed glioblastoma (GBM) patients experience challenges from both oncologic and neurologic perspectives. Cognitive impairment represents one of the quality of life (QoL) impairments faced throughout the GBM disease process. Objectives Measures of QoL are rarely performed after progression in clinical trials. We evaluated patient reported outcomes of cognitive function after tumor progression in newly diagnosed GBM patients participating in a study of bevacizumab (BV) with concurrent chemoradiation, followed by BV and temozolomide with the continuation of BV following progression. Methods In this prospective single-center trial, perceived cognitive function was measured using Functional Assessment of Cancer Therapy-Cognition (FACT-Cog) questionnaire at time of study enrollment (before chemoradiation), after chemoradiation, and every 6 mos until study discontinuation or subject demise. Three subscales were calculated: perceived cognitive impairments, perceived cognitive abilities, and impact on QOL, with higher scores indicating a more positive perception of cognitive function. Results The trial accrued 68 newly diagnosed GBM patients with mean age 55.4 yrs and 53% KPS ≥ 90%. Subjects who continued study participation 6 mos following completion of chemoradiation were divided into two groups: subjects with (n=16) and without (n=33) tumor progression 6 mos after chemoradiation completion. Both groups had similar baseline and post chemoradiation scores on FACT-Cog and these scores were not observed to decline over time. Conclusions Our observations of newly diagnosed patients with GBM suggest that perceived cognitive function and impact on QOL do not degrade despite progression. Further investigation is justified to inform future clinical trials to monitor QOL beyond progression.

PS061 REDUCED GRAY MATTER (GM) VOLUME IN ADOLESCENT AND YOUNG ADULT (AYA) CANCER SURVIVORS WITH SELF-PERCEIVED COGNITIVE IMPAIRMENT T. Ng1,2,3, J. Lee3, H.L.A. Yeo3, M. Shwe2,3, Y.X. Gan2,3, J.W. Chae3, M.C. Wen4, F. Mohamad1, N. KANDIAH4, A. Chan2,3,5 1 National Cancer Centre Singapore, Division of Medical Oncology, Singapore, Singapore 2 National Cancer Centre Singapore, Pharmacy, Singapore, Singapore 3 National University of Singapore, Pharmacy, Singapore, Singapore 4 National Neuroscience Institute, National Neuroscience Institute, Singapore, Singapore 5 Duke-NUS Graduate Medical School Singapore, Duke-NUS Graduate Medical School Singapore, Singapore, Singapore Introduction Literature suggested that AYA cancer survivors experience cognitive impairment post-chemotherapy. However, it is unclear if the observed cognitive changes are attributed to gray matter (GM) volume reduction. Objectives To compare the GM volume between AYA cancer survivors and healthy AYA controls using magnetic resonance imaging (MRI).

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Methods This was a cross-sectional study that involved AYA cancer survivors (mean age: 35.0 ± 2.0 years; university level education) and age- and education-matched health controls (mean age: 33.8 ± 2.3 years). MRI was performed using the 3T Achieva scanner, and all T1 images were bias-corrected and tissue-classified. GM volume maps were statistically analyzed using the general linear model to compare between AYA cancer survivors and controls. Results While no significant brain region showing group difference in GM volume at p<0.05, reduced GM volume was observed in the right fusiform gyrus, postcentral gyrus, inferior and middle frontal gyrus, and left insula in AYA survivors when compared to controls at the threshold of uncorrected p < 0.001 (Figure). Furthermore, AYA survivors had reduced total GM volume (mean ± SD: 647.42 ± 69.75 ml) than controls (mean ± SD: 705.97 ± 84.79 ml), but this difference was not statistically significant (t= 0.83, p= 0.45).

Conclusions GM volume in the frontal gyrus and left insula are significantly reduced among the AYA cancer survivors, and changes to these brain regions can negatively impact cognitive abilities such as attention and executive functions. Further studies are required to validate these preliminary findings.

PS062 GENETIC BIOMARKERS ASSOCIATED WITH CHANGES IN PAIN AND FUNCTIONAL INTERFERENCE FOLLOWING PALLIATIVE RADIOTHERAPY IN PATIENTS WITH BONE METASTASES A. Furfari1, A. Wan1, A. Wong2, K. Ding3, A. Bezjak4, R. Meyer5, R. Wong4, C. Wilson3, C. DeAngelis6, A. Azad2, E. Chow1, G. Charames2 1 Odette Cancer Centre - Sunnybrook Health Sciences Centre - University of Toronto, Radiation Oncology, Toronto, Canada 2 Mount Sinai Hospital, Pathology and Laboratory Medicine, Toronto, Canada 3 Cancer Research Institute- Queen’s University, Canadian cancer trials group, Kingston, Canada 4 Princess Margaret Cancer Centre- Ontario Cancer Institute, Radiation Medicine Program, Toronto, Canada 5 Juravinski Hospital and Cancer Centre- McMaster University, Department of Oncology, Hamilton, Canada 6 Odette Cancer Centre - Sunnybrook Health Sciences Centre - University of Toronto, Pharmacy, Toronto, Canada Introduction Cancer patients who receive palliative radiotherapy (RT) for painful bone metastases experience varying changes in pain and quality of life aspects. The EORTC QLQ-BM22 is a validated instrument to measure healthrelated quality of life (HRQOL) in this patient population through scales that assess painful sites (PS), painful characteristics (PC), functional interference (FI), and psychosocial aspects (PA). Objectives To identify single nucleotide variant (SNV) genetic biomarkers associated with changes in HRQOL. Methods 48 patients who received a single 8 Gy RT completed the EORTC QLQBM22 within 7 days before RT and at 42-days post RT. Genetic variation

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in the form of single-nucleotide variants (SNVs) was identified through sequencing saliva samples obtained at day of RT. Statistical analysis by the Cochran Armitage trend test identified SNVs associated with clinically significantly changes in the three scored QLQ-BM22 scales of PC, FI, and PA. Results The variants rs77853982 C/T in HLA-DRB5 and rs28404221 G/A in UGT2A1/2 were respectfully associated with improvement and deterioration of PC. ITGAM rs1143683 C/T and BBS9 rs11773504 G/A were both associated with improvement in FI. ABI3BP rs3732895 T/C and MT1A rs8052394 A/G were associated with improvement of PA. The SNVs identified are involved primarily in metabolism (UGT2A1/2, ABI3BP, MT1A) or immunity pathways in leukocytes (HLA-DRB5, ITGAM). Conclusions SNVs most significantly associated with improvements and deterioration in three HRQOL scales assessed by the QLQ-BM22 were identified for patients with bone metastases. Development of predictive genetic models for HRQOL will enable early intervention in patients projected to have poor QOL after palliative RT.

PS063 DOLLARS AND SENSE: EXPLORING THE FINANCIAL IMPACT OF CANCER FOR AUSTRALIAN PATIENTS AND THEIR FAMILIES K. White1, R. De Abreu Lourenco2, P. Kenny2, L. Lehane1, N. D'Abrew1 1 University of Sydney, Cancer Nursing Research Unit Sydney Nursing School, Sydney, Australia 2 University of Technology Sydney, Centre for Health and Economics and Research Evaluation, Sydney, Australia Introduction Although the Australian health care system funds a large portion of the costs of cancer treatment, some patients and their families experience substantial costs. Objectives To develop a deeper understanding of cancer patients’ experiences of the financial impact of cancer, how it influences treatment decision making and the strategies individuals use to meet these costs. Methods This is a qualitative study using in-depth semi structured interviews with individuals at different stages of their cancer treatment and representing a range of cancer types. Thematic analysis was utilised to understand participants’ experiences. Results Twenty patients and family members were interviewed. Four themes emerged reflecting participants’ experience of the financial impact of cancer: 1) a ripple effect on many aspects of daily life, extending to family income, work, and social life; 2) influences on decision making regarding cancer treatment, finances and family; 3) shifting financial capability as treatment periods extended and resources were depleted, often made worse by the challenges of negotiating income support through agencies not geared towards the long-term treatment effects of cancer; and, 4) attitudes and expectation where discussion of financial impacts was difficult for some, and none of the participants expected to be fully supported for all costs. Conclusions Many aspects of the lives of patients and families were affected as a consequence of the financial impacts of cancer and cancer treatment, although generally accepted by participants as theirs to manage. The findings will inform a larger quantitative study of the financial impact of cancer in Australia.

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PS064 SYMPTOM CLUSTERS IN PATIENT REPORTED OUTCOMES WITH MEDICAL CANNABIS N. Lao1, V. Ganesh1, L. Zhang1, L. Drost1, B.A. Wan1, A. Blake2, S. Chan1, A. Wolt2, P. Zaki1, M. Slaven3, E. Shaw3, C. DeAngelis4, H. Lam5, E. Chow1, S. O'Hearn2 1 Odette Cancer Centre- Sunnybrook Health Sciences Centre, Radiation Oncology, Toronto, Canada 2 MedReleaf Corporation, Clinical Research, Markham, Canada 3 Juravinski Cancer Centre- Hamilton Health Services, Family Medicine, Hamilton, Canada 4 Odette Cancer Centre- Sunnybrook Health Sciences Centre, Clinical Pharmacy, Toronto, Canada 5 Odette Cancer Centre- Sunnybrook Health Sciences Centre, Library Services, Toronto, Canada Introduction Medical cannabis has been reported to be efficacious in alleviating symptoms from various conditions, including chronic pain from cancer. There is limited research on the symptom profiles of current medical cannabis users. Symptom clusters have been identified in patients across a variety of conditions, and can be used by health care professionals to better manage patient symptoms and quality of life. Objectives To identify baseline symptom clusters in patients prior to treatment with medical cannabis using an online survey. Methods Principal component analysis (PCA) was performed using the PRINQUAL procedure to identify symptom clusters among the 10 most prevalent patient-reported symptoms at baseline. Results A total of 863 patients were included with the majority of respondents being male (69%) and Caucasian (92%). The average age of respondents was 46.5 years. Common symptoms reported included chronic pain, sleep disorders, anxiety disorders, depression and post-traumatic stress disorder. Three clusters were identified using PCA. Cluster 1 contained anxiety, depression, exhaustion and sleep interference. Cluster 2 consisted of limited mobility, numbness and pain. Cluster 3 included constipation, digestion problems and headache. All clusters displayed good internal consistencies, with Cronbach’s alpha values of 0.71, 0.67 and 0.64 respectively. Conclusions Three symptom clusters were identified at baseline using PCA. The demographic and symptom profiles of respondents in the present study are also similar to those previously reported in the literature. Understanding of symptom clusters in medical cannabis users may allow for more targeted intervention.

PS065 CANCER PATIENTS RECEIVING CHEMOTHERAPY EXPERIENCE MULTIPLE TOXICITIES SHOWING BOTH LONGITUDINAL AND CLUSTERED ASSOCIATIONS N.Z. Ibrahim Exstara1, R. Joshi2, L. Kelly3, N. Pratt1, J. Adams2, A. Stringer1 1 University of South Australia, Sansom Institute, Adelaide, Australia 2 Lyell McEwin Hospital, Medical Oncology, Adelaide, Australia 3 The University of Adelaide, School of Public Health, Adelaide, Australia Introduction Cancer patients receiving chemotherapy are likely to experience multiple toxicities. These may occur concurrently or individually, and result in reduced quality of life.

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Objectives To analyse the treatment-related toxicity data over multiple cycles of chemotherapy regimens, and whether certain toxicities cluster within patients. Methods Treatment-related toxicity data (including baseline demographics and clinical data) from adults undergoing chemotherapy at the Lyell McEwin Hospital (Adelaide, Australia) was collected for 115 subjects, excluding those with pre-existing and active gastrointestinal/oral or neurological conditions. Toxicities were recorded using the Antineoplastic Drug Patient Assessment Tool, utilising the CTCAE v4 scale. Symptom toxicities in cycle 1 were clustered into two groups using Bayesian latent class models. Analysis of symptom clusters over two or more cycles used latent Markov models. Results Patients were aged 62.1±11.9 years, with gender split 55:60 (M:F). Preliminary data analysis revealed the most prevalent toxicity reported in cycle 1 was fatigue (53.9%, ≥Grade 1). Other toxicities occurring in cycle 1 included nausea (12.1%), vomiting (3.4%), oral mucositis (9.6%), diarrhoea (13%), constipation (15.6%), peripheral neuropathy (13.9%), skin toxicity (7.8%), and ‘other’ (3.5%). Clustering and longitudinal analyses are still being undertaken. Conclusions Patients undergoing chemotherapy treatment are likely to experience multiple toxicities, which are now looked for specifically in cancer treatment centres. It is expected that there will be longitudinal relationships between toxicities, and clustering will be prevalent.

PS066 THE DEVELOPMENT OF SUPPORTIVE CARE GUIDANCE FOR PE OPL E AND T HEI R CAR ER S L I VIN G W IT H I MM U N OT H E R AP Y T R E AT M E NT F OR AD VA N C E D MELANOMA P. Hughes1, N. Kumaralingam1, A. Sangha1, V. Forjaz1, T. Wiseman2,3 1 The Royal Marsden NHS Foundation Trust UK, Health Services, London, United Kingdom 2 The Royal Marsden NHS Foundation Trust UK, Health Services Research, London, United Kingdom 3 University of Southampton, Applied Health in Cancer Care, Southampton, United Kingdom Introduction Melanoma, fifth most common cancer in the UK, with rising incidence is relatively common in younger people, ~25% occuring in patients aged under 50. Melanoma is challenging with high risk of recurrence and aggressive in its advanced stage. Previously, prognosis for patients diagnosed with Stage 4 melanoma was poor, many dying within 3-12 months. New immunotherapies and targeted therapies improved survival, offering potential cure. Trials report toxicity and symptoms but little Objectives To understand experiences, needs and supportive care requirements of people with stage 4 melanoma receiving systemic treatment and their carers, and develop supportive care guidance. Methods Phase 1 uses grounded theory methodology to explore experience of patients and carers living with immunotherapy treatment. 62 interviews (41 patients, 21 carers) were conducted across 4 NHS Trusts. Phase 2 uses a Delphi technique of experts (oncologists, CNSs, dieticians, physiotherapists, patients and carers) to produce evidence based supportive care guidance and a clinical pathway. Results Findings showed side-effects from immunotherapies impact patients physically and psychologically which impact carers and family. Themes include: process of diagnosis and illness trajectory, symptom management and burden, coping, finding new meaning and living well. Findings informed Phase 2.

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Conclusions The symptom burden of immunotherapy treatment can markedly effect people living with advanced melanoma and their carers. We provide the first evidence based supportive care guidance. Further interventions and resources can be developed for patients and carers to live well with advanced melanoma.

PS067 THE USE OF MEDICAL CANNABIS IN COMMON SYMPTOMS V. Ganesh1, P. Zaki1, S. O'Hearn2, A. Wolt2, S. Chan2, L. Zhang2, H. Lam1, B.A. Wan1, M. Slaven3, E. Shaw3, C. DeAngelis1, E. Chow1, A. Blake2 1 Sunnybrook Health Sciences Centre, Odette Cancer Centre, Toronto, Canada 2 MedReleaf, Research, Markham, Canada 3 Hamilton Health Sciences, Juravinski Cancer Centre, Hamilton, Canada Introduction The potential clinical utility of medical cannabis in the management of a wide variety of symptoms and conditions is gaining increasing attention. Objectives To investigate possible benefits and side effects associated with the use of cannabis in patients. Methods All patients received cannabis from a single Canadian medical cannabis provider. 2588 patients completed a voluntary online survey prior to the initiation of cannabis use, defined as baseline. Follow-up (FU) surveys were completed at 4 and 10 months after baseline. The survey collected information pertaining to patient demographics, medical conditions, presence and severity of symptoms, and quality of life (QOL). Results The most commonly reported medical symptoms were anxiety disorder (32.9%, n=713), depression (32.6%, n=706), sleep disorders (26.7%, n=579), post-traumatic stress disorder (PTSD) (22.6%, n=489), and arthritis (22.5%, n=488). At 4-month FU, a majority of patients demonstrated improvement in all symptoms: arthritis (70.0%, n = 98), anxiety (77.5%, n=162), depression (71.6%, n=211), sleep disorders (79.2%, n=154) and PTSD (76.9%, n=160), with significant improvements seen in anxiety (p=0.0006), PTSD (p=0.006), and sleep disorders (p=0.0006). Reductions in symptoms and symptom severity, as well as improvement in QOL were also demonstrated at 4-month FU and remained stable from 4-month to 10-month FU. Pain severity was significantly reduced from baseline to 10-month FU (p<0.0001). Conclusions To achieve optimal patient outcomes, future studies should investigate the efficacy of medical cannabis including effects of different cannabis varieties, doses, and methods of consumption when used for various medical symptoms.

PS068 CARDIAC FUNCTION IN CANCER-RELATED FATIGUE B. Brady1,2, M. Barrett1, G. King3, M.J. Kennedy4,5, S. Cuffe4, R.T. Murphy3,5, D. Walsh1,2,5 1 Our Lady's Hospice & Care Services, Academic Department of Palliative Medicine, Dublin, Ireland 2 University College Dublin, School of Medicine, Dublin, Ireland 3 St. James's Hospital, Department of Cardiology, Dublin, Ireland 4 St. James's Hospital, Department of Medical Oncology, Dublin, Ireland 5 Trinity College Dublin, School of Medicine, Dublin, Ireland Introduction Cancer-related fatigue (CRF) is a common, high-impact symptom. CRF is neither clearly defined nor is the pathophysiology understood which

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makes research a challenge. One possible mechanism for CRF is dysfunction of cardiac muscle. Cancer-related changes to cardiac muscle may precede any treatment-related cardiotoxicity. Cardiac biomarkers can be abnormal, even with normal cardiac imaging. Objectives To investigate cardiac function in people with solid tumour malignancies. Methods Treatment naïve participants were recruited from medical oncology outpatient clinics. Fatigue was measured subjectively (brief fatigue inventory [BFI]) and objectively (grip strength, timed-up-and-go [TUG] and sit-tostand [STS]). BFI ≥3 was indicative of fatigue. A 2D transthoracic echocardiogram assessed cardiac function, including muscle mass, systolic and diastolic function. Left ventricular (LV) myocardial strain was analysed using EchoPAC software (GE Healthcare™). A cardiac biomarker, NT-pro brain natriuretic peptide (NT-BNP), was measured on a subset of participants who were scheduled for chemotherapy. Results Interim results are presented; recruitment is ongoing. & 11 participants, 9 female & Cancer diagnoses: Oesophageal (2), breast (9) & Loco-regional disease: 8 & Mean BFI 2.35 (range 0-5.4) & BFI ≥3: 5/11 (45%)

Conclusions 1. High proportion of participants fatigued pre-treatment. 2. Prolonged IVRT in fatigued participants, indicative of diastolic dysfunction. 3. No difference in cardiac size, myocardial strain, or NT-BNP levels between fatigued and non-fatigued participants. 4. Feasible study, tests well tolerated.

eP001 A RANDOMIZED, DOUBLE-BLIND, PLACEBOC O N T R O L L E D P H A S E I I I S T U D Y E VA L U AT I N G O L A N Z A P I N E 5 M G C O M B I N E D W I T H S TA N D A R D ANTIEMETIC THERAPY FOR THE PREVENTION OF CINV I N P AT I E N T S R E C E I V I N G C I S P L A T I N - B A S E D CHEMOTHERAPY M. Abe1, T. Yanai2, K. Nakashima3, Y. Hirashima1, H. Murakami3, S. Hamauchi4, H. Ishikawa5, M. Sakurai5, T. Yamaguchi6, S. Zenda7, Y. Uchitomi8, H. Terakado2, S. Iwasa9, H. Hashimoto2 1 Shizuoka Cancer Center, Gynecologic Oncology, Shizuoka, Japan 2 National Cancer Center Hospital, Pharmacy, Tokyo, Japan 3 Shizuoka Cancer Center, Thoracic Oncology, Shizuoka, Japan 4 Shizuoka Cancer Center, Gastrointestinal Oncology, Shizuoka, Japan 5 Shizuoka Cancer Center, Pharmacy, Shizuoka, Japan 6 Tohoku University Graduate School of Medicine, Medical Statistics, Miyagi, Japan 7 National Cancer Center East, Radiation Oncology, Tokyo, Japan 8 National Cancer Center Hospital, Psycho Oncology, Tokyo, Japan 9 National Cancer Center Hospital, Gastrointestinal Oncology, Tokyo, Japan

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Introduction Olanzapine is effective for chemotherapy-induced nausea and vomiting (CINV). Although 10mg of olanzapine is widely used for CINV, patient sedation may be a concern. In Japan, three phase II studies revealed the efficacy and safety of 5mg of olanzapine combined with palonosetron (PALO), aprepitant (APR), and dexamethasone (DEX) for CINV induced by cisplatin-based chemotherapy. In these studies, complete response (CR: no vomiting, no rescue) in the delayed phase (24-120h) was 8395%. Compared with 10mg, 5mg of olanzapine seemed to be equally effective and less sedative. Objectives The aim of this phase III study is to evaluate the efficacy of 5 mg of olanzapine as compared with placebo, in combination with APR, PALO, and DEX, for the control of CINV induced by cisplatin-based chemotherapy. Methods Cisplatin-naïve patients receiving cisplatin-based (≥ 50 mg/m2) chemotherapy are enrolled. The two groups receive either 5mg of olanzapine or placebo daily on days 1 through 4, in combination with APR, PALO, and DEX. We expected the CR rate of the placebo and olanzapine arms to be 65% and 75%, respectively. According to this estimation, a total of 690 patients are required to achieve a significance level of 2.5% (one-sided) and 80% statistical power. The primary endpoint is CR rate in the delayed phase. Secondary endpoints include a CR during acute (0-24h) and overall phases (0-120h) are complete and total control rates during each phase. Results This trial was registered in the UMIN Clinical Trials Registry as UMIN000024676. Conclusions This trial began from February, 2017 in 30 institutes in Japan.

eP002 ONDANSETRON A NOVAL ANTI EMETIC A. Afzal1 1 Wah Medical College, Pharmacology, Wah Cantt, Pakistan Introduction Health and diseases are two very closely related issues that came into exisistance the moment the new life emerges on planet Earth There are several life threatening diseases in our world but ‘Cancer’ out powers them all in recent years. Chemotherapy induced nausea and vomiting (CINV) is the major problem affectiong more than 70% of caner patients globally. Ondansetron, a 5-HT3 receptor antagonist has now become a gold standard in the treatment of chemotherapy induced nausea and vomiting. Objectives The present study was carried out to explore the possible underlying mechanism of ondansetron in vitro Methods Experiments were performed in three groups (n=6) and ileal smooth muscles activity was recorded on power lab (USA). The effects of acetylcholine, serotonin, ondansetron alone was observed in three groups. The response obtained by acetylcholine served as a control for our study. Results Response with acetylcholine was 100% and with serotonin was 150 percent of control. Dose response curve with ondansetron was 120% of the control group. Conclusions Our study has indicated that ondansetron apart from having central action also has marked peripheral actions (via 5-HT4 receptors causes relaxation of intestinal tract and causes an increase in the motility and responses) that play an important role in CINV and may act as a partial agonist.

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Key Words: Serotonin, Ondansetron, Acetylcholine, Cancer Chemotherapy, Chemotherapy induced nausea and vomiting.

eP003 A RETROSPECTIVE CHART REVIEW OF HYPERSENSITIVITY AND INFUSION-SITE ADVERSE EVENTS (ISAES) ASSOCIATED WITH FOSAPREPITANT IV I N PAT I EN TS R EC EI VI NG AN TH RA CYC L IN E AND CYCLOPHOSPHAMIDE (AC)-BASED CHEMOTHERAPY R. Boccia1, R. Geller2, N. Clendeninn3, T. Ottoboni4 1 Center for Cancer and Blood Disorders, Hematology/Oncology, Bethesda, USA 2 Heron Therapeutics- Inc., Medical Affairs, San Diego, USA 3 Heron Therapeutics- Inc., Clinical, San Diego, USA 4 Heron Therapeutics- Inc., Pharmaceutical & PreClinical Research and Development, San Diego, USA Introduction The consensus guideline–recommended regimen for chemotherapyinduced nausea and vomiting prophylaxis following highly emetogenic chemotherapy (HEC) (eg, AC) and some moderately emetogenic chemotherapies includes a NK-1 receptor antagonist (RA), a 5-HT3 RA, and dexamethasone. Aprepitant and its IV prodrug, fosaprepitant, are the most widely used NK-1 RAs. Polysorbate-80, a surfactant for solubilizing fosaprepitant, has been associated with hypersensitivity and ISAEs; their incidence, likely underestimated because of reporting heterogeneity, has been reported at 29%-42% (Lundberg 2014; Fuji 2015). Objectives To identify the incidence of ISAEs and systemic reactions associated with fosaprepitant IV in patients receiving AC. Methods Patient medical records (documented codes, nursing notes/codes, physician notes) were evaluated from 14 US sites. Eligible men and women, 18-80 years, had Eastern Cooperative Oncology Group performance status 0-1 and were receiving doxorubicin (≥60 mg/m2) + cyclophosphamide (≥600 mg/m2) via peripheral IV line and a 3-drug antiemetic regimen including fosaprepitant. ISAE and systemic reaction incidences were collected over multiple cycles. Results Of 127 charts reviewed, 35 (28%) reported an ISAE and/or systemic reaction during or following infusion. In 32 patients with ISAEs, 137 individual ISAEs were documented over multiple chemotherapy cycles (range 0-90/cycle), most commonly erythema, injection-site pain, and swelling (Table 1). In 16 patients with systemic reactions, 50 individual reactions were documented over multiple cycles (range 0-36/cycle), most commonly edema/swelling, erythema, and dermatitis (Table 2).

Conclusions Patients receiving fosaprepitant and AC chemotherapy via peripheral line are at risk for hypersensitivity reactions. An IV surfactant–free NK-1 RA could reduce ISAE incidence in this setting.

eP004 COST-EFFECTIVENESS ANALYSIS OF OLANZAPINECONTAINING ANTIEMETIC THERAPY FOR MANAGING HIGHLY EMETOGENIC CHEMOTHERAPY IN SOUTH EAST ASIA: A MULTINATIONAL STUDY S. Chanthawong1, Y.H. Lim2, S. Subongkot1, A. Chan3,4, R. Andalusia5, R.S. Bustamam6, N. Chaiyakunapruk2,7,8,9 1 Faculty of Pharmaceutical Sciences - Khon Kaen University, Divison Clinical Pharmacy, Khon Kaen, Thailand 2 Monash University Malaysia, School of Pharmacy, Selangor, Malaysia 3 National University of Singapore, Department of Pharmacy, Singapore, Singapore 4 National Cancer Centre Singapore, Department of Pharmacy, Singapore, Singapore 5 “Dharmais” Cancer Hospital, Department of Research and Development, Jakarta, Indonesia 6 Hospital Kuala Lumpur, Department of Radiotherapy & Oncology, Kuala Lumpur, Malaysia 7 University of Queensland, School of Population Health, Brisbane, Australia 8 University of Wisconsin, School of Pharmacy, Madison, USA 9 Faculty of Pharmaceutical Sciences, Center of Pharmaceutical Outcomes Research CPOR- Department of Pharmacy Practice, Naresuan University, Thailand Introduction Recent studies suggested that olanzapine, together with dexamethasone and serotonin-3 receptor antagonist (5HT3RA), is effective to prevent chemotherapy-induced nausea and vomiting (CINV) associated with highly emetogenic chemotherapy (HEC). This regimen is particularly useful in regions where resources are limited such as South East Asia (SEA). Objectives To evaluate the cost-effectiveness of adding olanzapine into standard regimens for the prevention of CINV in patients receiving HEC in SEA countries. Methods Using a decision tree model, clinical and economic outcomes associated with olanzapine-containing regimen and standard regimen (doublet antiemetic regimen: dexamethasone+ondansetron) in most SEA countries except in Singapore (triplet antiemetic regimen: dexamethasone+palonosetron+aprepitant) for CINV prevention following HEC were evaluated. This analysis was performed

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in Thailand, Malaysia, Indonesia, and Singapore, using societal perspective with 5-day time horizon. Input parameters were derived from literature, network meta-analysis, government documents, and hospital databases. Outcomes were incremental costeffectiveness ratio (ICER) in USD/ quality-adjusted life year (QALY) gained. A series of sensitivity analyses including probabilistic sensitivity analysis were performed. Results Compared to doublet antiemetic regimen, addition of olanzapine resulted in incremental QALY of 0.0025 with cost saving of USD2.94, USD5.55, and USD2.20 in Thailand, Malaysia and Indonesia, respectively. Compared to triplet antiemetic regimen, adding olanzapine is costeffective with ICER of USD31,818/QALY for Singapore. The probability of being cost-effective at a cost-effectiveness threshold of 1 GDP/capita varies from 20-75% across countries. Conclusions The addition of olanzapine is cost-effective and viable to prevent CINV in patients receiving HEC in multiple SEA countries.

eP005 EFFICACY OF OLANZAPINE FOR THE PROPHYLAXIS AND RESCUE OF CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING (CINV): A SYSTEMATIC REVIEW AND METAANALYSIS L. Chiu1, R. Chow1, M. Popovic1, R. Navari2, N. Shumway3, N. Chiu1, H. Lam1, M. Milakovic1, M. Pasetka1, S. Vuong1, E. Chow1, C. DeAngelis1 1 Odette Cancer Centre - Sunnybrook Health Sciences Centre - University of Toronto, Department of Radiation Oncology, Toronto, Canada 2 University of Alabama Birmingham School of Medicine, Hematology/ Oncology, Birmingham, USA 3 San Antonio Military Medical Center, Haematology/Oncology, Texas, USA Introduction Olanzapine is a potent antipsychotic medication that inhibits a wide variety of receptors. It has been used in trials for the prophylaxis and rescue of chemotherapy-induced nausea and vomiting (CINV). Objectives This study systematically investigates the efficacy of olanzapine in relation to other antiemetics in the prophylaxis and rescue of CINV. Methods A literature search of Ovid MEDLINE, EMBASE, and CENTRAL was conducted to identify randomized controlled trials (RCTs) comparing olanzapine to other standard antiemetics for either prevention or rescue. The primary endpoints were the percentage of patients achieving no emesis or no nausea, in the acute, delayed, and overall phases. Results Ten RCTs in the preventative setting and three RCTs in the breakthrough setting were identified. Subgroup analysis demonstrated a similar degree of benefit from a 5 mg and 10 mg dose of olanzapine for the no emesis endpoint in the overall phase. In the prophylaxis setting, olanzapine was statistically superior in 5 of 6 endpoints and clinically superior in 4 of 6 endpoints. In the breakthrough setting, olanzapine was statistically and clinically superior in the only endpoint analyzed: no emesis. Conclusions Olanzapine is more efficacious than other standard antiemetics, both for prevention and breakthrough. Given the possible reduction in side-effects, the use of a 5 mg dose of olanzapine should be considered. Future RCTs should compare the 5 mg versus the 10 mg dosages further and report on the efficacy and percentage of patients developing side effects. Further analyses should be done without the influence of corticosteroids.

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eP006 OLANZAPINE FOR THE PROPHYLAXIS AND RESCUE OF CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING (CINV): A RETROSPECTIVE STUDY L. Chiu1, N. Chiu1, R. Chow1, L. Zhang1, M. Pasetka1, J. Stinson1, B. Lechner1, N. Pulenzas1, S. Verma1, E. Chow1, C. DeAngelis1 1 Odette Cancer Centre - Sunnybrook Health Sciences Centre - University of Toronto, Department of Radiation Oncology, Toronto, Canada Introduction While the efficacy of olanzapine in the prophylaxis of CINV has been documented, the literature on the use of olanzapine as a rescue medication for breakthrough CINV has been scarce. Objectives This study retrospectively evaluated the safety and efficacy of olanzapine for the treatment of breakthrough CINV. The efficacy and safety of olanzapine in the prophylactic setting was also examined in a smaller cohort. Methods Electronic charts of adult patients aged > 17 years receiving a prescription for olanzapine from the Odette Cancer Centre Pharmacy at Sunnybrook Hospital between January 2013 and June 2015 were reviewed retrospectively. Inclusion criteria required receiving one or more doses of olanzapine for the rescue or prophylaxis of CINV and documentation of the outcome. Results A total of 154 patients and 193 treatment cycles were included in the breakthrough setting, while a total of 16 patients and 20 treatment cycles were included in the prophylaxis setting. In the breakthrough setting, 88% of cases experienced improved nausea, while 21% of cases reported improved vomiting. In the prophylactic setting, 100% of cases experienced improved nausea, while 65% achieved improved vomiting. 43% of cases in the breakthrough setting and 65% of cases in the prophylactic setting experienced sedation. Conclusions Olanzapine is effective in improving CINV in both the prophylactic and breakthrough settings. The safety, efficacy, and appropriate dosage of olanzapine for the rescue of breakthrough CINV should be prospectively evaluated in a randomized controlled trial.

eP007 EFFICACY AND SAFETY OF OLANZAPINE FOR THE PROPHYLAXIS OF CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING (CINV) AS REPORTED IN PHASE I AND II STUDIES: A SYSTEMATIC REVIEW R. Chow1, L. Chiu1, R. Navari2, S. Passik3, N. Chiu1, M. Popovic1, H. Lam1, M. Pasetka1, E. Chow1, C. DeAngelis1 1 Odette Cancer Centre - Sunnybrook Health Sciences Centre - University of Toronto, Institute of Evaluative Clinical Sciences, Toronto, Canada 2 University of Alabama Birmingham School of Medicine, Department of Hematology & Oncology, Birmingham, USA 3 Millennium Health, Clinical Research and Advocacy, San Diego, USA Introduction Olanzapine is an atypical antipsychotic drug that inhibits serotonergic, dopaminergic, alpha-1 adrenergic, histaminic, and muscarinic receptors. Several phase I and II trials have been published documenting the use of olanzapine in controlling chemotherapy-induced nausea and vomiting (CINV). Objectives This review aims to summarize all phase I and II trials that reported on olanzapine for the prophylaxis of CINV. Methods A literature search was conducted in Ovid MEDLINE from 1946 to July week 1 2015, Embase Classic and Embase from 1947 to

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2015 week 28, and the Cochrane Central Register of Controlled Trials up until June 2015. Phase I and II trials reporting on olanzapine for the prophylaxis for CINV were included if they reported on at least one of four primary endpoints: complete response (CR), complete control (CC), no nausea, and no emesis. Other endpoints of interest included the safety of olanzapine as measured by the M.D. Anderson Symptom Inventory. Results Across the seven studies, there were a total of 201 patients. The CR across four studies was 97.2, 83.1, and 82.8 % for the acute, delayed, and overall phases, respectively. The CC for acute, delayed, and overall phases was 92.5, 87.5, and 82.5 %, respectively. The overall no nausea rate was 92.7, 71.8, and 70.6 % for the acute, delayed, and overall phases, respectively. The overall no emesis rates for the acute, delayed, and overall phases were 100, 94.5, and 90.4 %, respectively. Fatigue, drowsiness, and disturbed sleep were common side effects. Conclusions Olanzapine is efficacious and safe as a prophylaxis for CINV.

eP008 THE COMBINATION OF NK1 RECEPTOR ANTAGONIST, PALONOSETRON, AND DEXAMETHASONE FOR THE PROPHYLAXIS OF CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING: A SYSTEMATIC REVIEW AND METAANALYSIS R. Chow1, M. Popovic1, L. Chiu1, W. Fu1, S. Cheon1, H. Lam1, M. Milakovic1, M. Pasetka1, S. Vuong1, E. Chow1, C. DeAngelis1 1 Odette Cancer Centre - Sunnybrook Health Sciences Centre - University of Toronto, Institute of Evaluative Clinical Sciences, Toronto, Canada Introduction Chemotherapy-induced nausea and vomiting (CINV) is a common side effect of chemotherapy that has the potential to impair patients’ quality of life. The combination of different antiemetic medications targeting various molecular pathways affiliated with emesis has become the standard of care. Objectives The purpose of this meta-analysis is to investigate the efficacy of neurokinin-1 receptor antagonist (NK1 RA) in combination with palonosetron (PALO) and dexamethasone compared to PALO and/or dexamethasone in the prophylaxis of CINV. Methods A literature search of Ovid MEDLINE, EMBASE, and Cochrane CENTRAL was used to identify RCTs which reported on the efficacy of combined NK1 RA with PALO and dexamethasone compared to PALO and dexamethasone. The endpoints of interest were the percentage of patients achieving complete response (CR), complete control (CC), no nausea and no vomiting in the acute, delayed and overall phases. Results Four RCTs were identified, with 916 patients randomized to receive PALO and dexamethasone, and 1,213 patients to receive NK1 RA, combined with PALO and dexamethasone. The combination treatment was statistically superior to PALO and/or dexamethasone in eleven of twelve statistical analyses, with no superiority found in the acute phase of CC. Clinical superiority of combination therapy was achieved in 2 of 12 endpoints: no vomiting in the delayed and overall phases. Six other endpoints approached the treatment effect needed for clinical superiority. Conclusions NK1 RA with PALO and dexamethasone is more efficacious than PALO and/or dexamethasone. Future studies should investigate the activity of NK1 RAs in specific cohorts of patients receiving MEC other than AC.

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eP009 TREATMENT OF PONATINIB-INDUCED REFRACTORY NAUSEA AND VOMITING WITH NEPA: A CASE REPORT A. Dickman1, A. Whitfield2 1 University of Liverpool, Marie Curie Palliative Care Institute Liverpool, Liverpool, United Kingdom 2 Blackpool Teaching Hospitals NHS Foundation Trust, Palliative Medicine, Blackpool, United Kingdom Introduction Nausea and vomiting represent two of the most distressing adverse effects of cancer chemotherapy. In order to offer optimal anti-emetic prophylaxis, antineoplastic agents have been classified into one of four levels of emetogenicity: high, moderate, low and minimal. Ponatinib is a tyrosine kinase inhibitor (TKI) indicated for use in adult patients for the treatment of chronic myeloid leukaemia (CML) and is described as having a low emetogenic potential. Objectives The purpose of this case report is to discuss the successful use of regular 5-day interval doses of NEPA to control refractory nausea and vomiting in a patient receiving ponatinib. Methods A 44 year old female with CML was referred to the Specialist Palliative Care outpatient clinic at Blackpool Hospital. The patient was receiving ponatinib 15mg once daily; although a low dose, it was causing distressing nausea and vomiting. She had been troubled by these symptoms since starting TKIs over 4 years ago. During the preceding 4 years, the patient had received numerous TKIs, but unacceptable and intolerable symptoms of nausea and vomiting necessitated treatment changes, despite the regular use of different anti-emetic regimes. Aware of a potential drug interaction, netupitant/palonosetron (NEPA) was cautiously introduced at a dose of 300mg/0.5mg every 5 days. Results The patient experienced immediate cessation of vomiting, significant reduction in nausea and improved response to CML treatment after the introduction of NEPA. Conclusions Regular NEPA treatment may represent an effective treatment option for refractory nausea and vomiting; further study is recommended.

eP010 PHASE 3 EFFICACY AND SAFETY STUDY OF PALONOSETRON IV INFUSION VERSUS IV BOLUS FOR CHEMOTHERAPYINDUCED NAUSEA AND VOMITING (CINV) PROPHYLAXIS FOLLOWING HIGHLY EMETOGENIC CHEMOTHERAPY (HEC) M. Karthaus1, P. Szabò2, D. Voisin3, G. Rizzi3, T.E. Ciuleanu4 1 Klinikum Neuperlach, Hematology/Oncology and Palliative Care, Munich, Germany 2 Szabolcs-Szatmár-Bereg County Hospitals and University Teaching Hospital- SZSZBMK, Pulmonology, Nyíregyháza, Hungary 3 Helsinn Healthcare SA, Scientific Operations, Pazzallo- Lugano, Switzerland 4 Institute of Oncology Prof. Dr. Ion Chiricuta and UMF Iuliu Hatieganu, Medical oncology, Cluj Napoca, Romania Introduction Palonosetron is an effective and selective second-generation 5hydroxytryptamine-3 receptor antagonist (5-HT3RA) used for CINV prophylaxis in patients receiving HEC and moderately emetogenic chemotherapy (MEC). Currently administered as a 30-sec IV bolus, palonosetron is the preferred 5-HT3RA for MEC in ASCO and NCCN antiemetic guidelines, and in MASCC/ESMO guidelines for anthracycline-cyclophosphamide (AC) regimens when a neurokinin-1 (NK1)–RA is not available. This study

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was conducted in the context of developing the IV formulation for the netupitant (NK1RA) and palonosetron fixed combination (NEPA), currently available as an oral formulation. Objectives Demonstrate non-inferiority in preventing acute CINVof a single 30-min IV palonosetron infusion versus a single 30-sec IV palonosetron bolus following HEC. Methods Phase 3, multinational, randomized (1:1) double-blind study in 440 chemotherapy-naive patients with solid tumors (NCT02557035) comparing efficacy/safety of 0.25-mg palonosetron 30-min IV infusion vs 30-sec IV bolus, 30 min before HEC (excluding AC), along with oral dexamethasone (20 mg [day 1]; 8 mg twice-daily [days 2–4]). Primary endpoint: complete response (CR; no emesis/no rescue medication) in the acute (0– 24 hours) phase. Results The acute CR rate was high for both groups (Table); risk-difference was 3.8% (99% confidence interval [CI], -12.2; 4.7) demonstrating noninferiority (lower limit of the 99% CI was greater than -15% [pre-specified non-inferiority margin]). Acute “no emesis” and “no rescue medication” results were similar. Treatment-emergent and treatment-related adverse event frequency was comparable.

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Methods Patients were identified in the Premier Healthcare database, a geographically diverse census of inpatients and hospital-based outpatients. Adults treated for lung cancer with HEC during the years 2012-14 were identified and stratified based on their antiemesis prophylaxis. Acute (day of CT) and delayed CINV (days 2-7 post CT) were identified following initiation of CT. CINV was defined by ICD9 codes for nausea, vomiting, or volume depletion/dehydration or use of a rescue antiemetic medication. Rates of CINV and health care costs were then compared between the two cohorts. Results A total of 5,617 patients were identified, 3,498 (62%) Per-Guideline and 2,119 (38%) Non-Guideline. For acute CINV, Per-Guideline patients had significantly lower rates of CINV compared to Non-Guideline patients (5.8% vs. 8.8%, respectively, p<.001). Per-Guideline patients also had significantly lower rates of delayed CINV compared to Non-Guideline patients (55.0% vs. 60.9%, p<.001). Patients with CINValso had significantly greater inpatient and outpatient health care costs compared to those who did not. Conclusions Although defining CINV with retrospective claims has inherent limitations, these results suggest that following the recommendations in the MASCC Antiemesis guidelines may lead to lower CINV-related health care utilization and health care costs.

eP012 COMPARING RATES OF CHEMOTHERAPY INDUCED NAUSEA AND VOMITING IN PATIENTS WITH BREAST CANCER RECEIVING AC CHEMOTHERAPY TREATED WITH PALONOSETRON VS. ANOTHER 5HT3RA R. Copher1, G. Magee2, S. Misir3, R. Knoth1 1 Eisai Inc., Health Economics & Outcomes Research, Woodcliff Lake NJ, USA 2 Premier Healthcare Inc., Strategic Solutions, Charlotte NC, USA 3 Eisai Inc., Medical Affairs, Woodcliff Lake NJ, USA

Conclusions Palonosetron IV infusion was non-inferior to IV bolus in acute CINV prevention after HEC. Safety profiles were similar.

eP011 EXAMINING RATES OF CHEMOTHERAPY INDUCED NAUSEA AND VOMITING IN LUNG CANCER TREATED WITH ANTIEMETIC PROPHYLAXIS RECOMMENDED BY THE MASCC ANTIEMESIS GUIDELINES R. Knoth1, R. Copher1, G. Magee2, M. Kim3, S. Misir3, A. McBride4 1 Eisai Inc., Health Economics and Outcomes Research, Woodcliff Lake NJ, USA 2 Premier Healthcare Inc., Strategic Solutions, Charlotte NC, USA 3 Eisai Inc., Medical Affairs, Woodcliff Lake NJ, USA 4 University of Arizona Cancer Center, Hematology/Oncology, Tucson AZ, USA Introduction Current MASCC Antiemesis Guidelines recommend triple antiemetic therapy (5HT3RA, NK1, and dexamethasone) to prevent chemotherapy (CT) induced nausea and vomiting (CINV) in patients undergoing highly emetogenic chemotherapy (HEC). Objectives This analysis evaluated whether treatment according to guidelines resulted in reduced rates of CINV in patients diagnosed with lung cancer and initiated on HEC.

Introduction Adriamycin and cyclophosphamide (AC) is a common chemotherapy combination used to treat breast cancer (BC). Antiemetic guidelines recommend a triple antiemetic regimen (5HT3RA, NK1, and dexamethasone) to prevent chemotherapy induced nausea and vomiting (CINV) in AC chemotherapy. Palonosetron is a preferred 5HT3RA for triple therapy. Objectives This study examined the rate of CINV in patients diagnosed with BC and treated with either palonosetron or another 5HT3RA prior to AC chemotherapy. Methods Patients were identified in the Premier Healthcare database, a geographically diverse census of inpatients and hospital-based outpatients. Adults treated with AC chemotherapy for BC during the years 2012-14 were identified and stratified by 5HT3RA (i.e., Palonosetron vs. Other 5HT3RA). CINV was defined by ICD9 codes for CINV or volume depletion/dehydration or by use of a rescue antiemetic. Rates of acute (day of chemotherapy) and delayed CINV (days 2-7) were calculated and compared between cohorts. Results A total of 5,264 patients were included in the analysis, 3,455 (65.6%) treated with palonosetron and 1,809 (34.4%) treated with another 5HT3RA. Patients who received palonosetron (vs. another 5HT3RA) had a significantly lower rate of acute CINV (1.0% vs. 2.5% respectively, p < .001) and a lower rate of CINV overall (12.4% vs. 17.4% respectively, p < .001). The majority of delayed CINV occurred on day 2 following chemotherapy. Conclusions Prophylactic treatment with palonosetron led to significantly lower rates of acute and delayed CINV when compared to another 5HT3RA. This information could inform providers trying to reduce the rate of CINV in BC receiving AC.

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eP013 COMPARING RATES OF CHEMOTHERAPY INDUCED NAUSEA AND VOMITING IN PATIENTS WITH LUNG CANCER RECEIVING HIGHLY EMETOGENIC CHEMOTHERAPY TREATED WITH PALONOSETRON VS. ANOTHER 5HT3RA R. Knoth1, G. Magee2, S. Misir3, R. Copher1 1 Eisai Inc., Health Economics & Outcomes Research, Woodcliff Lake NJ, USA 2 Premier Healthcare Inc., Strategic Solutions, Charlotte NC, USA 3 Eisai Inc., Medical Affairs, Woodcliff Lake NJ, USA Introduction Antiemetic guidelines recommend a triple antiemetic regimen (5HT3RA, NK1, and dexamethasone) to prevent chemotherapy induced nausea and vomiting (CINV) in patients undergoing highly emetogenic chemotherapy (HEC). Palonosetron, a second generation 5HT3RA, is often included in this combination. Objectives This study examined the rate of CINV in patients treated in a hospitalbased cancer center, diagnosed with lung cancer (LC), initiated on HEC, and treated with palonosetron or another 5HT3RA. Methods Patients were identified in the Premier Healthcare database, a geographically diverse census of inpatients and hospital-based outpatients. Adults treated for LC with HEC during the years 2012-14 were identified and stratified by 5HT3RA (i.e., Palonosetron vs. Other 5HT3RA). CINV was defined by ICD9 codes for CINV, volume depletion/dehydration or by use of a rescue antiemetic. Rates of acute (day of CT) and delayed CINV (days 2-7 post CT) were calculated and compared between cohorts. Results A total of 3,336 patients were included in the analysis. Of these, 1,603 (48.1%) were treated with palonosetron and 1,733 (51.9%) were treated with another 5HT3RA. Patients treated with palonosetron (vs. another 5HT3RA) had significantly lower rate of acute CINV (3.4% vs. 7.4% respectively, p < .001) and a lower rate of CINVoverall (37.7% vs. 64.3%, p < .001). Most of the delayed CINV occurred on day 2 following CT. Conclusions Prophylactic treatment with palonosetron resulted in significantly lower rates of CINV when compared to another 5HT3RA. This retrospective analysis may be informative to providers trying to reduce the rate of CINV in LC with HEC.

eP014 ONLINE LEARNING INITIATIVE TO ADDRESS THE ONGOING CLINICAL CHALLENGES OF CHEMOTHERAPYINDUCED NAUSEA AND VOMITING (CINV) G. Krassas1, K. Cox2, D. D'Souza3, H. Goodall4, A. Lee5, C. Steiner6, E.K. Carson7 1 Scius Healthcare Solutions Pty Ltd, Medical education, Northbridge, Australia 2 Chris O'Brien Lifehouse, Chemotherapy Nurse Practitioner, Camperdown, Australia 3 Crown Princess Mary Cancer Centre- Westmead Hospital, Cancer Care Pharmacy, Westmead, Australia 4 Armidale Public Hospital, Armidale Oncology Unit, Armidale, Australia 5 Royal North Shore Hospital, Department of Medical Oncology, St Leonards, Australia 6 Northern Cancer Institute, Oncology, St Leonards, Australia 7 St Vincent's Hospital, Medical Oncology, Darlinghurst, Australia Introduction Nausea and vomiting are two of the most frequent and troubling side effects of chemotherapy, adversely impacting cancer therapy and

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quality of life. Patients often do not volunteer information on CINV and research indicates that physicians and nurses consistently overestimate the efficacy of antiemetic therapy. Delayed nausea occurs in up to 82% of patients receiving MEC or HEC despite receiving antiemetic therapy. Oncology nurses are well placed to take a lead role in evaluating CINV risk and response to antiemetic therapy in patients through regular, professional contact and supportive engagement. Objectives To evaluate the effectiveness of an online learning activity to advance CINV management by oncology nurses. Methods A multidisciplinary education committee developed the online educational activity with an independent education provider. The activity consists of three modules focusing on understanding CINV and barriers to optimised care; clinical evidence for antiemetics and CINV guidelines; case studies to operationalise key principles. The learning objectives are to: & Recognise the consequences of CINV & Assess individual patient’s risks for CINV & Overcome barriers to the identification of CINV & Review the evidence for the different classes of antiemetics & Optimise antiemetic therapy based on risks and clinical response. Results At the time of submission, the activity was yet to be launched. Initial evaluation will be completed by the time of the conference. Conclusions Despite advances in antiemetic therapy, many patients continue to experience troublesome CINV. Oncology nurses are at the forefront in managing CINV. Ongoing education is needed to raise the standard of care and improve clinical outcomes. eP015 G U I D E L I N E A D H E R E N C E M AT T E R S : R AT E S A N D CONSEQUENCES OF NON-ADHERENCE TO ANTIEMETIC PRACTICE GUIDELINES S.L. Liu1, M. Pauls1, Y. Zhao2, K. Thompson3, S. Snow4 1 Dalhousie University, Department of Medicine, Halifax, Canada 2 Dalhousie University, Department of Radiation Oncology, Halifax, Canada 3 Dalhousie University, Centre for Clinical Research, Halifax, Canada 4 Dalhousie University, Department of Medicine and Medical OncologyNova Scotia Cancer Centre, Halifax, Canada Introduction There is high variability in rates of adherence to established antiemetic guidelines across different cancer centres. Objectives (1) Evaluate the proportion of patients treated with highly (HEC) or moderately emetogenic chemotherapy (MEC) who received antiemetic regimens adherent to practice guidelines and; (2) Assess the rates of chemotherapy-induced nausea and vomiting (CINV). Methods A retrospective chart review was performed on 262 patients who received their first cycle of HEC or MEC at the Nova Scotia Cancer Centre (NSCC) in Canada between February and July 2016 inclusively. Patient, disease and treatment data were obtained. Adherence rate to the 2010 MASCC/ESMO Antiemetic Guidelines and rates of CINV based on the 2009 Common Toxicity Criteria version 4 were analyzed. Results 80 (30.5%) patients received HEC and 182 (69.5%) received MEC. The rate of adherence to antiemetic guidelines was 64.1%. Among the 94 cases of non-adherence, 73 received a HEC regimen, consistent with a statistically higher rate of non-adherence with HEC

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compared to MEC (p<0.0001). 83 non-adherent cases were due to inadequate antiemetic combinations, most commonly the omission of an NK1 antagonist. Rates of grade ≥1 nausea and vomiting were 40.4% and 14.5% respectively for the entire group, with a significantly higher rate of grade ≥1 nausea and/or vomiting in nonadherent population receiving HEC (p=0.01). Nausea and vomiting occurred more in patients who did not use breakthrough (p=0.04). Conclusions Adherence rate to MASCC antiemetic guidelines at the NSCC was 64.1%. Patients receiving a HEC had higher rates of nonadherence, and experienced higher rate of grade ≥1 nausea and vomiting.

eP016 LOW DOSE OLANZAPINE IN CHEMOTHERAPY INDUCED NAUSEA AND VOMITING: A BALANCE GAME BETWEEN SEDATION AND NAUSEA? S. Mukhopadhyay1, P. Dutta2, B. Bhattacharya2, D. Das2, S. Biswas1 1 Burdwan Medical College, Pharmacology, Burdwan, India 2 Burdwan Medical College, Radiotherapy, Burdwan, India Introduction Efficacy of olanzapine in the prophylaxis of chemotherapy induced nausea and vomiting (CINV) is often criticized due to high incidence of sedation. Therefore, a lower dose of olanzapine needs evaluation in contrast to the standard dose. Objectives To compare the efficacy, safety and sedation produced by two doses of olanzapine in control of CINV Methods This pilot study is a prospective, randomized, double blinded and controlled trial enrolling 100 patients receiving single day cycle of high and moderately emetogenic chemotherapy. Both groups received ondansetron 16 mg on day1 and dexamethasone 8mg from day 1-3. In addition, the test and control group receives olanzapine 5mg and 10mg respectively from day 1-3. CINV in acute, delayed and overall 1-5 days was measured along with daytime sedation. Quality of life (QOL) before and after chemotherapy was measured by FACT G7 questionnaire. Results Out of total 58 enrolled patients, 40 completed follow up and 8 patients lost to follow up. CINV was well controlled in both groups, (CR >75% in both). Though not different statistically, delayed nausea was more in test dose group (MAT score 1.14 in control vs 2.58 in test). The test group patients reported significantly low daytime sedation compared to control (p<0.02).

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eP017 ROLAPITANT FOR THE PREVENTION OF NAUSEA IN PATIENTS RECEIVING CISPLATIN- OR CARBOPLATINBASED CHEMOTHERAPY: ALTERNATIVE METHODS FOR EVALUATING NAUSEA R. Navari1, C. Nagy2, B.L. Rapoport3, D. Powers4, S. Arora5, R. ClarkSnow6 1 University of Alabama Birmingham School of Medicine, Hematology & Oncology, Birmingham, USA 2 Private Practice, NA, South Bend, USA 3 The Medical Oncology Centre of Rosebank, NA, Johannesburg, South Africa 4 TESARO- Inc., Medical Affairs, Waltham, USA 5 TESARO- Inc., Biostatistics, Waltham, USA 6 University of Kansas Cancer Center, CC Clinic Exams, Westwood, USA Introduction Rolapitant reduced delayed chemotherapy-induced nausea and vomiting (CINV) in three phase 3 studies. Use of rescue medication (RM) could have confounded nausea efficacy endpoints. Objectives To evaluate the effects of rolapitant and RM on efficacy assessments for nausea in the phase 3 trials of rolapitant + 5-hydroxytryptamine type 3 (5HT3) receptor antagonist (RA) + dexamethasone versus control (placebo + 5-HT3 RA + dexamethasone) for CINV prevention. Methods Post hoc exploratory analyses were performed in patients treated with rolapitant or control and receiving cisplatin (pooled data from NCT01499849 and NCT01500213; rolapitant, n=535; control, n=535) or carboplatin (NCT01500226; rolapitant, n=192; control, n=209). The percentages of patients with No Nausea (NN) or No Significant Nausea (NSN) who did not use RMs were assessed by regimen in the overall phase (0–120 hours). The number of days with NN was evaluated. Results For the at-risk period (0–120 hours), more patients receiving rolapitant than control avoided RM use (cisplatin: 81.9% vs 73.8%, P=0.002; carboplatin: 82.3% vs 71.8%, P=0.013). Among patients who avoided RM use, more of those receiving rolapitant than control reported NN (cisplatin: 51.0% vs 41.1%, P=0.001; carboplatin: 60.4% vs 48.3%, P=0.015) and NSN (cisplatin, 67.7% vs 60.2%, P=0.011; carboplatin, 74.5% vs 65.1%, P=0.041), with similar results observed with RM use. More patients receiving rolapitant than control reported 4–5 days of NN (cisplatin: 61.7% vs 52.3%; carboplatin: 71.9% vs 62.2%). Conclusions Rolapitant reduced nausea incidence and RM use in patients receiving cisplatin or carboplatin. RM use did not confound these results.

eP018 SYSTEMATIC REVIEW AND INDIVIDUAL PATIENT DATA META-ANALYSIS OF PALONOSETRON TRIALS FOR CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING: D E X A M E T H A S O N E F O R 3 D AY S V E R S U S DEXAMETHASONE FOR 1 DAY ALONE

There was no significant difference in QoL after chemotherapy among the groups. Conclusions Lower dose (5mg) of olanzapine is equally effective to the conventional 10mg /day dose in CINV prophylaxis though relatively higher nausea was noted. Sedation or somnolence problem could be alleviated with lowering the dose of olanzapine.

M. Aapro1, L. Celio2, Y. Okada3, K. OBA3, N. Furukawa4, Y. Kosaka5, K. Okita6, S. Yuki7, Y. Komatsu7 1 Clinique de Genolier, Cancer Center, Genolier, Switzerland 2 Fondazione IRCCS Istituto Nazionale Tumori, Department of Medical Oncology, Milan, Italy 3 The University of Tokyo, Department of Biostatistics, Tokyo, Japan 4 Nara Medical University, Department of Obstetrics and Gynecology, Nara, Japan 5 Kitasato University, Department of Surgery, Kanagawa, Japan

S70 6 Department of Surgery- Surgical Oncology and Science, Sapporo Medical University School of Medicine, Sapporo, Japan 7 Hokkaido University Hospital, Department of Gastroenterology and Hepatology, Sapporo, Japan

Introduction Several clinical trials have evaluated the need for corticosteroidcontaining antiemetic regimens on the days after the first 24 hours to control delayed chemotherapy-induced nausea and vomiting (CINV) during moderate emetogenic chemotherapy (MEC) or anthracycline and/or cyclophosphamide (AC)-containing chemotherapy. Objectives To evaluate whether the dexamethasone-sparing regimen is associated with a significant loss in overall antiemetic control using individual patient data (IPD) meta-analysis. Methods We conducted systematic review for any randomized trials reporting CINV outcomes for a single 1-day-dexamethasone (D1 group) containing antiemetic regimen in chemotherapy-naive adult patients scheduled to receive a MEC or AC-containing chemotherapy, compared with additional dexamethasone on days 2 and 3 (D3 group). The primary endpoint was complete response (CR) in the 5-day study period. Secondary endpoints were CR rates in 0–24 h and CR rates in 24–120 h; complete control in each period. Results All 5 eligible studies (N=1194) were enrolled in the meta-analysis. Overall, D1 group was not significantly inferior to D3 group in CR rate as well as complete control rate [pooled risk difference in CR rate -1.5%, 95% confidence interval -7.1–4.0%; in delayed CR rate -2.4%, 95% confidence interval -7.7–2.9%]. There was no significant interaction between dexamethasone regimen and patient characteristics (sex, age category (<60 or 60 years), and alcohol consumption). Conclusions These results strongly suggest that the dexamethasone-sparing regimen is not associated with a significant loss in overall antiemetic control in an adult patient undergoing MEC or AC-containing chemotherapy, irrespective of patient baseline characteristics.

eP019 APREPITANT AND FOSAPREPITANT DRUG INTERACTIONS: A SYSTEMATIC REVIEW P. Patel1,2, J.S. Leeder3,4, M. Piquette-Miller1, L.L. Dupuis1,2,5 1 University of Toronto, Leslie Dan Faculty of Pharmacy, Toronto, Canada 2 The Hospital for Sick Children, Department of Pharmacy, Toronto, Canada 3 Children’s Mercy-Kansas City, Division of Clinical PharmacologyToxicology & Therapeutic Innovation- Department of Pediatrics, Kansas City, USA 4 University of Missouri-Kansas City, School of Medicine, Kansas City, USA 5 Research Institute- The Hospital for Sick Children, Child Health Evaluative Sciences, Toronto, Canada Introduction Aprepitant and fosaprepitant, commonly used for the prevention of chemotherapy-induced nausea and vomiting, alter cytochrome P450 activity and consequently have the potential for numerous drug-drug interactions. However, there has been no comprehensive, systematic assessment of the literature describing these interactions to date. Objectives The primary objective was to describe the pharmacokinetic disposition of drugs co-administered with aprepitant or fosaprepitant using a standard definition of clinical significance. Our secondary objective was to describe adverse events ascribed to a drug interaction with aprepitant or fosaprepitant.

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Methods We systematically reviewed the literature to September 11, 2016 to identify articles evaluating drug interactions involving aprepitant/ fosaprepitant. The clinical significance of each reported pharmacokinetic drug interaction was evaluated based on the United States Food and Drug Administration guidance document on conducting drug interaction studies. The probability of an adverse event reported in case reports being due to a drug interaction with aprepitant/fosaprepitant was determined using the Drug Interaction Probability Scale. Results 4377 publications were identified. Of these, 64 met inclusion eligibility criteria: 34 described pharmacokinetic drug interactions and 30 described adverse events ascribed to a drug interaction. Clinically significant pharmacokinetic interactions between aprepitant/fosaprepitant and bosutinib PO, cabazitaxel IV, cyclophosphamide IV, dexamethasone PO, methylprednisolone IV, midazolam PO/IV, oxycodone PO and tolbutamide PO were identified as were adverse events resulting from an interaction between aprepitant/fosaprepitant and alcohol, anthracyclines, ifosfamide, oxycodone, quetiapine, selective serotonin reuptake inhibitors/ serotonin-norepinephrine reuptake inhibitors and warfarin. Conclusions The potential for a drug interaction with aprepitant and fosaprepitant should be considered when selecting antiemetic therapy.

eP020 SAFETY OF DEXAMETHASONE FOR NAUSEA AND VOMITING PROPHYLAXIS IN CHILDREN RECEIVING HEMATOPOIETIC STEM CELL TRANSPLANTATION E. Paw Cho Sing1,2, T. Schechter3, L. Sung3,4, M. Ali3, L.L. Dupuis1,2,4 1 The Hospital for Sick Children, Department of Pharmacy, Toronto, Canada 2 University of Toronto, Leslie Dan Faculty of Pharmacy, Toronto, Canada 3 The Hospital for Sick Children, Department of Pediatrics- Division of Hematology/Oncology, Toronto, Canada 4 The Hospital for Sick Children, Child Health Evaluative SciencesResearch Institute, Toronto, Canada Introduction Many children undergoing hematopoietic stem cell transplantation (HSCT) experience nausea and vomiting (NV) despite antiemetic prophylaxis. Guideline-consistent antiemetic prophylaxis includes dexamethasone, although evidence of its safety in children is limited. Uncertainty over its influence on HSCT outcomes and invasive fungal disease (IFD) are potential barriers to its use. Objectives To describe the safety of dexamethasone given for NV prophylaxis in children during HSCT conditioning. Methods We conducted a retrospective, single-centre analysis of children undergoing HSCT who received dexamethasone for NV prophylaxis. Dexamethasone dose, adverse events (AEs), HSCT outcomes, and IFD were abstracted from health records. Association between AEs and dexamethasone was assessed using the Liverpool Causality Assessment Tool (LCAT). Results Forty-six children (mean age 10 ± 4 years) were eligible for analysis. The most frequent AEs attributable to dexamethasone (LCAT category of probable or definite) were hyperglycemia (63%), hypertension (52%), and bradycardia (46%). The mean time to neutrophil engraftment was 22 ± 8 days. The incidence of aGVHD was 34% in those undergoing allogeneic HSCT (grade 1: 5; grade 2: 5; grade 3: 1). Four cases of IFD (9%) were identified (1 proven, 1 probable, and 2 possible). In 45

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children, event-free survival, overall survival, and transplant-related mortality at 1 year post-HSCT were 76%, 84%, and 4%, respectively. Conclusions In children undergoing HSCT, AEs attributable to dexamethasone, though frequent, were often self-limiting and easily manageable. There was no signal that dexamethasone given during HSCT conditioning negatively influences HSCT outcomes or increases the rate of IFD. Large comparative studies are needed to validate these findings.

eP021 THE FREQUENCY AND PATTERNS OF LORAZEPAM PRESCRIBING AND ADMINISTRATION IN HOSPITALIZED ONCOLOGY PATIENTS D. Pon1,2, K. Awuah1 1 Western University of Health Sciences, College of Pharmacy, Pomona, USA 2 City of Hope National Medical Center, Department of Pharmacy, Duarte, USA Introduction Evidence-based guidelines recommend lorazepam for prevention of anticipatory chemotherapy-induced nausea/vomiting (ACINV) but not for rescue nausea/vomiting (RNV). Lorazepam may increase risk for oversedation and falls. Objectives We aimed to characterize the frequency and patterns of lorazepam prescribing and administration for nausea/vomiting among hospitalized oncology patients. Methods This was an Institutional Review Board-approved retrospective review of patients admitted during 2 consecutive weeks in 2015. Demographic information, lorazepam orders, indications, prescribed administration sequence, and number of administrations were recorded. Orders for seizure and insomnia were excluded. Potentially inappropriate lorazepam prescriptions were identified based on frequency, dose, or multiple concurrent as needed orders. Potentially inappropriate administrations were lorazepam administered second- or third-line without documentation of any administrations of the first- or second-line agent. Falls and flumazenil usage were determined from institutional databases. Results 300 patients were enrolled in the study. 61% of patients were prescribed lorazepam for agitation/anxiety and/or nausea/vomiting. Lorazepam was most frequently prescribed for RNV (49%), followed by anxiety/agitation (30%) and ACINV (21%). When prescribed in sequenced order for RNV, lorazepam was ordered first-line in 24% of patients. 52% of patients prescribed lorazepam for RNV received at least one dose. 26% of lorazepam prescriptions were potentially inappropriate. 19% of administrations were potentially inappropriate. No difference in falls per 1000 patient hospital days was observed between patients prescribed or not prescribed lorazepam (0.7 vs. 1.5, P=0.16). No patient received flumazenil. Conclusions Potentially inappropriate prescribing of lorazepam was common, including multiple prescriptions for different indications and prescribing as a first-line agent for RNV.

eP022 NETU PI TANT / PALONOSETRON (NEPA) INDUCES PERSISTENT NK1 RECEPTOR INTERNALIZATION IN HEK293 CELLS C. Rojas1, A. Thomas1, B. Slusher1 1 Johns Hopkins University School of Medicine, Johns Hopkins Drug Discovery, Baltimore- MD, USA

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Introduction Previous studies from our laboratory indicate that palonosetron induces 5HT3 receptor internalization and inhibits Substance P (SP)-mediated NK1 receptor responses both in vitro and in vivo, likely as a result of inhibition of 5-HT3/NK1 receptor crosstalk. These results provided a tentative rationale for palonosetron’s improved ability among 5-HT3 receptor antagonists to prevent delayed emesis after emetogenic chemotherapy. More recently, using NG108-15 cells that express both the NK1 and 5-HT3 receptors, we have shown that palonosetron and netupitant trigger NK1 receptor internalization in an additive manner and synergistically inhibit the SP NK1 receptor response. Objectives Characterize the contribution of each antagonist on NK1 receptor internalization and determine the intracellular fate of NK1 receptors following NEPA-induced internalization. Methods NEPA, netupitant and palonosetron were first incubated for 1 hour with HEK-293 cells expressing only the NK1 receptor. Antagonists were then removed and cells were allowed to recover for 6 hours. The extent of SPtriggered Ca2+ mobilization was used as a representation of NK1 receptor levels at the surface. Results NEPA prevents SP-triggered Ca2+ mobilization in HEK-293 cells expressing the NK1 receptor; however, this effect was only due to netupitant. Palonosetron alone did not prevent Ca2+ mobilization in the absence of 5-HT3 receptors. Moreover, SP-mediated Ca2+ mobilization did not return 6 hours following NEPA removal. Conclusions The present studies, together with previous findings, suggest NEPAtriggered NK1 receptor internalization. Further, receptor internalization is probably followed by receptor degradation rather than recycling. Receptor synthesis may be required before NK1 receptor function is restored.

eP023 A N T I C I PAT I V E M O N I T O R I N G I M P R O V E S CHEMOTHERAPY INDUCED NAUSEA F. scotte1, R. Elaidi2, H. Aboudagga3, C. Thibault4, J. Stevens5, B. Bonan6, S. Oudard4 1 Georges Pompidou European Hospital, Medical Oncology and Supportive Care Unit, paris, France 2 Georges Pompidou European Hospital, ARTIC - medical oncology department, Paris, France 3 Georges Pompidou European Hospital, Pharmacy Unit, Paris, France 4 Georges Pompidou European Hospital, Medical Oncology, Paris, France 5 Direct Medica, global manager, Boulogne, France 6 Foch Hospital, Pharmacy Department, Suresnes, France Introduction The PROCHE [Programme for optimisation of the chemotherapy network] initiative is an innovative oncology-monitoring program designed to reduce patient waiting time and chemotherapy wastage, ultimately improving patient care. Objectives Primary objective was to evaluate the incidence of nausea reported by grade (NCI-CTC AE: from 0 to 4) from 2008 to 2016. Methods Association was quantified using Mantel-Haenszel khi2 and exact pvalues. Secondary objective compared the 2009-2016 patients with the control patients of 2008 period. Results Between Oct 2008 and Oct 2016, 3012 patients participated in the program, representing 36 803 questionnaires completed over the whole period. Nausea

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was, clinically and statistically, significantly improved during the whole follow-up period with a decrease of grade 3-4 from 0.6% to 0.08% and a decrease of grade 1-2 from 29.3% to 8.2%. The already adapted nausea management in 2008 with 70% of questionnaires reported no nausea improved to 92% in 2016, with a 10% improvement the year after program initiation. As MASCC propose to change guidelines with an improvement above 10%, such an organization may impact new recommendations. No adverse event (%) Grade 1-2 (%) Grade 3-4 (%) 2008 70.08 29.32 0.6 p<0.0001 2009 79.12 20.57 0.31 2010 2011 2012 2013 2014 2015 2016

85.71 87.57 89.53 90.60 90.39 90.61 91.68

14.07 11.87 10.39 9.36 9.61 9.39 8.23

0.23 0.56 0.09 0.04 0.00 0.00 0.08

the other prospective observational study in Japan and SENRI Trial in Japan. We assessed whether delayed CINV were controlled with the combination antiemetic treatment. We also evaluated risk factors by logistic regression analysis. Results A total of 402 patients were evaluable in this study. The median age was 64 (range: 29-85) with 241 males and 161 females. Three antiemetics were used in 141 (35.1%) patients. Delayed CINV were experienced more commonly in women than men. Delayed nausea was well controlled with 3 antiemetics than with 2 antiemetics for women (37.5% vs. 59.0%; P=0.0128). Delayed vomiting was well controlled with 3 antiemetics than with 2 antiemetics for overall (3.5% vs. 13.0%; P=0.0023) and for women (3.6% vs. 21.9%; P=0.0023). We identified several risk factors; women (odds ratio [OR]=2.894, 95% confidence interval [CI];1.881-4.453, P<0.0001) and age (OR=0.970, 95%CI;0.950-0.991, P=0.0044) for delayed nausea, and women (OR=3.105, 95%CI;1.545-6.239, P=0.0015) and 2 antiemetics (OR=4.204, 95%CI;1.592-11.101, P=0.0037) for delayed vomiting. Conclusions Three antiemetics combination are encouraged for CRC female patients treated with XELOX chemotherapy to alleviate delayed CINV.

Conclusions Anticipating anti-cancer treatment adaptation and prevention, following guidelines and using adapted antiemetics, explain these positive results. The PROCHE initiative improves chemotherapy induced nausea.

eP025 OLANZAPINE AND OMEPRAZOLE COMBINATION IS SIMPLE, SAFE AND EFFECTIVE FOR DELAYED NAUSEA A N D V O M I T I N G C O N T R O L I N A D J U VA N T CHEMOTHERAPY FOR EARLY STAGE BREAST CANCER

eP024 A POOLED ANALYSIS OF THE PATIENTS WITH COLORECTAL C A N C E R R E C E I V I N G X E L O X C H E M O T H E R A P Y: EVALUATING THE COMBINATION ANTIEMETIC THERAPY ON CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING

T. Tran1, N. Nguyen2, V. Pham2, T. Nguyen3, T. Tran2 1 FV Hospital, Oncology, Ho Chi Minh, Vietnam 2 Medical Medic Center, Oncology, Ho Chi Minh, Vietnam 3 University of Medicine and Pharmacy - HCMC, Pathology, Ho Chi Minh, Vietnam Introduction Delayed nausea and vomiting in chemotherapy are the most frequently of side effect. Objectives Our study to determine the effectiveness of Dexa+omeprazole+ metoclopramide versus Olanzapine in the prophylaxis of delayed emesis after emetogenic chemotherapy. Methods Patients after treated with AC dose-dense regimen or FEC regimen adjuvant chemotherapy for early stage breast cancer, received dexamethasone 4mg oral, twice time daily, omeprazole 20mg oral, twice time daily and metoclopramide (Primperan ®) 20mg oral, thrice time daily, all for five days (DexOmePrim) or olanzapine 10mg oral and omeprazole 20mg, once time daily all for three days (OO). Patient diary, EORTC QLQC30 with nausea and vomiting module and toxicity criteria were used to monitor and evaluate patient outcomes. Results From Jan 2013 to Dec 2016, 478 (mean=45.7 years) outpatients were randomized with 239 DexOmePrim and 239 OO confirmed eligible. Patient characteristics were similar between the two groups. No drugrelated serious adverse events were reported. During the first cycle of chemotherapy, OO was complete protection against vomiting better DexOmePrim (90 vs. 78%; p=0.01). For the entire study period, there was better OO (85 vs. 60%; p=0.02), lower average nausea score (0.10 vs. 0.20, p=0.02) and no cases must entry hospital for rescuing antiemetics. Global QoL declined in both groups during chemotherapy, but OO was less than DexOmePrim (p=0.03). Appetite was the same in both groups. There were no significant differences in toxicity. Conclusions The use of combination OO oral daily for three days after chemotherapy is simple, cheap cost, safe, and effective in preventing vomiting, reducing nausea, and preserving QoL.

M. Shimokawa1, J. Nishimura2, T. Kogawa3, D. Sakai4, M. Yasui5, T. Hayashi6, R. Matsui7, K. Aiba8, K. Tamura9 1 National Hospital Organization Kyushu Cancer Center, Crinical Research Institute, Fukuoka, Japan 2 Osaka University Graduate School of Medicine, Department of Gastroenterological Surgery, Osaka, Japan 3 National Cancer Center Hospital East, Department of Developmental Therapeutics, Chiba, Japan 4 Osaka University Graduate School of Medicine, Department of Frontier-Science for Cancer and Chemotherapy, Osaka, Japan 5 Osaka Medical Center for Cancer and Cardiovascular Diseases, Department of Surgery, Osaka, Japan 6 National Kyushu Medical Center, Department of Pharmacy, Fukuoka, Japan 7 National Cancer Center Hospital East, Department of Pharmacy, Chiba, Japan 8 The Jikei University School of Medicine, Division of Clinical Oncology/ Hematology, Tokyo, Japan 9 Fukuoka University, General Medical Research Center, Fukuoka, Japan Introduction The incidence and risk factors of delayed chemotherapy-induced nausea and vomiting (CINV) for colorectal cancer (CRC) patients receiving XELOX chemotherapy has not been clearly controlled. Objectives To evaluate the efficacy and risk factors of the combination antiemetic treatment for delayed CINV in CRC patients receiving XELOX chemotherapy. Methods Aggregated data were pooled from the two prospective observational studies and one clinical trial; A nationwide survey of CINV study group,

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eP026 CISPLATIN DOSE-DEPENDENT EFFECT ON NAUSEA CONTROL: SUBSET ANALYSIS FROM A PHASE 3 TRIAL OF NEPA VERSUS APREPITANT/GRANISETRON K. Jordan1, C. Lanzarotti2, S. Olivari3, P.J. Hesketh4 1 University of Heidelberg, Department of Medicine V, Heidelberg, Germany 2 Helsinn Healthcare, Statistics and Data Management, Lugano, Switzerland 3 Helsinn Healthcare, Medical Affairs, Lugano, Switzerland 4 Lahey Hospital & Medical Center, Lahey Health Cancer Institute, Burlington, USA Introduction Cisplatin is highly emetogenic, with antiemetic trials demonstrating a dose-dependent effect on emesis control. Exploration of a dosedependent effect on nausea control was of interest as it is more difficult to control than emesis and has not been previously evaluated. Objectives A post-hoc analysis was performed from the first head-to-head study comparing NK1 receptor antagonist regimens (NEPA [netupitant/ palonosetron fixed combination] versus APR/GRAN [aprepitant/ granisetron]) to determine if nausea control differed by cisplatin dose. Methods This analysis evaluated no significant nausea rates (NSN: defined as <25mm on 100mm VAS) for subsets of patients receiving cisplatin at doses of ≥70 mg/m2 or <70 mg/m2 and treated with a single oral dose of NEPA (day 1) or a 3-day oral APR/GRAN regimen. All patients received dexamethasone days 1-4. Results Treatment groups were balanced for gender/age/cancer type. Median cisplatin doses: 75 mg/m2 and 62 mg/m2 for high and low dose cisplatin subsets. A cisplatin dose-dependent effect on NSN was shown in both groups (Table). Complete response (no emesis/rescue use) results were similar. NSN rates favored NEPA in the ≥70 mg/m2 subset.

Conclusions Consistent with prior reports for emesis, a higher cisplatin dose was associated with lower rates of nausea control, confirming the importance of cisplatin dose in predicting nausea development and the need for an NK1 prophylactic antiemetic regimen.

eP027 EFFECT OF ANTI-EMETIC DRUGS ON CHEMOTHERAPEUTIC AGENTS-INDUCED GRIMACE EXPRESSION IN RATS K. Yamamoto1 1 Osaka University, Department of Medical Physics and EngineeringGraduate School of Allied Health Sciences- Faculty of Medicine, SuitaOsaka, Japan Introduction Chemotherapy-induced nausea and vomiting are not lifethreatening symptoms, but their insufficient control reduces the patients’ quality of life. To identify methods to manage nausea and vomiting in preclinical studies, an objective method to evaluate nausea and vomiting in laboratory animals is required. Rats have been considered unsuitable for the study of nausea and vomiting because they do not show a vomiting reflex.

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Objectives We often observed that rats grimace after emetogenic stimuli. In this study, we analyzed time-course changes in the facial expression of rats after the administration of chemotherapeutic agents, and investigated the effect of anti-emetic drug on the prevention of these cisplatin-induced changes. Methods Facial expressions were continuously recorded on motion video by infrared video camera. On the day of the experiment, rats received cisplatin (3 mg/ kg, i.p.) or cyclophosphamide (60 mg/kg,i.p.) with or without a daily injection of a 5-HT3 receptor antagonist (granisetron: 0.1 mg/kg, i.p.) or a neurokinin NK1 receptor antagonist (fosaprepitant: 2 mg/kg, i.p.) for 2 days. After injection of chemotherapeutic agents, their eye-opening index (the ratio between longitudinal and axial lengths of the eye) was calculated. Results Cisplatin and cyclophosphamide significantly decreased the index, and the decrease continued for 2 days. The acute phase (day 1), but not the delayed phase (day 2), of the decreased eye-opening index was inhibited by treatment with granisetron; however, fosaprepitant abolished both phases of decreases. Conclusions These findings indicate that the monitoring of facial expression has the potential to be useful for the detection of chemotherapy-induced nausea and vomiting in rats.

eP028 AVAILABILITY AND ACCESSIBILITY OF ANTIEMETICS RECOMMENDED BY THE MASCC/ESMO GUIDELINES IN THE EASTERN EUROPEAN AND BALKAN REGION A. Zilic1, S. Bosnjak1, F. Djordjevic1, I. Popovic2, J. Dimitrijevic1, M. Tomiska3, A. Skripekova4, C. Szczylik5 1 Institute of Oncology and Radiology of Serbia, Supportive oncology, Belgrade, Serbia 2 Institute of Oncology and Radiology of Serbia, Hospital Pharmacy, Belgrade, Serbia 3 Univeristy Hospital Brno, Department of Internal MedicineHaemathology and Oncology, Brno, Czech Republic 4 National oncology institute, Department of Clinical Oncology, Bratislava, Slovak Republic 5 Military Medicine Institute, Oncology Clinic, Warszawa, Poland Introduction The combination of NK1 receptor antagonist (NK1 RA), setron and dexamethasone is necessary for the optimal prevention of chemotherapy induced nausea and vomiting (CINV) after highly emetogenic chemotherapy (HEC: AC and non-AC) and carboplatin. Palonosetron is the preferable setron when NK1 RA is not available. Objectives To evaluate availability and accessibility of antiemetics (AE) recommended by the MASCC/ESMO 2016 antiemetic guidelines in hospitals of the Eastern European and Balkan region. Methods Data were collected by countries participating at the First Regional Education Meeting on Supportive Care for Eastern European and Balkan region. Availability was evaluated by the formulary availability and marketing authorization (registered or not). Accessibility was assessed by the coverage of the National Health Insurance Fund: fully reimbursed, partially reimbursed and not accessible (out- of- pocket). Results Most profund is the lack of NK1 RAs (Table 1). More than a half of the analyzed countries (9/14) have problem with access to NK1 RAs. In 7/14 there is no access to palonosetron either. Olanzapine is used in the offlabel setting.

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Support Care Cancer (2017) 25 (Suppl 2):S21–S266 1 Rapid Response Radiotherapy Program- Odette Cancer CentreSunnybrook Health Sciences Centre- University of Toronto- TorontoOntario- Canada, Department of Radiation Oncology, Toronto, Canada

Conclusions There is unequality in the access to AE across Eastern European and Balkan region. Clinically most important is the lack of access to NK1RAs which coupled with the lack of access to palonosetron, creates an important barrier for the prevention of CINV after HEC and carboplatin. Off-label use of olanzapine, as an effective alternative, is another barrier in successful prevention and control of CINV.

eP029 PELVIC INSUFFICIENCY FRACTURE MIMICKING BONE METASTASIS SYMPTOMS: A CASE REPORT Y. Ahmed1, S. Chan1, B.A. Wan1, A. Agarwal1, M. Popovic1, E. Chow1 1 Odette Cancer Centre- Sunnybrook Health Sciences Centre- University of Toronto, Radiation Oncology, Toronto, Canada Introduction With improved survival rates in patients receiving high-dose radiotherapy for pelvic malignancies, higher incidences of pelvic insufficiency fractures have been observed. Insufficiency fractures, like pathological fractures caused by bone metastasis and other etiologies, present with similar symptoms of pain, reduced mobility, and loss of independence, thus presenting a diagnostic challenge. Objectives To report a case of a pelvic insufficiency fracture in a patient with bladder cancer. Methods In this case report and literature review, we report the case of an eightyyear old male with a history of bladder carcinoma and lung metastases who presented with sudden pain in the hip and inability to bear weight. Results The patient was referred to the Rapid Response Radiotherapy Program by the Emergency Department for suspicion of pathological fracture. This was ruled out in favor of a traumatic fracture, secondary to insufficiency resulting from radiation treatment (~60 Gy) eight months prior. After successful management with minimally invasive cementoplasty, pain symptoms significantly decreased and ambulatory function was restored. Conclusions This case report highlights the need to consider pelvic insufficiency fractures in the differential diagnosis of cancer patients presenting with sudden pelvic pain, especially in elderly patients who have previously received high-dose radiotherapy. A thorough review of the patient’s past medical history along with appropriate imaging can confirm the cause of the fracture and guide management accordingly.

eP030 REACTIVATION OF TUBERCULOSIS OF THE LEFT HIP MASQUERADING AS BONE METASTASIS: A CASE REPORT A. Bobrowski1, R. McDonald1, S. Chan1, L. Probyn1, L. Rowbottom1, P. Zaki1, B.A. Wan1, M.J. Tao1, A. Agarwal1, E. Chow1

Introduction While uncommon in the Western world, tuberculosis (TB) persists as a significant health concern globally. Although primarily a pulmonary disease, 20% of TB cases impact other organs in addition to the lungs. Of these cases, 11% involve the skeletal system and 10% involve the hip. Objectives To present a rare case of latent TB reactivation in the left hip masquerading as a bone metastasis. Methods Case report and review of the literature conducted. Patient consent obtained. Results An elderly woman with a history of non-small cell lung adenocarcinoma presented to the Odette Cancer Centre in December 2015 with left hip discomfort. Biopsy results revealed a heterogeneous soft tissue mass situated in the subcutaneous tissues overlying the left greater trochanter with a different morphology and staining profile from the resected lung lesion, not indicative of metastasis. The mass tested positive for acid-fast bacteria, confirming Mycobacterium tuberculosis infection. The patient was administered a course of anti-TB medication and was followed by Public Health and the Infectious Disease Team. Conclusions This is the second case in the literature of a TB reactivation in the hip mimicking a neoplastic aetiology. Our findings suggest that while relatively uncommon, physicians may consider TB reactivation as a potential differential diagnosis with such a patient presentation.

eP031 CLINICAL PRESENTATIONS OF BELOW-KNEE BONE METASTASES AND THEIR MANAGEMENT: A CASE SERIES M. Choi1, L. Rowbottom1, R. Mcdonald1, A. Bobrowski1, S. Chan1, P. Zaki1, A. Agarwal1, A. Wan1, A. Turner1, E. Chow1, L. Probyn1 1 Sunnybrook Hospital, Radiation Oncology, Toronto, Canada Introduction Bone metastases are a common complication of advanced-stage malignancy; however, below-the-knee metastases, particularly affecting the fibula and tibia, are both infrequently observed in both the clinical setting and the literature, and present a therapeutic challenge to patients and physicians. Due to the weight-bearing capacity of bones below-the-knee, the disruption of the structural and functional integrity of these bones can reduce mobility and thus impair quality of life. Treatment options for these patients include surgery, radiotherapy, and/or chemotherapy. Objectives We report two female and two male cases presenting with painful belowknee metastases and their management. Methods Cases were presented to Sunnybrook Health Sciences Center and referred to Odette Cancer Centre for treatment. Results Orthopedic surgery was consulted in the management of all four cases. Two patients underwent surgical fixation followed by radiotherapy, while the other two received palliative radiotherapy alone. Surgical management followed by radiotherapy in the former two patients led to effective symptomatic control and increased bone stability.

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surgery (2.9%). The first patient underwent a second surgery at 9 months due to progression, and a third surgery 3 months after the second due to displacement of the prosthesis; the second patient underwent a second surgery at 11 months due to prosthesis displacement. Of the 42 patients who had radiological imaging available post radiation, they on average received 5 scans (range: 1 17) with a median follow-up time of 4.5 months from the radiation to the latest scan (range: 8 days - 6 years). Progression of bone metastases was seen in 8 patients (19.0%) and displacement of the prosthesis was reported for 1 patient (2.4%). Conclusions Postoperative radiotherapy slowed down progression of BM and reduced the need for second surgery.

eP033 QUANTITATIVE CHANGES ON CT IMAGING AFTER STEREOTACTIC BODY RADIATION THERAPY TO NONSPINE BONE METASTASES

Conclusions While limited to a small number of cases, our findings suggest a combination surgery and radiotherapy approach may be effective in treating below-knee metastases, though degree of benefit likely depends on location of metastases and effect on patient mobility. Further studies are warranted to determine an algorithmic approach to the management of this rare advanced-stage presentation.

eP032 EFFICACY OF POSTOPERATIVE RADIATION TREATMENT ON BONE METASTASES IN EXTREMITIES L. Drost1, V. Ganesh1, A. Wan1, S. Chan1, M. Christakis2, M. Tsao1, E. Barnes1, M. Ford3, J. Finkelstein3, A. Yee3, E. Chow1 1 Sunnybrook Health Sciences Centre, Radiation Oncology, Toronto, Canada 2 Sunnybrook Health Sciences Centre, Radiology, Toronto, Canada 3 Sunnybrook Health Sciences Centre, Orthopedics, Toronto, Canada Introduction Impending or pathological fractures due to bone metastases (BM) may require surgical procedures. Postoperative radiotherapy is often recommended to halt local progression and prosthesis displacement, hence reducing the need for second surgery. Objectives To investigate the radiological changes and the need for second surgery following postoperative radiotherapy. Methods Data were collected from 68 patients who received postoperative radiation to their extremities in a palliative radiotherapy clinic between January 2009 and November 2016. Results 68 patients (33 men and 35 women) with a median KPS of 60 received postoperative radiation (mostly 20 Gy in 5 fractions) with a median of 24 days after surgery (range: 6 - 172 days). The most common primary cancers were lung (31%), breast (27%), prostate (15%) and kidney (15%). Only 2 patients required subsequent

S. Finkelstein1, S. Raman1, J. Van Der Velden1, A. Dhillon2, F. Tonolete2, N. Chiu1, L. Probyn3, R. McDonald1, D. Erler2, D. Brotherston1, N. Thavarajah1, C. Lang3, A. Sahgal1, E. Chow1, L. Chin4 1 Sunnybrook Health Sciences Centre, Department of Radiation Oncology, Toronto, Canada 2 Odette Cancer Centre, Department of Radiation Therapy, Toronto, Canada 3 Sunnybrook Health Sciences Centre, Department of Medical Imaging, Toronto, Canada 4 Odette Cancer Centre, Department of Medical Physics, Toronto, Canada Introduction In recent years, stereotactic body radiation therapy (SBRT) has emerged as an attractive treatment option for bone metastases. Assessing response after high-dose radiation therapy requires a different paradigm and previous studies have identified unique imaging changes after SBRT to bone metastases. Objectives This study investigates quantitative texture analysis changes on serial CT imaging after SBRT to non-spine bone metastases. Methods 38 cases at our institution were identified after receiving SBRT to non-spine bone metastases and having at least 1 follow-up CT scan. The lesions were contoured by a physician observer on the baseline planning CT scan and diagnostic CT scans. Using MATLAB software, a number of first and second order quantitative parameters were extracted for the contoured regions of interest: Average CT number. Energy, Contrast, Correlation, Homogeneity, Entropy, Inverse difference moment, Cluster shade and Cluster prominence. Results The majority of cases were renal cell carcinoma (32%), followed by prostate cancer (24%). 20 bone metastases were clearly lytic, 6 bone metastases were clearly sclerotic and the remaining cases were mixed. In total, 186 contours were generated. The highest magnitude of change in the quantitative features were contrast (45% average increase), cluster prominence (43% average increase) and energy (41% average increase). The overall average CT number was stable (1% average decrease) but with more significant individual changes based on whether the lesion was lytic or sclerotic. Conclusions In this exploratory analysis, we investigated quantitative changes on CT imaging after high dose radiotherapy. Future studies should correlate these quantitative changes with radiologist assessment and pain response.

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eP034 A CASE REPORT OF BONE METASTASES FROM APPENDICEAL ADENOCARCINOMA AND A REVIEW OF THE LITERATURE V. Ganesh1, L. Probyn1, S. Vuong1, S. Caskenette1, A. Wan1, A. Agarwal1, E. Chow1 1 Sunnybrook Health Sciences Centre, Radiation Oncology, Toronto, Canada Introduction Accounting for less than 0.5% of all gastrointestinal cancers, appendiceal adenocarcinoma (AA) is a rare cancer, with significant debate surrounding the nature of the disease and optimal management. Metastases of AA, particularly distant metastases, have not been reported extensively in literature. Objectives We report the rare case of a 50-year-old male with recurrent mucinous AA who developed painful pelvic bone metastases. Methods Case report and review of the literature. Patient consent obtained. Results The patient underwent a right hemicolectomy in 2013 for a moderately differentiated, node-negative T4b tumour. He underwent 8 cycles of adjuvant oral capecitabine. In 2015, computed tomography (CT) scans of the abdomen and pelvis showed lytic involvement of the left pubic bone (Figure 1) with thickening of the adjacent soft tissue (Figure 2) and metastatic lymphatic involvement. To palliate his symptoms, the patient underwent 30 Gy of external beam radiation treatment in 10 fractions to the pelvis. He demonstrated a good pain response after completion of EBRT, with elimination of analgesic use one month post-treatment.

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Introduction Single fraction radiation treatment (SFRT) is recommended for its equivalence to multiple fraction (MF)RT in the palliation of uncomplicated bone metastases (BM). However, adoption of SFRT has been slow. Objectives To summarize SFRT-related patterns of practice and clinical guidelines in the palliative RT of uncomplicated BM. Methods Literature searches for studies published following 2014 were conducted using several online repositories of grey literature, Ovid MEDLINE, Embase, Embase Classic, and the Cochrane Central Register of Controlled Trials databases. Results A total of 11 studies regarding patterns of practice and 21 articles detailing clinical practice guidelines were included for final synthesis. The majority of organizations have released high level recommendations for SFRT use in treatment of uncomplicated BM, based on evidence of non-inferiority to MFRT. However, there are key differences between guidelines, such as varying strengths of recommendation for SFRT use over MFRT; contraindication in vertebral sites for SFRT; and risk estimation of pathologic fractures after SFRT. There are differences in the recommendation of palliative RT for BM under the Choosing Wisely campaign. Differences in guidelines may be influenced by committee composition and organization mandate. Differences in patterns of practice may be influenced by individual centre policies, payment modalities and consideration of patient factors such as age, prognosis, and performance status. Increased use of SFRT was reported in 5 out of 6 studies reporting temporal trends post-2010. Conclusions Although there is some misalignment between authoritative groups, the majority of guidelines recommend use of SFRT and others consider it to be a reasonable alternative to MFRT.

eP036 A BONE SCAN MAY NOT BE ENOUGH FOR THE DIAGNOSIS OF BONE METASTASES: A CASE REPORT S. Goodall1, R. Chow1, L. Rowbottom1, R. McDonald1, A. Wan1, A. Agarwal1, M. Christakis1, C. DeAngelis1, F. Charbonneau1, E. Chow1 1 Sunnybrook Health Sciences Centre, Department of Radiation Oncology, Toronto, Canada

Conclusions Although there is a lack of evidence-based guidelines specific to the treatment of AA, there are a variety of therapies available (e.g., chemotherapy, cytoreductive surgery, radiation, etc.), with decision-making between therapeutic strategies largely determined by prognostic factors. This case demonstrates successful palliative management of bone metastases from a primary mucinous AA with EBRT.

eP035 A REVIEW OF PATTERNS OF PRACTICE AND CLINICAL G U I D E L I N E S I N T H E PA L L I AT I V E R A D I AT I O N TREATMENT OF UNCOMPLICATED BONE METASTASES V. Ganesh1, S. Chan1, S. Raman1, R. Chow1, P. Hoskin2, H. Lam1, B.A. Wan1, L. Drost1, C. DeAngelis1, E. Chow1 1 Sunnybrook Health Sciences Centre, Odette Cancer Centre, Toronto, Canada 2 Mount Vernon Hospital, Oncology, Middlesex, United Kingdom

Introduction In patients with a history of cancer and musculoskeletal discomfort, bone scintigraphy is usually the first-line imaging technique employed to investigate for bone metastases. Bone scintigraphy is cost-effective and has good sensitivity. However, this imaging modality detects both malignant and benign bone lesions and can therefore be misleading when not supported by other types of imaging to diagnose bone metastases. Objectives We report a case of misleading bone scintigraphy suggestive of a diagnosis of bone metastases. Methods Case report and review of relevant literature. Patient consent obtained. Results A 77-year-old patient with a remote history of breast cancer presented with musculoskeletal pain. A bone scan identified possible pelvic metastases that were subsequently determined to be benign lesions using a computed tomography scan. By initiating prompt referral for computed tomography imaging, with the positive outcome of no evidence of metastatic disease, the patient’s anxiety was alleviated.

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Conclusions This case adds to previously reported examples demonstrating the need for additional imaging with computed tomography or magnetic resonance imaging to definitively diagnose bone metastases. The potential for misdiagnosis and associated distress for the patient when using bone scintigraphy alone supports the need for correlative imaging studies in the diagnosis of bone metastases.

eP037 PROSPECTIVE OBSERVATIONAL STUDY TO EVALUATE THE PERSISTENCE OF TREATMENT WITH DENOSUMAB IN PATIENTS WITH BONE METASTASES FROM SOLID TUMORS IN ROUTINE CLINICAL PRACTICE: INTERIM ANALYSIS F. Haslbauer1, A. Petzer2, M. Safanda3, A. Tomova4, M. Porubska5, Z. Bajory6, D. Niepel7, C. Jaeger8, D. Kalinin9, R. Greil10,11 1 Landeskrankenhaus Voecklabruck, Department of internal medicine, Voecklabruck, Austria 2 Ordensklinikum Linz - Barmherzige Schwestern, Department for internal medicine I - medical oncology- hematology and gastroenterology, Linz, Austria 3 Nemocnice Na Homolce, Oncology Clinic, Prague, Czech Republic 4 Complex Oncology Center Plovdiv EOOD, Department of oncology, Provdiv, Bulgaria 5 Onkologicky ustav Sv. Alzbety, Department of oncology, Bratislava, Slovak Republic 6 University of Szeged, Urology clinic, Szeged, Hungary 7 Amgen Europe GmbH, Medical Affairs, Vienna, Austria 8 Amgen GmbH, Medical Affairs, Vienna, Austria 9 Quartesian LLC, Statistical programming, Kharkov, Ukraine 10 Salzburger Landeskliniken - Universitätsklinikum, Department of internal medicine III, Salzburg, Austria 11 Paracelsus Medizinische Privatuniversität, Department of internal medicine, Salzburg, Austria Introduction In phase 3 head-to-head trials denosumab demonstrated superiority versus zoledronate in preventing SREs in patients with advanced solid tumors (ST). Persistence in real-world is undetermined and would affect clinical efficacy. Objectives To evaluate persistence of denosumab at 24 weeks in routine clinical practice. Methods Single-arm, prospective, non-interventional study in patients with bone metastases from ST (breast, prostate, lung, other) treated with denosumab in real-world in Austria, Bulgaria, Czech Republic, Hungary, Slovakia (62 centers). Study initiation: 08/2012; interim analysis data cut-off: 12/2014. Primary objective: persistence at 24 weeks (=6 denosumab subcutaneous injections; permissible intervals: 4±1 weeks). Results 158 patients were included, 121 completed 24 weeks. 76 patients discontinued prematurely: 37 died, 19 discontinued denosumab, including 2 due to SADR; 11 were lost to follow-up, 2 withdrew consent, other (n=7). Median (IQR) duration of denosumab exposure was 326 (116.0, 346.0) days; median number of doses was 10 (4.0, 12.0). Persistence with denosumab at 24 weeks was 61% (95% CI 51.969.9) varying across ST with the highest mean persistence (76%, [95% CI: 64.9-85.6]) noted in breast cancer patients and the lowest in lung cancer patients (18%, [95% CI: 2.3-51.8]) (Table). Initial median serum calcium range: 2.19-2.34 mmol/L; range after week 5: 2.22-2.28 mmol/L; ~60% received calcium and vitamin-D supplements (SmPC recommendation), decreasing to ~50% by dose 6.

Conclusions Persistence at 24 weeks was 61% of 121 patients with wide variation between tumors and countries; only 50-60% received calcium/vitaminD throughout denosumab treatment (SmPC recommendation); calcium remained within the normal range. ONJ rate was comparable with previous reports.

eP038 THE RARE PRESENTATION OF AN UPPER EXTREMITY OSTEOLYTIC METASTASIS IN A PROSTATE CANCER PATIENT M. Hwang1, S. Chan2, P. Zaki2, L. Probyn2, A. Wan2, A. Agarwal2, M. Jiayi Tao2, E. Chow2 1 , Toronto, Canada 2 Sunnybrook Health Sciences Centre, Odette Cancer Centre, Toronto, Canada Introduction Metastases to the bone often present as osteoblastic lesions in the pelvis and lower extremities in patients with prostate cancer. However, it is also possible for metastases to present as osteolytic lesions, and while uncommon, such metastases may present in upper extremities. Objectives To report a rare case of an osteolytic metastasis in the humerus of a patient with prostate cancer. Methods Report of a patient case. Patient consent obtained. Results We report the case of a 72-year-old man with high volume, high-grade prostate cancer, presenting with an osteolytic lesion in the neck of his right humerus at the time of diagnosis. Androgen deprivation therapy was initiated to manage the patient’s prostate cancer, which spread to his lower torso over a two-year period. Over the two years, the lytic humeral lesion reportedly caused increasingly severe pain and fracturing, eventually requiring surgical fixation and postoperative radiotherapy. Conclusions Despite lytic bone metastases from prostate cancer in the upper extremities being a relatively rare presentation, it is important to investigate and/ or monitor any bony lesion for metastatic growth in cancer patients, given early diagnosis and treatment may make a difference in the prognosis and quality of life of the patient.

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eP039 BONE MINERAL DENSITY LOSSES ARE RELATED TO CANCER STAGES N. Mady1, S. Levasseur1, A. Thorburn2, J. di Tomasso3, L. Rosenthall4, A. Vigano5, R. Kilgour2 1 Concordia University, Psychology, Montreal, Canada 2 Concordia University, Exercise Science, Montreal, Canada 3 McGill University, McGill University Health Centre, Montreal, Canada 4 McGill University, Radiology, Montreal, Canada 5 McGill University, Medicine, Montreal, Canada Introduction Bone mineral density (BMD) losses have been associated with aging, menopause, and cancer. However, little is known if cancer stage influences the degree of bone mineral loss. Objectives We assessed femoral neck and total hip BMD measurements in cancer patients according to their cancer stages. Methods Using dual energy x-ray absorptiometry (DXA), mean t-scores from right and left total hip (TH) and femoral neck (FN) scans were obtained from 118 cancer patients (49 females; 69 males; age 65.3±12.5 yrs; weight 70.2±16.4 kg) who were divided into three categories of cancer stages (Restorativecancer free patients, Supportive-advanced cancer patients receiving oncological treatments, and Cachexia-patients with anorexia and/or weight loss secondary to advanced disease.). T-score values that categorized patients according to the World Health Organization categories of BMD loss [normal (≥-1.0), osteopenic (<-1.0 to >-2.5), osteoporotic (≤-2.5)] were generated using the DXA software. Sarcopenia was calculated from appendicular skeletal muscle mass measurements from whole body DXA scans. Results Of the 118 patients measured, 78 (66%) had BMD losses classified as either osteopenic (n=61, 52%) or osteoporotic (n=17, 14%). When compared to the supportive care group, patients in the cachexia group had significantly lower BMD (mTH, -1.25± 1.11 vs -0.54±1.27, p=0.009; mFN, -1.70±0.99 vs. -1.18±0.97, p=0.02) t-scores and had a greater incidence of sarcopenia (p=0.002). Appendicular skeletal muscle index correlated with mFN (r=0.22; p=0.016) and mTH (r=0.26; p=0.005). Conclusions Health care professionals should address nutritional and functional strategies to improve BMD in all cancer patients and especially with those who are cachectic.

eP040 IV BISPHOSPHONATE AND DENOSUMAB: IS THERE ASSOCIATION WITH ONSET OF OSTEONECROSIS OF THE JAW AFTER EXPOSURE OF ≤ TEN DOSES? V. Lim1, E. Drill2, A. Owosho1, E. Riedel2, S.K. Yom1, J. Huryn1, C. Estilo1 1 Memorial Sloan Kettering Cancer Center, Dental Service, New York, USA 2 Memorial Sloan Kettering Cancer Center, Epidemiology-Biostatistics, New York, USA Introduction Intravenous (IV) bisphosphonate therapy has long been associated with osteonecrosis of the jaw (ONJ). Denosumab has recently been shown to also have association with ONJ. Objectives This study aims to assess whether there are any factors associated with developing ONJ after ≤ 10 versus > 10 doses of treatment with IV bisphosphonate (zoledronic acid, pamidronate) or denosumab therapy for management of multiple myeloma and metastatic cancer.

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Methods 139 oncologic patients with ONJ treated at Memorial Sloan Kettering Cancer Center (MSKCC) with ≤ 10 doses of IV bisphosphonate, denosumab, or a duo combination of the above medications were identified. Fisher’s exact tests were used to compare the low (≤ 10) versus high (> 10) dose groups by treatment type and by patient characteristics in the subset of patients treated only with zoledronic acid. Results 57% of patients received IV zoledronic acid, 8% pamidronate, 10% denosumab, and the remainder received combination therapy. Denosumab-only patients were more likely to be in the low-dose group for ONJ onset than patients in other treatment groups (50% vs 21%, p=0.02). In patients treated only with zoledronic acid, multiple myeloma patients were more likely to be in the lowdose group than patients with breast or prostate cancer (50% vs 18%, 22%, p=0.01). Conclusions More patients developed ONJ after ≤ 10 doses of denosumab therapy alone compared to ≤ 10 doses of other therapies. Type of primary cancer may be associated with ONJ onset after ≤ 10 doses of IV zoledronic acid therapy.

eP041 R A D I U M - 2 2 3 I S A W E L L T O L E R AT E D A N D S A F E TREATMENT FOR METASTATIC CASTRATION RESISTANT PROSTATE CANCER (MCRPC): REAL WORLD DATA FROM A SINGLE CANCER CENTER N. Tsoukalas1, M. Saigí Morguí1, C. Mills2, A. Dudek1, A. Pouptsis1, C. Nikolaou1, D. Enting1, S. Chowdhury1, V. Lewington2, S. Rudman1 1 Guy's and St Thomas' NHS Foundation Trust, Oncology, London, United Kingdom 2 Guy's and St Thomas' NHS Foundation Trust, Nuclear Medicine, London, United Kingdom Introduction Radium-223 is an alpha emitter that selectively targets bone metastases. It has been approved for the treatment of CRPC with bone metastases and without visceral involvement. Objectives We present real world data for the first two years of Radium-223 administration at Guy’s Hospital. Methods CRPC patients with bone metastases received Radium-223 for a period of two years. 50kBq/kg Radium-223 was given intravenously every 28 days for 6 cycles. Results 60 patients with median age 75 years (49-86) were studied. ECOG PS was 0-1 in 55% and 2 in 45%. 80% had > 6 bone metastases while 20 % had a superscan. 63.3% had bone pain WHO score 2 or more and 30% were receiving concurrent bisphosphonates. The majority (71.7%) had received 2 or more lines of prior treatments. 49 (81.7%) had finished treatment while the remaining 11 patients continue Radium-223. 22 of 49 (45%) completed all 6 cycles of treatment, while disease progression was the main cause for treatment interruption (26 patients) and 1 stopped due to toxicity. Patients with 2 or less previous lines of treatment had an increased likelihood of completing 5 or 6 cycles of therapy (p=0.013). There was a trend for patients PS 0-1 to complete 5-6 cycles of Radium223 compared to patients PS 2 (p=0.79). Treatment was well tolerated and safe. Most of adverse events were grade 1-2 while incidence of grade 3-4 events was less than 3% (anaemia). Conclusions Radium-223 is well tolerated and safe treatment. Optimal patient selection remains crucial in order to ensure effective treatment delivery.

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eP042 CONSERVATIVE SURGERY TREATMENT OF MEDICATION RELATED OSTEONECROSIS OF THE JAW (MRONJ) STAGE II AND III. A PRELIMINARY REPORT E. Vardas1, E. Kalfarentzos2, K. Tsiklakis3, N. Papadogeogakis2, F. Tzerbos2, V. Petsinis2, E. Papadopoulou1, M. Kouri1, D. Galiti3, C. Chatzihalepli 1 , A. Vourli 1 , I. Athanasiadis 4 , A. Ardavanis 5 , A. Nikolaidi4, D. Tryfonopoulos6, G. Samelis7, O. Nicolatou-Galitis1 1 Dental School- National & Kapodistrian University of Athens- Greece, Clinic of Hospital Dentistry, Athens, Greece 2 Dental School- National & Kapodistrian University of Athens- Greece, Department of Oral & Maxillofacial Surgery, Athens, Greece 3 Dental School- National & Kapodistrian University of Athens- Greece, Department of Oral Diagnosis & Radiology, Athens, Greece 4 Mitera Hospital-Hygeia- Athens- Greece, Oncology Department, Athens, Greece 5 Oncology Department, Saint Savvas Hospital- Athens- Greece, Athens, Greece 6 Saint Savvas Hospital- Athens- Greece, Oncology Department, Athens, Greece 7 Hippokration General Hospital- Athens- Greece, Oncology Department, Athens, Greece Introduction Conservative surgical management of MRONJ involves sequestrectomy and/or superficial surgical debridement of necrotic bone, in combination with oral antibiotics and chlorhexidine rinses. Objectives To present the clinical outcome of 14 oncology patients with metastatic bone disease and MRONJ, who were managed with a conservative surgical approach Methods Five patients had breast cancer, 6 prostate cancer and 3 multiple myeloma; 8 patients received zolendronic acid, 4 denosumab and 2 zolendronic acid followed by denosumab. Seven patients had MRONJ stage II and seven had stage III according to the AAOMS (2014) staging system. All patients were unresponsive to noninvasive treatments for MRONJ. Antiresorptives were interrupted and surgical interventions were performed under local analgesia. Primary wound closure was achieved and biopsies were obtained. The mean follow-up period was 6 months postoperatively. Results MRONJ affected maxilla in three patients and mandible in eleven. Necrotic bone was observed histologically. Eight patients healed with complete mucosal coverage. Six patients required additional surgery; 1 patient healed and 5 were stabilized at stage I. In total nine patients (5 with stage II and 4 with stage III) healed (64,29%) and four were stabilized (28,6%) at stage I (2 with stage II and 2 with stage III). One patient died. Conclusions In this cohort study, the relatively high healing rate of MRONJ (64,29 %) indicates that conservative surgical strategies can be beneficial when conservative measures have failed.

eP043 LESS INVASIVE SPINAL SURGERY USING BONE CEMENT FOR METASTATIC DISEASE TO THE SPINE: A REPORT OF TWO CASES S. Finkelstein1, A. Wan1, A. Yee1, M. Ford1, J. Finkelstein1 1 Sunnybrook Health Sciences Centre- University of Toronto, Department of Orthopedics, Toronto, Canada Introduction Metastases to the spinal column are a cause of pain and neurological compromise and may lead to pathological fractures that greatly reduce quality of life. Open surgery is often required to stabilize the vertebra, but can be associated with operative morbidity and complications. Recent use

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of less invasive approaches where bone cement is injected into the vertebra has eliminated the need for complex surgeries. Objectives We describe two cases demonstrating two techniques for cement augmentation in patients with spinal metastases. Methods The patients’ clinical presentations, outcomes, pre-operative, and postoperative imaging were reviewed and presented. Results The first patient was a 54-year-old male with multiple myeloma treated systemically and cured, but with spread to the spine creating mechanical instability. Spinal involvement included destruction and pathological fracture of a neurologically intact L4 vertebra. Radiation was unsuccessful at relieving pain. Cement augmentation using percutaneous kyphoplasty was performed with immediate pain relief reported by the patient. The second patient was a 44-year-old female with plasmacytoma with mid thoracic back pain, spinal cord compression, and pathological fracture. Unilateral decompression of the T7 vertebrae followed by kyphoplasty restored neurological function and stability. Immediate pain relief and improvement in neurological function was achieved after surgery. Conclusions Vertebral cement augmentation has allowed spine surgeons to achieve the same goals as traditional open procedures but with much less morbidity, shorter hospital stays, less blood loss and smaller incisions. The present cases illustrate how this less invasive technique relieved pain and significantly improved patient quality of life.

eP044 THE IMPROVEMENT OF BONE METASTASES ON BONE SCANS FOLLOWING PALLIATIVE RADIOTHERAPY: A CASE REPORT P. Zaki1, S. Chan1, L. Probyn1, B.A. Wan1, M. Hwang1, M.J. Tao1, E. Chow1 1 Odette Cancer Center, Radiation Oncology, Toronto, Canada Introduction Bone is among the most common sites of metastases in breast, lung, and prostate cancer patients. Bone metastases (BM) often result in multiple skeletal complications, most frequently bone pain, which significantly increases morbidity and reduces quality of life (QOL) among patients. Radiotherapy is an effective tool to palliate bone pain and improve QOL regardless of fractionation. Objectives We explore a case of a patient with a history of lung cancer who received multiple fraction re-irradaition for widespread BM. Methods Multiple modes of imaging, primarily bone scans, were retrospectively reviewed to assess response to radiotherapy following each treatment. Results Initially, the patient received 20 Gy of radiation in 5 fractions to treat BM in the lumbar and thoracic spine. However, upon follow-up, a bone scan and magnetic resonance imaging (MRI) demonstrated progression of BM in those areas as well as new areas, including the pelvis and scapulae. Accordingly, the patient received 20 Gy of radiation in 8 fractions to treat the lesions in the pelvis and scapulae and re-treat those in the lumbar and thoracic spine. A bone scan following re-treatment demonstrated improvement of BM in the scapulae, lumbar and thoracic spine, and pelvis. These findings were reinforced by a computerized tomography (CT) scan. Conclusions Radiotherapy is not only efficacious in palliating bone pain and improving QOL, but may aid in the improvement of BM upon re-irradiation. Radiotherapy should continue to be prescribed to treat painful BM and assessed using serial bone scans with other concurrent imaging when available.

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eP045 DOES GENDER AFFECT SELF-PERCEIVED PAIN IN CANCER PATIENTS? A META-ANALYSIS AND SYSTEMATIC REVIEW Y. Ahmed1, M. Popovic1, B.A. Wan1, L. Michael1, H. Lam1, E. Chow1 1 Odette Cancer Centre- Sunnybrook Health Sciences Centre- University of Toronto, Radiation Oncology, Toronto- Ontario, Canada Introduction Pain is reported in approximately 50-70% of cancer patients. Studies on differences in perceived pain between genders generally report an inclination of lower pain thresholds and increased pain prevalence in women. This may be attributed to gender-specific behaviours, stereotypes, and unknown aetiological factors. Despite differences in perceived pain by gender being heavily investigated, there are sparse and inconclusive results on gender differences in self-perceived pain in the cancer setting. Objectives To examine the effect of gender on baseline perceived pain intensity in cancer patients through systematic review and meta-analysis of observational studies and controlled trials. Methods A literature search was conducted using Ovid MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials to identify studies that reported on gender-specific pain intensity in cancer patients. Using random-effects modeling, weighted mean differences and 95% confidence intervals (CI) were used to estimate the effect of gender on pain severity in cancer patients. Results Of the 1911 search results reviewed, 13 studies met all inclusion criteria and reported usable data for meta-analysis. The weighted mean difference [95% CI] in pain intensity was as follows: -0.26 (p=0.09, [-0.57, 0.04]) for the 0-10 Numerical Rating Scale (NRS) group (patient number=3752, 9 studies). When restricted to patients with advanced cancer, the weighted mean difference was -0.08 (p=0.58, [-0.36, 0.20]) (patient number=2762, 4 studies). The weighted mean difference in Brief Pain Inventory (BPI) scores between males and females was 0.03 (p=0.96, [-1.23, 1.29]) (patient number=521, 4 studies).

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Rapid Response Radiotherapy Program- Odette Cancer CentreSunnybrook Health Sciences Centre- University of Toronto, Department of Radiation Oncology, Toronto, Canada 2 Mount Sinai Services Inc., N/A, Toronto, Canada 3 Mount Sinai Hospital, Pathology and Laboratory Medicine, Toronto, Canada 4 University of Toronto, Laboratory Medicine and Pathobiology, Toronto, Canada 5 Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada

Introduction Cancer pain represents a significant burden to patients and a therapeutic challenge for physicians. Genetic variations and short nucleotide variants (SNVs) have been attributed to these differences in analgesic efficacy and toxicity. Objectives To present recent peer-reviewed evidence exploring biomarkers significantly associated with analgesic efficacy and toxicity related to treatment for cancer pain. Methods A literature search was conducted in OVID MEDLINE and Embase with the following keywords: “cancer,” “pain,” “pain management,” “inflammation,” and “biomarkers.” Articles that reported on genetic or inflammatory biomarkers associated with cancer pain and/or the clinical efficacy and toxicity of analgesics for the management of pain were considered eligible. Screening and data extraction were conducted by paired reviewers. Results A total of 16 articles were included in this systematic review, with 52 associated biochemical and genetic biomarkers identified. A number of studies found GG and GA OPRM SNV rs1799971 and the COMT rs4680 SNV genotypes were significantly associated with higher analgesic dose use. Genetic variations in the β-arrestin 2 gene correlated to opioid switching. While UGT2B7 variations did not alter morphine/metabolite ratios in cancer patients that switched opioids, genetic variation in STAT6 impacts morphine analgesia. Levels of ICTP, OPG, PINP, ALP and DYD were also associated with bisphosphonate-induced analgesia for bone metastases. Conclusions This review demonstrates individual differences exist in analgesic effectiveness and adverse effects. Given the multifactorial, multi-gene nature of cancer pain and analgesic response, larger genome association studies are warranted to further explore these associations and their therapeutic implications.

eP047 AN ENDOMETRIAL CANCER PATIENT WITH PAINFUL BONE METASTASES PRESENTING WITH REGIONSPECIFIC RESPONSE TO EXTERNAL BEAM RADIATION THERAPY: A CASE REPORT M. Borean1, A. Agarwal1, E. David1, L. Probyn1, V. Ganesh1, S. Vuong1, R. McDonald1, E. Barnes1, A. Turner1, T. Barakat1, S. Caskenette1, L. Rowbottom1, S. Chan1, A. Wan1, E. Chow1 1 Sunnybrook Health Sciences Centre, Department of Radiation Oncology, Toronto, Canada Conclusions Baseline perceived pain in cancer patients did not significantly differ based on gender.

eP046 BIOMARKERS FOR RESPONSE TO ANALGESICS IN THE MANAGEMENT OF CANCER PAIN: A REVIEW OF THE LITERATURE A. Bobrowski1, A. Agarwal1, L. Rowbottom1, R. McDonald1, A. Furfari1, S. Chan1, P. Zaki1, B.A. Wan1, H. Lam1, A. Azad2,3,4, R. Chow1, E. Chow1, G. Charames3,4,5, C. DeAngelis1

Introduction Although presenting in only 1% of endometrial cancer patients, bone metastases are not only painful, but increase risk of complications such as vertebral compression fractures (VCFs) that greatly reduce quality of life. Treatment of painful bony metastases primarily involve external beam radiation treatment (EBRT), and treatment of painful VCFs include percutaneous vertebroplasty (PV). Objectives To document differential region-specific responses to radiation treatment in a patient with endometrial cancer and bone metastases. Methods A retrospective chart review was conducted.

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Results A 50-year-old female with endometrial cancer and widespread bony metastases presented with severe chest and lower back pain, rated “10/10”. Initial diagnosis was made in July 2015 after imaging revealed a uterine mass. Subsequent CT scan and bone scan showed extensive destructive lytic lesions in multiple areas of the skeleton, including the sternum, lumbar spine, left acetabulum, and right ischium. Radiotherapy of 20Gy/5 was prescribed to the sternum, lumbar spine, and left pelvis, resulting in significant pain relief in the sternum, but considerable residual pain in the lumbar spine. MRI investigation correlated this with an L2 vertebral plana. The patient underwent a PV procedure in November 2015, and reported significant pain relief in her lower back upon follow-up. Conclusions Limited pain relief following EBRT to the spine may be caused by an VCF. PV should be considered as an adjunct to EBRT in settings where there is a known or impending fracture with likely involvement of mechanical pain. Multimodal strategies for managing bone metastases may help reduce pain and improve patient quality of life.

eP048 PELVIC INS UFFI CIENCY FRACTURE S IN WOME N FOLLOWING RADIATION TREATMENT: A CASE SERIES S. Chan1, L. Rowbottom1, R. McDonald1, E. David2, H. Chung1, A. Yee3, A. Turner1, B.A. Wan1, A. Agarwal1, E. Chow1 1 Odette Cancer Centre - Sunnybrook Health Sciences Centre - University of Toronto, Radiation Oncology, Toronto, Canada 2 Odette Cancer Centre - Sunnybrook Health Sciences Centre - University of Toronto, Medical Imaging, Toronto, Canada 3 Odette Cancer Centre - Sunnybrook Health Sciences Centre - University of Toronto, Orthopedic Surgery, Toronto, Canada Introduction Insufficiency fractures are stress fractures that occur from normal weight-bearing on weakened bone. Radiation treatment to malignancies in the prostate, rectum, anus, or cervix may increase the risk of insufficiency fractures in the pelvic region by damaging osteoblasts that are essential to bone formation. In elderly women with cancer, this risk is greater due to their susceptibility to developing osteoporosis. Objectives To report two cases of painful pelvic insufficiency fractures in women who previously received radiotherapy to the rectum. Methods Retrospective chart reviews were conducted. Results

After consulting an orthopedic surgeon, one patient underwent a cementoplasty, while the other patient was encouraged to take bone strengthening medications. Conclusions Pelvic insufficiency fractures may be confused with pathological fractures resulting from bone metastases on imaging and should be identified for proper management.

eP049 DOES THE TIME OF RADIOTHERAPY AFFECT TREATMENT OUTCOMES? A REVIEW OF THE LITERATURE S. Chan1, L. Rowbottom1, R. McDonald1, G.A. Bjarnason2, M. Tsao1, C. Danjoux1, E. Barnes1, M. Popovic1, H. Lam1, C. DeAngelis3, B.A. Wan1, A. Agarwal1, E. Chow1 1 Odette Cancer Centre - Sunnybrook Health Sciences Centre - University of Toronto, Radiation Oncology, Toronto, Canada 2 Odette Cancer Centre - Sunnybrook Health Sciences Centre - University of Toronto, Medical Oncology, Toronto, Canada 3 Odette Cancer Centre - Sunnybrook Health Sciences Centre - University of Toronto, Pharmacy, Toronto, Canada Introduction Circadian rhythm dependent cell cycle progression produces daily variations in radiosensitivity. Objectives This literature review aims to summarize the data on whether radiotherapy outcomes differ depending on administration time. Methods A literature search was conducted on Ovid Medline, Embase, Cochrane Central Register of Controlled Trials and PubMed utilizing keywords such as “radiotherapy”, “circadian rhythm”, “treatment outcome”, and

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“survival”. Articles evaluating the correlation between radiotherapy time and outcomes in cancer patients were included and relevant information was extracted. Results Nine studies met the inclusion criteria. Four investigated lung cancer patients undergoing stereotactic radiosurgery for brain metastases with one study observing improved local control and survival in patients treated in the morning. Another two studies with breast and cervical cancer patients observed that the prevalence of toxicities was higher in afternoon and morning cohorts, respectively. Two studies in head and neck cancer patients found trends indicating morning patients experienced less oral mucositis. Increased toxicities and biochemical failure rates were associated with evening treatment in prostate cancer patients.

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done before the education, and post-test was done after last lecture. We also evaluated previous history for education. The data were analyzed using t-tests with a SPSS program. Results The participants of this study were 54 in pretest and 47 doctors in posttest. The median participated sessions were three times. And the mean score was 18.6 (total score was 24) for pretest and 19.6 for post-test (p = 0.23). Thirty nine (72.2%) physicians received less than two hours of education within one year. Conclusions There was not enough time to training about cancer pain management. And in terms of the method of education, large group teaching about cancer pain management is not effective for residents. We need small group or individualized learning program.

eP051 A PRACTICAL FRAMEWORK TOWARDS OPTIMAL CANCER PAIN MANAGEMENT IN RESOURCE-LIMITED SETTINGS

Conclusions As inconsistencies in the literature exist regarding the timedependency of radiotherapy outcomes, further investigation is warranted.

eP050 T H E E F F E C T S O F C A N C E R PA I N M A N A G E M E N T E D U C AT I O N F O R R E S I D E N T P H Y S I C I A N S O N KNOWLEDGE, AND ATTITUDE H.J. Chang1, H.S. Kim2, B.S. Kim2, S.H. Nam2, T. Lim2, H.Y. Lee1, W. Eo1, S.Y. Yoon3, Y.H. Cho3, H.H. Song4, G. Jang4, J.H. Kwon4 1 Kyung Hee University hospital at Kangdong, internal medicine, Seoul, Republic of Korea 2 Seoul Veterans Hospital, internal medicine, Seoul, Republic of Korea 3 Konkuk University School of Medicine, internal medicien, Seoul, Republic of Korea 4 College of Medicine- Hallym University Sacred Heart Hospital, internal medicien, Anyang, Republic of Korea Introduction Cancer pain is one of the most prevalent and important consequences of cancer. Excellent pain management is an important priority for patients with cancer pain. Effective cancer pain management is influenced by the knowledge and attitudes of treating physicians. Especially house doctor’s role in cancer pain treatment is critical. Objectives We evaluated the effects of cancer pain management education program for resident physicians on their knowledge and attitude by survey. Methods This study used a nonequivalent control group pre-post test design. Data collection was conducted from Apr to Dec 2016. Education program is composed of six lectures. The pretest was

S. Ahmedzai1, J. Bautista2, K. Bouzid3, R. Gibson4, A.A.I. Hassan5, S. Hattori6, D. Keefe7, D.C. Kraychete8, D.H. Lee9, K. Tamura10, J.J. Wang11, G. Yuddi12 1 University of Sheffield, Academic Unit of Supportive Care- Department of Oncology, Sheffield, United Kingdom 2 University of Santo Tomas Hospital, Palliative Care Unit, Manila, Philippines 3 E.H.S Pierre & Marie Curie, Department of Medical Oncology, Algiers, Algeria 4 Academic: Division of Health Sciences, University of South Australia, Adelaide, Australia 5 National Center for Cancer Care and Research - Hamad Medical Corporation, Palliative Care Unit, Doha, Qatar 6 The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Department of Palliative Care and Pain Management, Tokyo, Japan 7 University of Adelaide, Department of Medicine, Adelaide, Australia 8 Universidade Federal da Bahia, Departamento de Anestesiología y Cirugía, Salvador, Brazil 9 Asan Medical Center, Oncology- Center for Personalized Cancer Medicine- Lung Cancer Center- Skin Cancer Center, Seoul, Republic of Korea 10 Fukuoka University Hospital, Division of Medical OncologyHematology and Infectious Diseases, Fukuoka, Japan 11 Changzheng Hospital, Department of Oncology, Shanghai, China 12 Dharmais Hospital National Cancer Centre, Anaesthesiology and Pain Management, Jakarta, Indonesia Introduction Cancer pain management (CPM) in resource-limited settings remains inadequate, owing to barriers in opioid availability and accessibility, lack of education among healthcare providers, as well as fears and lack of awareness among patients and their caregivers. There remains a significant gap between existing international evidence-based guidelines and current practices in these settings. Objectives To develop a framework towards improved pain management for cancer patients, by building on existing work in the field and providing a resource-based algorithm which would enable high quality patient care with optimal use of available resources. Methods CAPER, comprising members from 10 countries, undertook a pragmatic review of the literature from 2007 to date, then collaborated to develop a resource-based management algorithm and educational strategies to close the gaps in CPM (Figure 1).

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cycles 2 and 3, with an average median duration of 4 days. Median onset of muscle pain flare was 4 days for all three cycles, with a median duration of 4 days for cycles 1 and 2, and 5 days for cycle 3. Joint and muscle pain persisted one year after treatment in approximately half of responding patients. Conclusions This study documents the significant prevalence of T-APS in docetaxel patients and shows long-term pain persistence.

eP053 BIOMARKERS RELATED TO CANCER-RELATED SYMPTOM BURDEN AND QUALITY OF LIFE: A REVIEW OF THE LITERATURE

Results We developed an algorithm that recognizes existing guidelines as the gold standard, and have applied a hierarchy of resource-based constraints to tailor the optimum analgesic regimen sensitive to the needs of patients and local availability of analgesics. The utility of this algorithm will be demonstrated during the MASCC meeting by the use of real-life case studies contributed by CAPER members. We also formulated an associated educational toolkit, and framework for policy and advocacy in improving pain medications access in resource-limited settings. Conclusions We have taken the crucial first steps in our efforts to bridge the gap in CPM, by providing an implementation framework for optimizing cancer pain management where access to guideline-recommended drugs is limited.

eP052 A PROSPECTIVE STUDY OF DOCETAXEL-ASSOCIATED PAIN SYNDROME N. Chiu1, L. Zhang1, R. Dent2, A. Giotis1, J. van Draanen1, D. GalloHershberg3, L. Chiu1, R. Chow1, M. Pasetka4, J. Stinson4, E. Stacey1, S. Verma1, H. Lam1, E. Chow1, C. DeAngelis4 1 Odette Cancer Centre - Sunnybrook Health Sciences Centre - University of Toronto, Department of Radiation Oncology, Toronto, Canada 2 National Cancer Centre, Radiation Oncology, Singapore, Singapore 3 North York General Hospital, Pharmacy, Toronto, Canada 4 Odette Cancer Centre - Sunnybrook Health Sciences Centre - University of Toronto, Pharmacy, Toronto, Canada Introduction Taxane-associated acute pain syndrome (T-APS) is a common side-effect of taxane chemotherapy. At present, the prospective studies which study T-APS examine only paclitaxel patients. No study has examined T-APS manifestation up to one-year after treatment. Objectives To prospectively investigate the natural history of T-APS in a docetaxel patient cohort and examine long-term manifestation of T-APS. Methods Taxane-naive breast cancer patients completed diaries on days 1-7, 14, 21 for three cycles following treatment and 1, 3, 6, 9, 12 months post-treatment. Questionnaires to assess pain and interference were adapted from the Brief Pain Inventory. Results A total of 278 patients were accrued, 217 analyzed, and 188 in the docetaxel cohort. A total of 74.5% of docetaxel patients experienced joint pain flare and 78.2% experienced muscle pain flare at some point in the course of three treatment cycles. Joint and muscle pain peaked on days 4-5 for each cycle and median pain severity for joint and muscle pain was 4/10 during the 21-day period. Median onset of joint pain flare was 3 days for cycle 1 and 4 days for

M. Choi1, L. Rowbottom1, S. Chan1, P. Zaki1, A. Furfari1, R. McDonald1, C. DeAngelis1, A. Azad1, R. Chow1, A. Wan1, A. Agarwal1, E. Chow1, G. Charames1 1 Sunnybrook Hospital, Radiation Oncology, Toronto, Canada Introduction In addition to associated mortality outcomes, cancer patients often experience various morbidities and symptom-related burden which impact their health-related quality of life (HRQoL). Symptoms often present in conjunction with one another, referred to as symptom clusters, and may result in cumulative HRQoL changes. Biomarkers may facilitate identification of specific symptom clusters and guide clinicians regarding their etiologies and optimal management. Objectives To summarize the available literature regarding genetic and biological biomarkers related to cancer-related symptoms and HRQoL. Methods A literature review was conducted using OVID MEDLINE and Embase (1947 to 2016 Week 16) with the following keywords: “inflammation”, “cancer pain”, “neoplasm”, “biological marker”, “allele”, and “genomics”. Articles were limited to English-language papers involving human participants. Title-and-abstract screening, full-text screening and data extraction for studies deemed eligible were conducted in duplicate by paired reviewers. Results Out of a total of 5,480 hits identified, 42 studies were deemed eligible for inclusion. Commonly-experienced symptoms reported by cancer patients included fatigue, depression and anxiety; declines in HRQoL were also commonly-reported across studies. A number of genetic and biological biomarkers were found to be associated with cancer-related symptoms and HRQoL declines, including: CRP, IL-1B, sIL-1R1, IL-6, IL-6R, IL10, decreased HB count, NCR31, TLR4, CXCR3, SOD2, PTGS2, and LTA. Conclusions Our findings highlight a complex neuroendocrine-immuno-chemicalcognitive network which appears to influence the cognitive and physical symptoms in cancer patients and their HRQoL. Further research is warranted to explore therapeutic avenues which may target these modulating factors to provide more optimal cancer-related symptom control.

eP054 GENDER DIFFERENCES IN PAIN AND PATIENT REPORTED OUTCOMES: A SECONDARY ANALYSIS OF THE NCIC CTG SC.20 RANDOMIZED TRIAL R. Chow1, K. Ding2, R.M. Meyer3, Y.M. van der Linden4, D. Roos5, W.F. Hartsell6, P. Hoskin7, J.S.Y. Wu8, A. Nabid9, C.J.A. Tissing-Tan10, B. Oei11, S. Babington12, W.F. Demas13, C.F. Wilson2, R.K.S. Wong14, M. Brundage15, L. Zhu2, E. Chow1 1 Sunnybrook Health Sciences Centre- University of Toronto, Odette Cancer Centre, Toronto, Canada 2 Cancer Research Institute- Queen's University, Canadian Clinical Trials Group, Kingston, Canada

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McMaster University, Juravinski Hospital and Cancer Centre, Hamilton, Canada 4 Leiden and Radiotherapy Institute Friesland, Leiden University Medical Centre, Leeuwarden, Netherlands Antilles 5 University of Adelaide, Royal Adelaide University, Adelaide, Australia 6 Central DuPage Hospital Cancer Center, Central DuPage Hospital Cancer Center, Warrenville, USA 7 Mount Vernon Hospital Cancer Centre, Mount Vernon Hospital Cancer Centre, Middlesex, United Kingdom 8 University of Calgary, Tom Baker Cancer Centre, Calgary, Canada 9 Centre Hospitalier Universitaire de Sherbrooke, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada 10 Institute for Radiation Oncology Arnhem, Institute for Radiation Oncology Arnhem, Arnhem, Netherlands Antilles 11 Dr. Bernard Verbeeten Instituut, Dr. Bernard Verbeeten Instituut, Tilburg, Netherlands Antilles 12 Christchurch Hospital, Christchurch Hospital, Christchurch, New Zealand 13 Northeast Ohio Medical University, Akron City Hospital, Akron, USA 14 Radiation Medicine Program- Ontario Cancer Institute- University of Toronto, Princess Margaret Cancer Centre, Toronto, Canada 15 Queen's University, Queen's University, Kingston, Canada Introduction Gender differences may lead to variations in disease presentations and outcomes. Objectives To explore the gender difference in pain and patient reported outcomes in cancer patients with bone metastases undergoing re-irradiation. Methods Patients completed Brief Pain Inventory (BPI) and European Organisation for Research and Treatment of Cancer QLQ-C30 before and 2 months after re-irradiation for painful bone metastases. Patient demographics, primary cancer site, site of painful bone metastases, Karnofsky performance status, BPI and C30 were compared using multi-variant analysis. P-values < 0.05 were considered statistically significant. Results There were 847 patients (499 men, 348 women). The most common primary cancer sites were prostate (27.0%), breast (26.3%) and lung (22.4%). At baseline, men had more mild pain (1-4/10) (p=0.002) and more superficial bones referred for radiation (p=0.02), whereas women had more interference in mood (p=0.02) and normal work (p=0.01) in the BPI. Men had worse dyspnea scores (p=0.01) but were less worried with financial aspects (p=0.04) in the C30. There was no significant difference in response to radiation at 2 months between genders. Women did report more improvement in normal work (p=0.03), mood (p =0.01), sleep (p = 0.04) and enjoyment of life (p=0.01) in the BPI, and nausea (p = 0.02) in the C30. Conclusions In cancer patients with bone metastases undergoing re-irradiation, there appears no significant difference in general between genders in response to radiation. However, women were more likely to report improved quality of life after treatment. The difference in dyspnea scores might be related to different smoking/lung cancer rates between genders.

eP055 GENDER DIFFERENCES IN PAIN AND PATIENT REPORTED OUTCOMES: A SECONDARY ANALYSIS OF THE NCIC CTG SC. 23 RANDOMIZED TRIAL S. Chow1, K. Ding2, M. Brundage3, R.M. Meyer4, A. Nabid5, P. Chabot6, G. Coulombe7, S. Ahmed8, J. Kuk9, A.R. Dar10, A. Mahmud11, A. Fairchild12, C.F. Wilson2, J.S.Y. Wu13, K. Dennis14, C. DeAngelis1, R.K.S. Wong15, L. Zhu2, E. Chow1 1 Sunnybrook Health Sciences Centre- University of Toronto, Odette Cancer Centre, Toronto, Canada

Support Care Cancer (2017) 25 (Suppl 2):S21–S266 2 Cancer Research Institute- Queen's University, Canadian Clinical Trials Group, Kingston, Canada 3 Queen's University, Kingston General Hospital, Kingston, Canada 4 McMaster University, Juravinski Hospital and Cancer Centre, Hamilton, Canada 5 Centre Hospitalier Universitaire de Sherbrooke, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada 6 Hopital Maisonneuve-Rosemont, Hopital Maisonneuve-Rosemont, Montreal, Canada 7 CHUM-Hopital Notre-Dame, CHUM-Hopital Notre-Dame, Montreal, Canada 8 CancerCare Manitoba, CancerCare Manitoba, Winnipeg, Canada 9 Grand River Hospital, Grand River Regional Cancer Centre, Kitchener, Canada 10 London Regional Cancer Program, London Regional Cancer Program, London, Canada 11 Kingston General Hospital, Cancer Centre of Southeastern Ontario, Kingston, Canada 12 Cross Cancer Institute, Cross Cancer Institute, Edmonton, Canada 13 University of Calgary, Tom Baker Cancer Centre, Calgary, Canada 14 University of Ottawa, The Ottawa Hospital, Ottawa, Canada 15 Radiation Medicine Program- Ontario Cancer Institute, Princess Margaret Cancer Centre, Toronto, Canada

Introduction Gender differences may contribute to variations in disease presentations and health outcomes. Objectives To explore the gender difference in pain and patient reported outcomes in cancer patients with bone metastases undergoing palliative radiotherapy. Methods Patients completed the European Organisation for Research and Treatment of Cancer (EORTC) QOL Bone Metastases module (QLQBM22) and EORTC QOL Core-15-Palliative (QLQ-C15-PAL) before treatment, days 10 and 42 after a single 8 Gy radiation treatment. Worse pain score were classified as mild (1-5), moderate (6) and severe (7-10). Patient demographics, performance status, analgesic consumption, BM22 and C15 were compared with multi-variant analysis. P-values < 0.05 were considered statistically significant. Results There were 298 patients (170 male, 128 female) with median age of 69 years. The most common primary cancer sites were breast, lung and prostate. At baseline, there were no differences in BM22 and C15 scores, except for worse nausea scores in females (p=0.03). In patients with moderate pain, females reported worse scores in agitation (p=0.01), while in severe pain, females reported worse nausea scores (p=0.03). At Day 42, there was no significant difference in response to radiotherapy. However, there was significance difference in psychosocial aspects (p=0.002) with higher proportion of male reporting either improved or worsened. Among the responders, females reported better improvement in emotional aspects (p=0.03). In non-responders, there were significant differences in dyspnea (p=0.02) and psychosocial aspects (p=0.04). Conclusions In cancer patients with bone metastases undergoing palliative radiotherapy, there appears no significant difference in general between genders in symptom presentations, patient reported outcomes and response to radiation.

eP056 A G E D I F F E R E N C E S I N R E S P O N S E A N D PAT I E N T REPORTED OUTCOMES IN RE-IRRADIATION OF BONE METASTASES: A SECONDARY ANALYSIS OF THE NCIC CTG SC.20 RANDOMIZED TRIAL R. Chow1, K. Ding2, R. Meyer3, Y. van der Linden4, D. Roos5, W.F. Hartsell 6 , P. Hoskin 7 , J.S. Wu 8 , A. Nabid 9 , M. van Acht 10 , G.

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Wanders11, S. Babington12, W.F. Demas13, C.F. Wilson2, R.K. Wong14, M. Brundage15, L. Zhu2, E. Chow1 1 Sunnybrook Health Sciences Centre - University of Toronto, Department of Radiation Oncology, Toronto, Canada 2 Cancer Research Institute - Queen's University, Canadian Clinical Trials Group, Kingston, Canada 3 McMaster University, Juravinski Hospital and Cancer Centre, Hamilton, Canada 4 Leiden and Radiotherapy Institute Friesland, Leiden University Medical Centre, Leeuwarden, Netherlands Antilles 5 University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia 6 Central DuPage Hospital Cancer Centre, Central DuPage Hospital Cancer Centre, Warrenville, USA 7 Mount Vernon Hospital Cancer Centre, Mount Vernon Hospital Cancer Centre, Middlesex, United Kingdom 8 University of Calgary, Tom Baker Cancer Centre, Calgary, Canada 9 Centre Hospitalier Universitaire de Sherbrooke, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada 10 ErasmusMC, ErasmusMC, Rotterdam, Netherlands Antilles 11 MAASTRO Clinic, MAASTRO Clinic, Maastricht, Netherlands Antilles 12 Christchurch Hospital, Christchurch Hospital, Christchurch, New Zealand 13 Northeast Ohio Medical University, Akron City Hospital, Akron, USA 14 Ontario Cancer Institute - University of Toronto, Princess Margaret Cancer Centre - Radiation Medicine Program, Toronto, Canada 15 Queen's University, Queen's University, Kingston, Canada

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Sunnybrook Health Sciences Centre - University of Toronto, Department of Radiation Oncology, Toronto, Canada 2 Cancer Research Institute - Queen's University, Canadian Clinical Trials Group, Kingston, Canada 3 Queen's University, Queen's University, Kingston, Canada 4 McMaster University, Juravinski Hospital and Cancer Centre, Hamilton, Canada 5 Centre Hospitalier Universitaire de Sherbrooke, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada 6 Hospital Maisonneuve-Rosemont, Hospital Maisonneuve-Rosemont, Montreal, Canada 7 CHUM-Hospital Notre-Dame, CHUM-Hospital Notre-Dame, Montreal, Canada 8 CancerCare Manitoba, CancerCare Manitoba, Winnipeg, Canada 9 London Regional Cancer Program, London Regional Cancer Program, London, Canada 10 Kingston General Hospital, Cancer Centre of Southeastern Ontario, Kingston, Canada 11 Cross Cancer Institute, Cross Cancer Institute, Edmonton, Canada 12 University of Calgary, Tom Baker Cancer Centre, Calgary, Canada 13 University of Ottawa, Ottawa Hospital, Ottawa, Canada 14 Ontario Cancer Institute - University of Toronto, Princess Margaret Cancer Centre - Radiation Medicine PRogram, Toronto, Canada

Introduction Age differences may lead to variations in disease presentations and outcomes. Objectives To explore the age difference in response and patient reported outcomes in cancer patients with bone metastases undergoing re-irradiation. Methods Patients completed Brief Pain Inventory (BPI) and European Organisation for Research and Treatment of Cancer QLQ-C30 before and 2 months after re-irradiation for painful bone metastases. Patient demographics, primary cancer site, site of painful bone metastases, Karnofsky performance status, BPI and C30 were compared using multi-variant analysis with the cut-off age of 70 years. We did the sensitivity analyses with the cut-off age of 65 and 75 years. P-values < 0.05 were considered statistically significant. Results There were 847 patients with 545 (64.3%) < 70 years old. At baseline, older patients were more likely male, had prostate cancer, consumed less analgesic, scored better in emotional and social functioning, fatigue, pain, sleep and financial items of C30, scored also better in general activity, mood, normal work, relation with other people, sleep and enjoyment of life in BPI items. There was no significant difference in response to radiation, changes from baseline in C30 at 2 months, or overall survival between the two groups. Younger patients had better improvement from baseline in BPI enjoyment of life at 2 months. The results did not change in the sensitivity analyses. Conclusions In cancer patients with bone metastases undergoing re-irradiation, there appears no significant difference in general with age in response to radiation. Elderly patients should be offered re-irradiation if needed.

Introduction Age differences may contribute to variations in disease presentations and health outcomes. Objectives To explore the age difference in response and patient reported outcomes in cancer patients with bone metastases undergoing palliative radiotherapy. Methods Patients completed the European Organisation for Research and Treatment of Cancer (EORTC) QOL Bone Metastases module (QLQBM22), EORTC QOL Core-15-Palliative (QLQ-C15-PAL) and dexamethasone symptom questionnaire (DSQ) before treatment, days 10 and 42 after a single 8 Gy radiation treatment. Patient demographics, performance status, analgesic consumption, BM22, C15 and DSQ were compared with multi-variant analysis with the cut-off age of 75 years. Pvalues < 0.05 were considered statistically significant. Results There were 298 patients (170 male, 128 female) with 209 (70%) < 75 years old. The most common primary cancer sites were breast, lung and prostate. At baseline, younger patients had better performance status, consumed more analgesic, and reported worse scores in nausea, insomnia and functional interference while the older more likely had prostate cancer. There were no significant differences in the incidence of radiation induced pain flare, response to radiation, changes from baseline for BM22, C15-PAL and DSQ nor overall survival at day 42 between the two groups. Responders to radiation in elderly group reported better improvement in physical and emotional domains when compared with non-responders. Conclusions In cancer patients with bone metastases undergoing palliative radiotherapy, there appears no significant difference in general with age in response to radiation and patient reported outcomes. Palliative radiotherapy should be offered to elderly patients if needed.

eP057 A G E D I F F E R E N C E S I N R E S P O N S E A N D PAT I E N T REPORTED OUTCOMES: A SECONDARY ANALYSIS OF THE NCIC CTG SC. 23 RANDOMISED TRIAL

eP058 AVAILABILITY OF AND ACCESS TO STRONG OPIOID MEDICATIONS FOR THE CANCER PATIENTS IN EASTERN EUROPE AND BALKANS

S. Chow1, K. Ding2, M. Brundage3, R.M. Meyer4, A. Nabid5, P. Chabot6, G. Coulombe7, S. Ahmed8, A.R. Dar9, A. Mahmud10, A. Fairchild11, C.F. Wilson2, J.S. Wu12, K. Dennis13, C. DeAngelis1, R.K. Wong14, L. Zhu2, E. Chow1

J. Dimitrijevic1, S. Bosnjak1, F. Djordjevic1, A. Zilic1, M. Tomíška2, C. Szczylik3, A. Skripekova4 1 Institute for Oncology and Radiology of Serbia, Department of Supportive and Palliative care, Belgrade, Serbia

S86 2 The University Hospital Brno, Department of Internal MedicineHematology and Oncology, Brno, Czech Republic 3 Medical Military Institute, Department of Oncology, Warsaw, Poland 4 National Oncology Institute, Department of Clinical Oncology, Bratislava, Slovak Republic

Introduction Cancer pain is the most common symptom of cancer. The implementation of the cancer pain guidelines depends on availability of and accessibility to guideline-recommended medications. Objectives The purpose of this research was to investigate the availability and accessibility of strong opioids in Eastern Europe and Balkans. Methods The survey was conducted among 15 countries of the region with data collected for morphine, hydromorphone, oxycodone, methadone, transdermal fentanyl (fentanyl TD) and fentanyl for the breakthrough pain (fentanyl BTP). Methadone for substitution therapy was not included in this survey. Availability was evaluated by the formulary availability and marketing authorization. Accessibility was evaluated by the National Health Insurance Fund coverage as fully reimbursed, partially reimbursed or not accessible (out-of-pocket). Results Slovenia is the only country with all investigated strong opioids available and fully reimbursed (Table 1). Morphine is available and fully reimbursed in all countries. Fentanyl TD is available and fully reimbursed in 14/15 countries except in Albania in which it is out-of-pocket medication. Morphine in the only available and fully reimbursed strong opioid in Albania. Hydromorphone, oxycodone, methadone and fentanyl BTP are not available in 8/15, 4/15, 6/15 and 4/15 countries, respectively.

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Methods Randomized, double-blind, active-controlled, parallel-group, noninferiority trial with 16-day titration of cebranopadol QD (200/400/600/ 800/1000μg) or morphine-PR BID (30/60/90/120/150mg/day) to individual optimal dose followed by 4-week fixed dose maintenance phase. Primary and secondary efficacy endpoints were average daily use of rescue medication (morphine sulfate immediate release) and clinically relevant pain reduction, respectively, over the last 2 weeks of maintenance in full and per protocol analysis sets (FAS, PPS). The trial was terminated due to low accrual. Results 126 cebranopadol-naïve but opioid-experienced patients were treated. 86 completed the trial; 15 discontinued due to adverse events from cebranopadol and 7 from morphine-PR. Mean (SD) baseline pain score was 6.3 (1.1) (11-point numerical rating scale) on prior opioid treatment. Primary endpoint: non-inferiority for cebranopadol versus morphine-PR (p<0.0001; FAS, PPS) and also superiority over morphine-PR (FAS: p=0.0016; PPS: p=0.0454) was demonstrated. Secondary endpoint: the vast majority of patients (≥75%, either treatment) had a clinically relevant pain reduction. However, non-inferiority could not be demonstrated. 83.1% of patients on cebranopadol and 82.0% on morphine-PR experienced treatment-emergent adverse events. Most common (≥10%) across groups were constipation, nausea, vomiting, fatigue, oedema peripheral, asthenia, decreased appetite, and malignant neoplasm progression. Conclusions These data suggest that cebranopadol was effective, safe and well tolerated in opioid-experienced patients with chronic cancer-related pain.

eP060 CEBRANOPADOL, A NOVEL FIRST-IN-CLASS ANALGESIC DRUG CANDIDATE: FIRST EXPERIENCE IN PATIENTS WITH CANCER-RELATED PAIN TREATED FOR UP TO 26 WEEKS E.D. Koch1, S. Kapanadze1, M.H. Eerdekens1, G. Kralidis2, J. Letal2, I. Sabatschus3, S.H. Ahmedzai4 1 Grünenthal GmbH, Clinical Science, Aachen, Germany 2 Grünenthal GmbH, Data Sciences - Statistics, Aachen, Germany 3 Grünenthal GmbH, Global Drug Safety, Aachen, Germany 4 University of Sheffield- School of Medicine and Biomedical Science, Department of Oncology, Sheffield, United Kingdom

Conclusions All countries have at least one first-line strong opioid available and accessible with major differences among countries in the region.

eP059 CEBRANOPADOL, A NOVEL FIRST-IN-CLASS ANALGESIC DRUG CANDIDATE: EFFICACY, SAFETY, TOLERABILITY IN PATIENTS WITH CANCER-RELATED CHRONIC PAIN M.H. Eerdekens1, S. Kapanadze1, E.D. Koch1, G. Kralidis2, G. Volkers2, W. Meißner3 1 Grünenthal GmbH, Clinical Science, Aachen, Germany 2 Grünenthal GmbH, Data Sciences - Statistics, Aachen, Germany 3 Jena University Hospital, Department of Anesthesiology and Intensive Care, Jena, Germany Introduction Preclinically, cebranopadol acts via the nociceptin/orphanin FQ peptide receptor and opioid receptor agonism. Objectives We evaluated efficacy and safety of oral cebranopadol versus morphine sulfate prolonged release (morphine-PR) in patients with cancer-related pain who were treated with opioids (NCT01964378).

Introduction Preclinically, cebranopadol acts via the nociceptin/orphanin FQ peptide receptor and opioid receptor agonism. Objectives This trial (NCT02031432) evaluated safety and tolerability of oral cebranopadol for up to 26 weeks in patients with cancer-related pain, treated with cebranopadol or morphine sulfate prolonged release in a preceding, double-blind trial (NCT01964378). Methods This was a single-arm, open-label trial. Flexible titration of cebranopadol QD (200/400/600/800/1000μg) to individual optimal dose was followed by 24-week treatment. Primary and secondary safety endpoints were incidence and intensity of treatment-emergent adverse events (TEAEs), respectively. Efficacy reported as change in average pain intensity (11point numerical rating scale) in the last week of treatment was a secondary endpoint. Results 76 patients received cebranopadol. 38 (50%) completed the trial. Sixty-four patients (84.2%) experienced at least 1 TEAE. Most common (≥10%) were asthenia, malignant neoplasm progression, decreased appetite, nausea, constipation, anemia, fatigue, oedema peripheral, pyrexia, arthralgia, back pain, headache, somnolence, and vomiting. Intensity of most TEAEs was mild (36.6%) or moderate (45.4%).

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Average pain intensity was mild for the entire treatment duration:

Conclusions Considering trial design limitations, cebranopadol was safe and well tolerated in a population with pain from advanced cancer disease. The data suggest that the pain was adequately controlled in this difficult-to-manage patient population. Moreover, a switch from previous morphine treatment was successful and well tolerated.

eP061 RECRUITMENT AND RETENTION IN A PILOT STUDY OF P H A R M A C O G E N O M I C S A N D PA I N C O N T R O L I N PALLIATIVE CARE A. Fenech1, J. Smith2, S. Rajasekhara2, Y. Chang2, D. Portman2, K. Donovan2 1 H. Lee Moffitt Cancer Center and Research Institute, Health Outcomes and Behavior, Tampa, USA 2 H. Lee Moffitt Cancer Center and Research Institute, Supportive Care Medicine, Tampa, USA Introduction Increasingly, research is aimed at identifying the hereditary basis for interindividual differences in opioid effects to explain altered efficacy and side effects in cancer pain management. Objectives We describe rates of recruitment and retention in a pilot study examining the relationship of genetic variants and pain relief to pain control in cancer patients receiving palliative care. Methods Patients newly referred to a Palliative Medicine clinic were screened for eligibility and approached during their first clinic visit. A blood sample was collected for genetic analysis and patients were reassessed for pain and opioid side effects at 1, 2, 4 and 8 weeks later. Results In 18 months, 459 eligible patients were screened, 229 approached. Nearly half cancelled or no-showed for their initial clinic visit. One hundred twenty patients (M age = 55 years, female = 53%) were enrolled. Baseline assessments were completed by 95%; 68% completed at least two follow-up assessments. Pain catastrophizing was marginally (p = .09) related to retention. Blood samples were provided by 75% while on-study. Approximately 26% were lost to follow-up, withdrew consent, or were discharged to hospice or died. Pain scores, pain relief and morphine equivalent daily values trended in the expected direction over study period. Conclusions High rates of no-shows/cancellations in outpatient palliative care clinic adversely affect recruitment. Retention over eight weeks was moderately successful in this population. Findings have informed the design of a prospective randomized trial examining genotype-guided versus usual care pain management in the palliative care outpatient setting.

eP062 OUTPATIENT URINE DRUG TESTING AT INITIAL VISIT IN A SUPPORTIVE CARE CLINIC K. Donovan1, A. Fenech2, L. Akins1, S. Thirlwell1, D. Portman1 1 H. Lee Moffitt Cancer Center and Research Institute, Supportive Care Medicine, Tampa, USA 2 H. Lee Moffitt Cancer Center and Research Institute, Health Outcomes and Behavior, Tampa, USA

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Introduction Opioids are the cornerstone of cancer pain management, but some patients engage in improper use, which may compromise patient safety. To support patient wellbeing, proper prescribing of controlled substances is essential. Frequently, research recommends the use of urine drug testing (UDT) to assist clinicians in responsibly prescribing opioids when managing pain. However, guidelines do not provide instruction for when UDT should be utilized in cancer care. Often, UDT has been limited to random testing or testing of cancer patients with suspected misuse. Objectives We sought to maximize the utility of UDT by determining the prevalence of abnormal results in patients seen for supportive care. Methods We conducted a retrospective chart review of patients newly referred to an outpatient supportive care clinic between December 2013 and September 2016. Results One thousand one hundred and eight consecutive patients underwent routine UDT as part of their initial visit. Total number of drug and/or metabolites identified was 3,165.Thirteen percent were indicative of noncompliance: nearly half of these, 47%, indicated the absence of an opioid currently prescribed. Marijuana was detected in 19% of patients, cocaine in 1.4%. Nineteen percent of all results were indicative of the presence of a prescription drug, not currently prescribed. The vast majority, were nonprescribed opioids in 37% of patients. Conclusions Findings suggest use of UDT meets the standards of medical necessity to be a credible element of clinical care. The high rate of irregularities in the results may support obtaining the test at initial visit to guide subsequent care.

eP063 SYMPTOM PREVALENCE AMONG PATIENTS ADMITTED UNDER THE SUPPORTIVE AND PALLIATIVE CARE P R O G R A M I N Q ATA R : A S I N G L E I N S T I T U T I O N EXPERIENCE A. Hassan1,2, A. Allam1, S. Jobran1, H. Eltahir1 1 National Center for Cancer Care & Research- Hamad Medical Corporation, Medical Oncology, Doha, Qatar 2 Cancer Management & Research, Medical Research InstituteAlexandria University, Alexandria, Egypt Introduction Symptom control is an essential part of cancer treatment, especially with advanced cancer where patients often suffer from diverse and severe symptoms. Objectives The aim of this study is to report on the most frequently encountered symptoms, associated comorbidities and the palliative performance score. Methods A retrospective cohort study that included 262 patients admitted to Palliative care unit at NCCCR in Qatar over the period from 1-1-2012 till 31-12-2014. The initial palliative care assessment forms were reviewed for the presenting symptoms, PPS and associated comorbidities. Further analysis of pain in terms of quality and severity was also reported. Results The study period was from 01-01-2012 till 31-12-2014 using the initial palliative care assessment form. Pain was the most common symptom encountered (70% of cases), followed by fatigue (52%), weakness (44%), anorexia (36%) and dyspnea (23%). Anxiety and depression was reported in 17% of patients. Further analysis of pain quality revealed that dull aching pain was the most common (53%) type of pain, followed by sharp pain (15%) and colicky cramping in 9% of cases. The median score of pain on NRS was 3 with a range from 0-9. Most patients had more than 3 symptoms at initial presentation (74%) of cases). Around 50% of patients presented with poor palliative performance score (PPS 30% or less).

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Conclusions Patients with advanced incurable cancer admitted to the unit present with a high burden of symptoms including pain, fatigue, anorexia and dyspnea. Majority of those patients have poor PPS. This entails daily assessment and management of their symptoms.

eP064 COMPARATIVE ANALYSIS OF DIFFERENT METHODS OF PAIN MANAGEMENT FOR ELDERLY CANCER PATIENTS IN THE SURGICAL INTENSIVE CARE UNIT B.W.Y. Huang1, C.K. Fang2, C.C. Chen3, Y.L. Lai4 1 Mackay Memorial Hospital, Anesthesiology-Critical care medicineHospice and palliative care center, Taipei, Taiwan R.O.C. 2 Mackay Memorial Hospital, hospice and palliative care center, Taipei, Taiwan R.O.C. 3 Mackay Memorial Hospital, Anesthesiology, Taipei, Taiwan R.O.C. 4 Mackay Memorial Hospital, Radiation Oncology-Hospice Palliative Care Center-MacKay Medical college, Taipei, Taiwan R.O.C. Introduction With technological advancements, more elderly cancer patients are undergoing surgery and need surgical intensive care unit (SICU) care. optimal pain management after operation can not only release cancer and surgical pain but also provide a more stable hemodynamic status which enables shorten length of hospital stay and reduced medical costs. We aimed to determine the pain management method that provided better acute pain control in all-cause elderly cancer SICU patients. Objectives This retrospective cohort study included a chart review of all-cause cancer patients of a 26-bed SICU (1029-bed medical center) from April 2011 through September 2012. Cancer patients who were unconscious, uncooperative, < 65 years, or had American Society of Anesthesiologists (ASA) classification
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eP065 OPIOIDS PRESCRIBING IN PEOPLE WITH AND WITHOUT CANCER: DATA FROM THE VICAN 5 FRENCH SURVEY A. JANAH1, S. CORTAREDONA1,2, A.D. BOUHNIK1, P. PERETTIWATEL1, M.K. BENDIANE1,2 1 UMR 912 / SESSTIM, Université AIX-MARSEILLE, Marseille, France 2 ORS PACA- Observatoire régional de la santé Provence Alpes Côte d’Azur, Université AIX-MARSEILLE, Marseille, France Introduction According to WHO recommendations, opioids' prescription is an essential sign of national improvement in cancer pain relief. However, no data on opioid analgesics' dispensing in France is available. Objectives We compared the prevalence and trends of opioids’ prescribing in 20092015 among people with and without cancer. Methods Using propensity scores, we matched the following two cohorts: cancer survivors followed 5 years after diagnosis (2010) and individuals without cancer. Using French health insurance databases about prescribed opioids, we applied conditional Poisson regressions to estimate adjusted relative risks for monthly opioids prescribing. Then, among cancer patients only, multivariate negative binomial regressions were conducted to identify factors associated to opioids prescribing, focusing on patient characteristics’ impact. Results Cancer was associated with a higher prescription of analgesics compared to the non-cancer population. While Step II opioids prescribing decreased over time, that of step III remained marginal and tended to stabilize. Older people were most adversely affected by an under-prescription of opioids especially those of step III. Besides, the matched case/control study suggested gender inequalities in favour of men, while multivariate analysis, did not support this finding. Conclusions the inconsistency of our findings about prescribed opioids' trends with what was reported from literature about the increase or invariability of pain among cancer survivors in the middle term after diagnosis, rise interrogations about possible changes in pain perception, or about the evolution of cancer pain management’ strategies. Further researches would explore these hypotheses and explain what may be attributable to patients’ characteristics in pain management to address possible inequalities.

eP066 USE OF HALOPERIDOL IN OPIOID INDUCED HYPERALGESIA W. Jehangir1, M. Zankhana1, M. Davis1 1 Geisinger Medical Center, Palliative Medicine, Danville, USA

Conclusions PCEA is the recommended acute pain management method for all-cause elderly cancer SICU patients.

Introduction Opioid-induced hyperalgesia is a well-established state of nociceptive sensitization paradoxically caused by exposure to opioids. OIH is characterized by paradoxical response to certain painful stimuli when the patient is receiving opioids for the treatment of pain. Objectives Identification of signs and symptoms of opioid induced hyperalgesia and Recognize the role of haloperidol. Methods A 67 years old male diagnosed with myelofibrosis and myeloproliferative neoplasm was started on azacitidine. After the first does he developed weakness, fever and pancytopenia. He was treated for febrile illness with antibiotics. His pancytopenia persisted despite azacitadine. A repeat bone marrow biopsy revealed transformation to AML. He was started on

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FLAG which he did not tolerate. Subsequently, patient’s family opted for comfort measures. He was discharged to nursing home with hospice and IV hydromorphone PCA, basal dose 0.3mg/hr and PCA dose 0.3mg Q30min for pain. Later, he developed progressive pain which intensified with increasing basal to 0.6mg/hr and PCA 0.6mg Q30min. His pain intensity worsened further on increasing doses. Once OIH was considered, he was started on oral haloperidol 1mg Q1H PRN. After the first dose pain intensity reduced significantly. Results Haloperidol is the only commercial agent which is a potent S-1R blocker. S-1R activation is coupled to pain facilitation and inhibition of opioid antinociception, antagonists inhibit pain hypersensitivity and "releases the brake" enabling opioids enhanced antinociceptive effects, both at CNS and PNS. Conclusions This patient history illustrates the balance between treating pain with opioids and the adverse effect, opioids induced hyperalgesia. Haloperidol rebalances the equation.

eP067 THE ROLE OF THE BRAIN IN CHEMOTHERAPY-INDUCED PERIPHERAL NEUROPATHY: AN FMRI STUDY I. Kleckner1, R. Aslin2, C. Heckler1, M. Janelsins1, N. Mohile3, M. Asare1, C. Cole1, P.J. Lin1, K. Mustian1, V. Rao4, S. Kesler4 1 University of Rochester Medical Center, Surgery Cancer Control Division, Rochester, USA 2 University of Rochester, Rochester Center for Brain Imaging, Rochester, USA 3 University of Rochester Medical Center, Neuro-Oncology, Rochester, USA 4 MD Anderson Cancer Center, Neuro-Oncology, Houston, USA Introduction Over half of patients receiving taxane, platinum, and vinca alkaloid chemotherapy experience chemotherapy-induced peripheral neuropathy (CIPN), which involves numbness and neuropathic pain in the hands and feet. CIPN has no effective treatments partly because its etiology is poorly understood. We theorize that CIPN symptoms are partly caused by impairment of interoceptive brain circuitry, which processes bodily sensations via the posterior insula and anterior cingulate cortex (ACC). Objectives To investigate whether CIPN is associated with altered connectivity in interoceptive brain circuitry. Methods Fifty women with breast cancer (50±9 years) reported CIPN symptoms (CIPN-20) and underwent resting fMRI one or more times: before surgery, one month after completion of chemotherapy, and one year after chemotherapy. We used an a priori seed-based investigation of connectivity between the posterior insula and the ACC. We compared connectivity between 31 patients without CIPN symptoms (≤10 CIPN-20Sensory), 19 patients with CIPN symptoms (>10 CIPN-20-Sensory), and 280 healthy adults (174 women, average 19.3 years) from another study. Results Patients with CIPN symptoms had significantly reduced connectivity between the posterior insula and the ACC compared to patients without CIPN symptoms (p=0.01, d=0.73). Connectivity between the posterior insula and the ACC was negative in patients with CIPN symptoms but positive in both healthy adults and patients without CIPN symptoms. Conclusions CIPN is characterized by reduced connectivity in interoceptive brain circuitry. Interoceptive networks may be a target for the development of therapies directed to prevent or treat CIPN. Future work will assess causal relationships between CIPN symptoms and reduced connectivity.

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eP068 USE OF CORTICOSTEROIDS FOR PAIN CONTROL IN C AN CE R PAT I E NT S W IT H B O N E M E TAS TA SE S : A COMPREHENSIVE LITERATURE REVIEW M.Y. Lim1, B. Adam2, A. Arnav3, F.S. Mauricio4, E. Chow5 1 Princess Margaret Hospital, Department of Oncology, Hong Kong, Hong Kong S.A.R. 2 Division of Experimental Medicine- Faculty of Medicine- McGill University- Montréal- Quebec- Canada, Division of Experimental Medicine- Faculty of Medicine- McGill University- Montréal- QuebecCanada, Montreal, Canada 3 School of Medicine- University of Toronto- Toronto- Ontario- Canada, School of Medicine- University of Toronto- Toronto- Ontario- Canada, Toronto, Canada 4 Radiation Oncology Unit- Hospital de Caridade Astrogildo de AzevedoSanta Maria- Brazil, Radiation Oncology Unit- Hospital de Caridade Astrogildo de Azevedo- Santa Maria- Brazil, Santa Maria, Brazil 5 Edmond Odette Cancer Center- Sunnybrook Health Sciences CentreToronto- Ontario- Canada, Edmond Odette Cancer Center- Sunnybrook Health Sciences Centre- Toronto- Ontario- Canada, Toronto, Canada Introduction Despite a limited understanding of the exact mechanism, corticosteroids are commonly employed for pain control in patients with bone metastases. Objectives The aim of this review was to evaluate the efficacy of corticosteroidmediated pain control in patients with bone metastases associated with solid cancers. Methods A literature search was conducted using OVID MEDLINE and Embase databases (from 1946 up to July 19, 2016). Studies involving patients with bone metastases receiving corticosteroids as the primary means of pain control were included. Screening and data extraction were conducted by paired reviewers, with consensus established by discussion, or a third adjudicator. Results A total of 12 studies were included. Rates of pain relief achieved with corticosteroid use varied from 30% to 70%, but generally reflected moderate pain control. Corticosteroid use significantly reduced the incidence of pain flare alongside radiotherapy, reportedly by almost half of baseline pain severity. Adverse events were not documented consistently across studies, though grade 2-3 hyperglycemia was noted in approximately 2% of patients by some studies. Conclusions Recent evidence suggests that short-term corticosteroid use may provide moderate pain and pain flare control with radiotherapy for patients with bone metastases. The risk of developing adverse effects should be carefully considered prior to therapy initiation on a case-by-case basis.

eP069 CLASSIFICATION OF PAINFUL BONE METASTASES AS MILD, MODERATE, OR SEVERE USING BOTH EORTC QLQC15-PAL AND EORTC QLQ-BM22 R. McDonald1, K. Ding2, E. Chow1, R.M. Meyer3, A. Nabid4, P. Chabot5, G. Coulombe6, S. Ahmed7, J. Kuk8, A.R. Dar9, A. Mahmud10, A. Fairchild11, C.F. Wilson2, J.S.Y. Wu12, K. Dennis13, C. DeAngelis14, R.K. Wong15, L. Zhu2, M. Brundage16 1 Odette Cancer Centre- Sunnybrook Health Sciences Centre, Department of Radiation Oncology, Toronto, Canada 2 Cancer Research Institute- Queen's University, Canadian Clinical Trials Group, Kingston, Canada 3 Juravinski Hospital and Cancer Centre- McMaster University, Department of Oncology, Hamilton, Canada

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Centre Hospitalier Universitaire de Sherbrooke, Department of Oncology, Sherbrooke, Canada 5 Hopital Maisonneuve-Rosemont, Department of Radiation Oncology, Montreal, Canada 6 CHUM-Hopital Notre-Dame, Department of Radiation Oncology, Montreal, Canada 7 CancerCare Manitoba, Department of Radiation Oncology, Winnipeg, Canada 8 Grand River Regional Cancer Centre- Grand River Hospital, Department of Radiation Oncology, Kitchener, Canada 9 London Regional Cancer Program, Department of Radiation Oncology, London, Canada 10 Cancer Centre of Southeastern Ontario- Kingston General Hospital, Department of Radiation Oncology, Kingston, Canada 11 Cross Cancer Institute, Department of Radiation Oncology, Edmonton, Canada 12 Tom Baker Cancer Centre- University of Calgary, Department of Oncology, Calgary, Canada 13 The Ottawa Hospital and University of Ottawa, Department of Radiation Oncology, Ottawa, Canada 14 Odette Cancer Centre- Sunnybrook Health Sciences Centre, Department of Pharmacy, Toronto, Canada 15 Princess Margaret Hospital- Radiation Medicine Program- Ontario Cancer Institute- University of Toronto, Department of Radiation Oncology, Toronto, Canada 16 Queen's University, Department of Radiation Oncology, Kingston, Canada Introduction Categorizing pain as mild, moderate, and severe is useful for both patients and physicians. Previous studies have utilized either only the Brief Pain Inventory (BPI) or the BPI in conjunction with a quality of life (QOL) tool, yielding inconsistent results. Objectives To determine optimal cutpoints (CPs) using QOL outcomes to define mild, moderate, and severe pain in cancer patients referred to radiotherapy for painful bone metastases. Methods This is a secondary analysis of the NCIC CTG SC.23 trial. Prior to radiation treatment, patients scored their worst pain in the past 3 days using the BPI worst pain score; to be eligible for participation, all patients required a pain score > 2. Patients also completed the QLQ-BM22 and the QLQ-C15-PAL. Using multivariate analysis of variance, pain severity categories (mild, moderate, severe) were those which yielded the largest F ratio for between category effect on Pillai’s trace, Wilk’s λ, and Hotelling’s trace F statistics. Results A total of 298 patients were included. Median age was 69 years (range 3296) and 57% were male. The largest F ratios were for CPs 5,6 and 5,7. Therefore, optimal CPs were determined to be 1-5, 6, and 7-10 for mild, moderate, and severe pain, respectively. Patients with severe pain had poorer scores on all QOL domains compared to those with mild pain. Conclusions Pain scores should be classified as 1-5 for mild pain, 6 for moderate pain, and 7-10 for severe pain. Further studies should investigate the utility of combining these categorizations with QOL indicators.

eP070 EFFICACY AND SAFETY OF OXYNORM® COMPARED TO MORPHINE SULFATE ADMINISTERING THROUGH IV CONTINUOUS INFUSION IN MODERATE-SEVERE CANCERRELATED PAIN H.S. Oh1, K.H. Lee2, J.H. Kang3, M.K. Choi4, B.Y. Shim5, Y.J. Eum6, H.J. Park6, J.H. Kang7 1 Gangneung Asan Hospital - University of Ulsan College of Medicine, Internal medicine, Gangneung, Republic of Korea

Support Care Cancer (2017) 25 (Suppl 2):S21–S266 2 Yeungnam University Hospital, Hematology/Oncology, Daegu, Republic of Korea 3 Gyeongsang National University Hospital, Internal Medicin, Jinju, Republic of Korea 4 Chungbuk National University Hospital, Internal Medicine, Cheongju, Republic of Korea 5 St. Vincent's Hospital, Medical Oncology, Suwon, Republic of Korea 6 Mundipharma Korea LTD, Medical affairs, Seoul, Republic of Korea 7 Seoul St. Mary's Hospital, Medical Oncology, Seoul, Republic of Korea

Introduction Oxycodone is a semi-synthetic opiate alkaloid derived from the opioid alkaloid thebaine. Oxycodone is a full opioid agonist with affinity for mu and kappa receptors (1, 2). A number of clinical studies compared oxycodone with morphine/fentanyl have been conducted. (3-5). Studies have been carried out for intravenous pain control treatment for cancer patients, but further data is needed for Asian cancer patients. Objectives To compare the efficacy and safety after administration of OxyNorm® (oxycodone hydrochloride) or morphine with IV continuous infusion in Korean patients with cancer-related pain. Methods This was a 5 day, randomized, open-label multi-centre non inferiority study. 8 subjects were randomized to receive either morphine or oxycodone as continuous infusion. All subjects had the efficacy assessments, which are evaluated by numeric rating scale (NRS), Patient Global Impression of Change (PGI-C), Clinical Global Impression of Change (CGI-C), total dose consumption, and adverse events assessment. Results Changes in mean pain score from baseline on day5 were statistically significant for both groups (-3.29 ± 2.17 points, p<0.0001 in the study group and - 3.17 ± 1.85, p<0.0001 in the control group). However, the change between each group was not statistically significant( p = 0.9612). Changes in the highest/current/mean pain scores (NRS) from baseline to day1, 2, 3, 4 and 5 were similar. Total dose consumption, PGI-C and CGIC were similar between each group. The incidences of adverse events had no statistically significant difference. Conclusions OxyNorm® and morphine sulfate showed equivalent analgesic efficacy and safety profiles for cancer pain in Koreans

eP071 EVALUATION OF THE ANALGESIC EFFECT RELATED TO THE LASER THERAPY: A PRE-CLINICAL STUDY G. Ottaviani1, F. Celsi2, L. Zupin2, S. Crovella2, K. Rupel1, M. Gobbo1, R. Di Lenarda3, S. Zacchigna3, M. Biasotto1 1 University of Trieste, Dental School - Oral Medicine and Pathology, Trieste, Italy 2 Institute for Maternal and Child Health IRCCS Burlo Garofolo, Immuno-genetics group, Trieste, Italy 3 University of Trieste, Department of Medical- Surgical and Health Sciences, Trieste, Italy Introduction In oncological patients, affected by oral mucositis (OM), pain worsens the quality of life, often requiring high doses of analgesic drugs, and could lead to the halting of the therapies, with significant negative impact on their cancer prognosis. Moreover, supportive care and pain management due to OM has significant economic impacts: LT represents an excellent resource as supportive therapy with direct implication for improving cancer patient care. Objectives Despite the increasing number of studies confirming the analgesic property of LT, the molecular targets on which laser light exerts its action have

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not been elucidated yet. Through a pre-clinical approach we analyzed the analgesic property of laser therapy in order to optimize pain management in oncological patients. Methods Primary culture of neurons from dorsal root ganglion derived from C57BL/6 mice was employed for the experiments as an in vitro model of sensory neurons. Cells were irradiated with two laser protocols: L1 and L2. One and 24 hours later the effect of irradiation on ERK protein activation was analyzed trough the analysis of protein phosphorylation (Western Blot and immunofluorescence). TRPV1 expression was measured using immunofluorescence. Results After laser exposure, TRPV1 expression and the phosphorylation of ERK, reached a statistically significant increase. Conclusions Both ERK and TRPV1 are two molecules potentially correlated with pain signalling pathways. In the present work two different laser therapy protocols were able to affect the sensorial neurons possibly influencing nociception. Specifically, we observed an increased phosphorylation of ERK using L2 protocol and an increased expression of TRPV1 using L1 protocol.

eP072 PROFICIENCY OF NURSE PRACTITIONER ASSESSMENT IN O U T PAT I E N T PA L L I AT I V E R A D I O T H E R A P Y: A PROSPECTIVE DESCRIPTIVE STUDY H. Rabel1, A. Fairchild2, T. O'Rourke1, W. Duggleby1, S. Ghosh3, E. Pituskin1 1 University of Alberta, Nursing, Edmonton, Canada 2 University of Alberta, Medicine, Edmonton, Canada 3 University of Alberta, Biostatistics, Edmonton, Canada Introduction Palliative radiotherapy (PRT) is a common and effective therapy for painful bone metastases. However, such referrals are often urgent, making timely access to a radiation oncologist (RO) challenging, and prolonging devastating symptoms for the patient (PT). We hypothesized that an experienced nurse practitioner (NP) may contribute to efficient and expert holistic assessment in this area of high PT need. Objectives To prospectively evaluate symptom burden and functional status in advanced cancer PTs referred for PRT assessed by a NP or RO. Methods Serial PTS attending a PRT clinic were randomly assessed by RO or NP, utilizing history, examination and validated tools (Edmonton Symptom Assessment System [ESAS]; Karnofsky Performance Status [KPS]; and Palliative Performance Status [PPS]) to determine eligibility for PRT. Those assessed by trainees were excluded. PT data were prospectively entered in an ethics-approved database. Results From 1 January 2008 to 31 December 2010, 235 patients were assessed, 98 by the RO and 137 by the NP. Of all baseline ESAS symptoms, no significant difference existed between PTS assessed by NP compared to RO. Similarly, baseline KPS and PPS was not significantly different between groups. 72/98 PTS (73%) assessed by RO received PRT, 108/137 (79%) assessed by NP received PRT, not significant. Conclusions Our results show an experienced NP is proficient in assessing PTS with advanced cancer and complex symptoms referred for PRT. Such advanced providers may improve clinic efficiency, enhance timely access to PRT and attenuate burden of suffering for PTS. Our findings warrant replication in other settings.

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eP073 P S O A S M Y O FA S C I A L PA I N : I M P O RTA N C E A N D RELEVANCE IN ABDOMINAL TUMOURS R. Ramanjulu1 1 Cytecare Cancer Hospital, Pain and Palliative Care, Bangalore, India Introduction Psoas muscle spasm is an easily missed diagnosis. It is important to consider this condition as a part of the differential diagnosis for patients with abdominal tumours presenting with low back ache. Symptoms caused by psoas muscle spasm might mimic other musculoskeletal and visceral causes of pain due to its close proximity to the kidneys, ureters, pancreas, appendix, sigmoid colon, lumbar lymph nodes and nerves. Symptoms include pain in the lumbosacral region, pain radiating to the groin and anterior aspect of the thigh and difficulty in achieving a full erect posture. Objectives This report is to emphasise the importance of considering psoas muscle spasm in the differential diagnosis of pain in patients with abdominal tumours. Examination of the psoas needs to be included as a part of assessment of such patients to help identify this entity. Methods Patients were referred to pain and palliative care for unresolved low back pain. A thorough assessment of the musculoskeletal system identified psoas muscle spasm as the underlying cause. In addition to medications, interventions to release the spasm were performed. Details will be presented at the conference. Results Significant improvement in mobility due to easy posture change, thus improving performance status and quality of life of the patient. Conclusions Primary role of the psoas muscle is hip flexion. Psoas muscle spasm leads to compensation in posture during erect. Untreated, will potentially cause additional restricted mobility and performance status, thus decrease in quality of life. Early diagnosis in patient would help in appropriate management.

eP074 ANALGESIC EFFECT OF BENZYDAMINE HYDROCHLORIDE IN PAIN ASSOCIATED WITH ORALM U C O S I T I S I N PAT I E N T S T R E AT E D W I T H RADIOTHERAPY WITH OR WITHOUT CHEMOTHERAPY: ANALYSIS FROM A PROSPECTIVE RANDOMIZED TRIAL M. Rastogi1, A. Gandhi1, S. Nanda1, R. Srivastava2, K. Chufal3, M. Azam1, C. Prakash1 1 Dr.Ram Manohar Lohia Institute of Medical Sciences, Radiation Oncology, Lucknow, India 2 SIPS, ENT, Lucknow, India 3 Batra Hospital & Research Centre, Radiation Oncology, New Delhi, India Introduction We earlier reported the efficacy of Benzydamine (BZD) in reduction of oral mucositis rates in head and neck cancer (HNC) patients for radiation doses (>50 Gray). Objectives This analysis reports analgesic effects of BZD from the same study. Methods 120 patients of HNC with planned radiation doses of =>60 Gray were randomized to Group A (control radiotherapy alone), Group B (study radiotherapy alone), Group C (Control chemo-radiotherapy) or to Group D (study chemo-radiotherapy). Group A and C were advised saline mouth rinses and in Group B and D additional BZD rinses were advised. Pain was graded as

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per CTCAE version 4.0 (common terminology criteria for adverse events). Severe pain was defined as a numeric rating scale (NRS) of >5. Results Patient characteristics are in table 1.

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correlated with difficulty sleeping, worrying, difficulty concentrating, and feeling sad, nervous or irritable (p<0.001). Of the 60 patients reporting severe pain (≥3/4), its site was identified in 53 (88.3%); most commonly oropharynx (29.7%), head (18.9%), abdomen (14.9%) and musculoskeletal (12.2%). Only 1.1% (4/362) of the cohort was referred for symptom control over the month prior to or following assessment. Conclusions Pain is frequent and distressing in patients with newly-diagnosed or relapsed AL. Further research is needed to assess the efficacy of supportive care interventions in this population.

eP076 QUALITY OF LIFE IN PATIENTS WITH HEAD AND NECK CANCER DURING EARLY RADIOTHERAPY

The median duration of Grade 3 pain in Group B versus Awas 5 versus 11 days (p=0.03) and Group D versus C was 8 versus 12 days (p=0.06) respectively. Need of additional analgesic in Group B versus A were 25% versus 60%; p=0.029; the need of step 3 WHO pain medications were 10% versus 25%; p=0.04 and median time from initiation of radiation and first requirement of analgesic medication was 21 versus 12 days (P=0.046) respectively. When comparing Group D versus C, numerically the pain parameters were lesser but all p>0.05. Conclusions BZD significantly reduces pain associated with OM even at doses >50 Gray in HNC patients. However, more potent analgesics (viz. morphine gargles) may be required in patient undergoing chemo-radiotherapy.

eP075 PAIN IN PATIENTS WITH NEWLY DIAGNOSED OR RELAPSED ACUTE LEUKEMIA: CHARACTERISTICS AND PREDICTORS A. Shaulov1, G. Rodin1, A. Rydall1, G. Popovic1, A. Schimmer2, L.W. Le3, C. Zimmermann1 1 Princess Margaret Cancer Centre- University Health Network, Department of Supportive Care, Toronto, Canada 2 Princess Margaret Cancer Centre- University Health Network, Department of Medical Oncology and Hematology, Toronto, Canada 3 Princess Margaret Cancer Centre- University Health Network, Department of Biostatistics, Toronto, Canada Introduction Prevalence, correlates and causes of pain in patients with acute leukemia (AL) have not been well studied. Objectives To assess characteristics and predictors of pain in patients with newlydiagnosed or recently relapsed AL. Methods Patients completed the Memorial Symptom Assessment Scale (MSAS). Demographics, disease and treatment variables were recorded. Two raters completed chart reviews in duplicate for patients with severe pain to assess its site. Results 362 patients were recruited from January 2008-October 2013: 249 (68.8%) with AML, 80 (22.1%) ALL and 33 (9.1%) APL. Of these, 326 (90.1%) were newly-diagnosed and 346 (95.6%) received chemotherapy. Of 360 who completed the MSAS, pain was reported in 174 (48.3%), of whom 34.4% scored ≥3/4 on severity, 43.1% on frequency, and 44.3% on painrelated distress. On multivariable analysis, pain was associated with younger age (OR 1.02, p<0.001) and ALL diagnosis (OR 1.43, p<0.05); illness duration and treatment intensity were not associated with pain. Pain was

A. Schaller1 1 Linköping University, Division of Community Medicine- Department of Medical and Health Sciences- Faculty of Health Sciences- Pain and Rehabilitation Centre- County Council of Östergötland, 581 83 Linköping, Sweden Introduction Individuals with head neck cancer (HNC) have a potentially severe diagnosis and often suffer from tumor-related pain as well as from adverse side effects of treatment such as radiotherapy. Knowledge about quality of life (QoL) during early radiotherapy in this group is limited and should be assessed in connection with diagnosis and treatment. Objectives This study identifies potential factors that may influence QoL in patients with HNC during the early stages of RT. We hypothesized that pain intensity, pain interference, catastrophizing, and mood disturbance correlates with QoL during early radiotherapy. Methods In this study, 54 patients (53% of eligible patients) were consecutively included from the regular flow to the Pain and Rehabilitation Center at Linköping University. The patients completed self-reported questionnaires on demographics, pain intensity, pain interference, anxiety, depression, pain catastrophizing, and QoL. Results The patients scored high for QoL, low for pain intensity, and low for pain interference, and the patients reported no clinical depression or anxiety. Regression analyses showed that pain intensity and depression negatively influenced quality of life. Conclusions During early RT, patients with HNC constitute a relatively low affected group with minor physical and psychological impairment. This positive outcome might be related to adequate health care system with improved efficiency of therapies and subsequent expectations of favorable prognosis. Early screening for pain and depression in a targeted preventive strategy might maintain QoL during the course of the disease; however, this assumption needs to be investigated further.

eP077 KNOWLEDGE AND ATTITUDE OF BACHELOR LEVEL N U R S I N G S T U D E N T S R E G A R D I N G C A N C E R PA I N MANAGEMENT: A CROSS-SECTIONAL STUDY B. Sharma1 1 National Academy of Medical Sciences NAMS- Bir Hospital Nursing Campus, Nursing, Kathmandu, Nepal Introduction Pain is the worst human experience, if left undiagnosed and untreated, it may negatively affect the quality of life of an individual. For the

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successful pain assessment and management nurses require sufficient knowledge and appropriate attitudes regarding pain Objectives To determine the knowledge and attitudes regarding cancer pain management among Bachelor nursing students studying in Government College in Nepal. Methods The descriptive, cross-sectional survey conducted with convenient sample of 47 students. Knowledge and Attitudes Survey Regarding Pain was used. Data were analyzed by descriptive statistics. Results The results showed, mean score of knowledge was 23 out of 37 (62.24% out of 100%). Less than half of the students (45%) recognized patients have pain even when vital signs are stable; respiratory depression rarely occurs while receiving stable opioid dosage; usual duration of 1-2 mg morphine IV is 4-5 hours; recommended route of opioid is oral for patients with persistent cancer related pain. More than 80 % students have agreed, patients should not be encouraged to endure pain; there is no role of placebo for active pain management. About 100 % of students agreed sedation assessment is recommended to prevent opioid-induced respiratory depression; opioid doses should be adjusted in accordance with individual patient’s response. Conclusions In general students have average knowledge and positive attitudes towards cancer pain management. Knowledge on pain pharmacology items was lower than that of non-pharmacology items. Study underlines need for review of curricula for in-depth and up-to-date pharmacological pain management and incorporates evidence-based research.

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eP079 DO PATIENTS WITH CANCER PAIN ACHIEVE COMPLETE PAIN RELIEF FROM OPIOID THERAPY: RESULTS OF A SYSTEMATIC LITERATURE REVIEW P. Sloan1 1 Lexington, USA Introduction Opioids are the mainstay of treatment for cancer pain.1,2 Cancer patients are encouraged to titrate opioid analgesics to become pain-free. 3 Despite unlimited availability to opioids, patients often do not titrate themselves lower than pain scores of 30/100 on a visual analog scale. 4 This suggests that, on average, patients are not achieving pain free status, and the etiology of this findiing is unclear. Objectives The objective of investigation was to systematically review all published clinical opioid trials in cancer pain patients to assess patient pain scores and determine if pain free status was achieved in the majority of patients. Methods A digital review of the English language scientific literature encompassed all published papers to January, 2015. Keywords searched included: cancer pain, opioids, pain scores, and analgesia; which produced 905 potential papers. Each title was then reviewed for a clinical trial of opioid therapy for cancer pain, resulting in 180 possible papers. Results The literature revealed 62 papers of eligible trials of opioid therapy for cancer pain (Table 1). A total of 5,251 patients were counted across all studies. The weighted mean pain score at the start of opioid therapy across all studies was 5.4 (0=no pain; 10=worst possible pain), and at the end of trials was 2.7.

eP078 PULSED RFA OF SPHENOPALATINE GANGLION FOR FACIAL PAIN IN CANCER RELATED PAIN: A PROSPECTIVE STUDY R. Ramanjulu1 1 Cyte Care Hospital, Dept of Integrated Oncology, Bangalore, India Introduction Pain is present in up to 80% of patients with cancer of the head and neck. Pulsed radiofrequency ablation is relatively new use of an older procedure, conventional thermal radiofrequency. Objectives This study was designed to analyze the effectiveness of PRFA of sphenopalatine ganglion for severe pain in the orofacial region in advanced head and neck cancer pain patients on oral morphine or fentanyl patch with or without adjuvant and to assess the quality of life before and after radiofrequency ablation. Methods 20 consecutive consenting patients were enrolled into the study and were divided into two equal groups of 10 patients each. One group received pulsed radiofrequency (group p) after a positive diagnostic block and other group was given a diagnostic block followed by alcohol neurolysis (group A). The pain intensity, percentage of pain relief, analgesic consumption, breakthrough pain, changes of any medication, side effects were recorded in each visits. Results Pain score (VRS) decreased in both the groups but statistically significantly in PRFA group (group p) on 2nd day onward (1.4 vs 2.1 at 1 week, 2.2 vs 2.6 at 1 month, 1.8 vs 2.8 at 3 month and 2.6 vs 3.1 at 6 month. all the patients experienced relief of pain and found to be statistically significant (p value<0.05). analgesic consumption was decreased in both the groups. Karnofsky score improved from the baseline of 60 to 90 subsequently in both groups. Conclusions Pulse radio frequency ablation and alcohol neurolysis of sphenopalatine ganglion can be done for effective management of cancer facial pain.

Conclusions Cancer pain patients do not titrate themselves to 0/10 relief despite unlimited access to opioids, and in spite of the stated goal of opioid therapy being complete pain relief. The mean pain score for patients treated for cancer pain is higher than what healthcare providers would recommend.

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eP080 A SUCCESSFUL INTERDISCIPLINARY COOPERATION BETWEEN NEUROSURGERY AND PALLIATIVE CARE IN THE TREAMENT OF INTRACTABLE ONCOLOGICAL PAIN I. Strauss1, R. Tellem2, U. Hochberg3, M. Arad4 1 tel aviv medical center, neurosurgery, Tel-Aviv, Israel 2 tel aviv medical center, palliative care, tel aviv, Israel 3 tel aviv medical center, pain service, tel aviv, Israel 4 tel aviv medical center, palliaitve care, tel aviv, Israel Introduction There is a great importance to deliver good pain management to cancer patients suffering from advanced disease. There are selected patients for whom pharmacotherapy does not achieve acceptable pain relief or is limited by side effects. These patients, may benefit from neurosurgical procedures that selectively intervene along the pain processing pathways. Patients with localized pain can benefit from selective percutaneous cordotomy, while patients with diffuse pain are candidates for stereotactic radiofrequency cingulotomy. Careful selection is critical for the success of these procedures. In the last year we have established a specialized service consisting of palliative care specialists, pain specialists and a neurosurgeon specifically for this task. Objectives To present our experience in interdisciplinary evaluation of cancer patients undergoing neurosurgical interventions for intractable pain. Reviewing clinical considerations guiding the choice of the therapeutic approach. Methods Retrospective review of all patients who were evaluated and operated for intractable oncological pain. Results Nineteen cancer patients suffering from intractable pain due to metastatic disease were selected for neurosurgical intervention. 10 patients with localized pain underwent percutaneous selective cordotomy and 9 patients with diffuse pain underwent bilateral stereotactic cingulotomy. 14 of the 19 operated patients achieved good sustained pain relief (73.5%). We had no procedural related mortality. There was 1 operative complication of mild hemiparesis after cordotomy. 2 patients who developed transient apathy after cingulotomy. There was a high degree of satisfaction among patients and families from the procedures. Conclusions In carefully selected patients, evaluated by a interdisciplinary palliative care team, neurosurgical procedures can produce significant pain relief.

eP081 URINE DRUG SCREEN FINDINGS AND SUBSEQUENT OPIOID MANAGEMENT AMONG AT-RISK ONCOLOGY PATIENTS IN A SUPPORTIVE CARE CLINIC J. Tsukanov1, E. Del Fabbro1, D. Noreika1, B. Cassel1, N. Skoro1 1 Virginia Commonwealth University, Hematology- Oncology- and Palliative Care, Richmond, USA Introduction Although professional organizations provide no guidelines regarding assessment and management of opioid abuse risk in oncology patients, there are increasing concerns about substance abuse and diversion. The role of Urine Drug Screens (UDS) in identifying substance abuse and influencing subsequent management in cancer pain is uncertain. Objectives Describe UDS findings and subsequent changes in opioid management therapy in an outpatient supportive care clinic Methods A retrospective chart review of 173 consecutive oncology patients. UDS was ordered on 49 (28%) patients at-risk for substance misuse based on

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one or more criteria: aberrant behavior; a past history of substance abuse, or ‘positive‘ CAGE-AID screening questionnaire. Urine opioids, benzodiazepines, heroin, cocaine, cannabis and amphetamines were measured by mass spectroscopy assay. Results 69% (34/49) of UDS were abnormal and 97 % (33/34) had subsequent opioid changes. Prescribed opioids were absent/abnormally low in 13/34 (38%); 44% had non-prescribed opioids; 61% were positive for illicit substances, cocaine most common. Management changes included decreasing opioids (48%, 16/33); switch to methadone (32%); switch to extended- release opioids (17%). 66% (10/15) of normal UDS patients underwent similar medication changes. Odds ratio of opioid change was 16.5 times in UDS positive patients (95% CI 1.72 to 158.22; p=.0151). Conclusions Active substance misuse was identified by UDS in > two thirds of ‘atrisk’ patients. Changes in opioid management were more likely in abnormal compared to normal UDS patients. UDS may influence decision making and opioid prescribing in at-risk supportive care patients.

eP082 USING EXTERNAL BEAM RADIATION TREATMENT AS AN ADJUNCT IN RADIUM-223 TREATMENT V. Ganesh1, A. Agarwal1, S. Vuong1, T. Barakat1, M. Borean1, A. Wan1, E. Chow1 1 Odette Cancer Centre - Sunnybrook Health Sciences Centre - University of Toronto, Radiation Oncology, Toronto, Canada Introduction Castrate-resistant prostate cancer (CRPC) commonly metastasizes to the bone, afflicting 90% of these patients. Radium-223 dichloride (223Ra) has proven promising in the treatment of CRPC patients, prolonging life and reducing bone-turnover systemically. However, many patients undergoing 223Ra treatment require further palliation of pain. External beam radiation treatment (EBRT) may therefore be used in between 223Ra injections to provide accelerated pain relief. This can allow patients to continue their 223Ra regimens and gain its associated benefits (i.e., improved overall survival, and delayed time to PSA progression or skeletalrelated events). Objectives To report the case of a 65-year-old male whose pain persisted after his first cycle of 223Ra, and was successfully treated with a single fraction of EBRT. Methods A retrospective chart review was conducted. Results The patient was diagnosed with prostate cancer in 2013. In 2015, he received the first dose of 223Ra but reported severe pain in his right ischium in 2015 and was referred to the Rapid Response Radiotherapy Program (RRRP). Imaging results revealed significant sclerotic bone lesions. The patient subsequently delayed his second 223Ra injection and underwent a single fraction of EBRT at a dose of 8Gy. He received significant pain reduction ten days post-EBRT, and resumed 223Ra treatment. Conclusions The clinically significant benefits observed with both treatments support the use of EBRT as an adjunct therapy with 223Ra.

eP083 GENETIC BIOMARKERS ASSOCIATED WITH PAIN FLARE AND DEXAMETHASONE RESPONSE FOLLOWING PALLIATIVE RADIOTHERAPY IN PATIENTS WITH PAINFUL BONE METASTASES A. Furfari1, A. Wan1, A. Wong2, K. Ding3, A. Bezjak4, R. Meyer5, R. Wong4, C. Wilson3, C. DeAngelis6, A. Azad2, E. Chow1, G. Charames2

Support Care Cancer (2017) 25 (Suppl 2):S21–S266 1 Odette Cancer Centre - Sunnybrook Health Sciences Centre - University of Toronto, Radiation Oncology, Toronto, Canada 2 Mount Sinai Hospital- Toronto, Pathology and Laboratory Medicine, Toronto, Canada 3 Cancer Research Institute- Queen's University, Canadian Cancer Trials Group, Kingston, Canada 4 Princess Margaret Cancer Centre, Radiation Medicine Program, Toronto, Canada 5 Juravinski Hospital and Cancer Centre, Department of Oncology, Hamilton, Canada 6 Odette Cancer Centre - Sunnybrook Health Sciences Centre - University of Toronto, Pharmacy, Toronto, Canada

Introduction In patients who receive palliative radiation therapy (RT) for painful bone metastases, 40% experience a transient increase in pain known as a pain flare (PF). Prophylactic dexamethasone has been shown to reduce PF incidence to 25%. Objectives To identify DNA biomarkers associated with PF and dexamethasone response. Methods Patients receiving a single 8 Gy RT for painful bone metastases (n=69), and patients receiving prophylactic dexamethasone in addition to RT (n=34) recorded daily pain levels. To identify single-nucleotide variants (SNVs), patient saliva samples obtained at day of RT were sequenced for 4813 disease-associated genes, then filtered and tested for statistically significant associations with PF or dexamethasone response. Results PF occurred in 26 patients receiving RT only, and 15 patients on prophylactic dexamethasone. Thirty-two variants were associated with PF (n=26), including rs72655982 C/T (p=0.003) and rs72655988 G/A (p=0.003) in DNAH11, and rs28404221 G/A in UGT2A1/2 (p=0.003). Twenty variants were associated with no PF (n=43), including NPAS2 rs11541353 C/T (p=0.02), APOA5 rs3135506 (p=0.02), and RMB28 rs117445229 C/T (p=0.02). Variants associated with PF despite prophylactic dexamethasone include EPHB6 rs8177173 G/A (p=0.004), and FGFRL1 rs4647932 C/T (p=0.007). Fifteen variants were associated with response to dexamethasone (n=29), including UMPS rs1801019 G/C (p=0.006) and MYBPC3 rs3729989 T/C (p=0.01). Conclusions Significant SNVs associated with PF were found in metabolic (APOA1, UGT2A1/2), circadian rhythm (NPAS2), and splicing (RMB28) genes. SNVs associated with dexamethasone response include metabolism (UMPS) and cancer signaling (EPHB6, FGFR1) genes. Identification of SNVs predictive of pain flare and dexamethasone response enables targeted prophylactic therapy according to a patient’s predisposed response.

eP084 THE COST DIFFERENCES BETWEEN CONVENTIONAL RADIOTHERAPY AND SHORT-SCHEDULED INTENSITY MODULATED RADIOTHERAPY IN BONE METASTASES UNDER PUBLIC-ASSISTED HEALTH INSURANCE COUNTRY Y.K. Won1, D.S. Lee1 1 Uijeongbu St Mary's hospital - Catholic University Medical College, Radiation oncology, Uijeongbu-si- Gyeonggi-do, Republic of Korea Introduction Conventional external beam radiotherapy (RT) has used in cancer patient with bone metastases. Fractionated schedule with 30 Gy/10 days is generally used. Intensity modulated RT (IMRT) technique is able to shorten RT schedule by 1-5 days schedule with improved local control and pain relief. However, IMRT has higher reimbursement compare to conventional RT.

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Objectives The purpose of this study was to assess the cost difference between conventional RT and short-scheduled IMRT and effectiveness of increased IMRT reimbursement for the patient with bone metastases under the public-assisted health insurance system. Methods We compared the reimbursement by national health insurance of four possible treatment schedules for palliative treatment (10-fraction conventional RT versus 5-fraction IMRT, fractionated SBRT, and single-time SBRT) and consider cost and opportunity cost of admission. A Markov model is used for cost-effectiveness analysis. Results Average reimbursement of 4 treatment schedule were 796$, 2830$, 2974$, and 1919$ in South Korea. Comparing to other countries, the reimbursement of IMRT and SBRT was relatively under-estimated due to inappropriate cost adjustment. Assuming the short-schedule IMRT and SBRT shows higher pain control as 12 % (76 % vs 88 %), short-schedule IMRT and SBRTwere favored over $50,000 per quality-adjusted life year. If adding the reimbursement of increased hospital admission days, which counts 350$, short-schedule treatment were favored most of scenarios. Early discharge was another advantage for patients and utilization of the hospital Conclusions In South Korea, short-scheduled IMRT could be adequate treatment option for cancer patients. The result emphasized the importance of adequate pricing of the novel treatment technique.

eP085 CLINICAL EQUIVALENCE WITH G-CSF BIOSIMILARS: METHODOLOGIC APPROACH IN A (NEO) ADJUVANT SETTING IN NON-METASTATIC BREAST CANCER A. Krendyukov1, M. Schiestel2, N. Höbel1, M. Aapro3 1 Hexal AG, Medical Affairs, Holzkirchen, Germany 2 Hexal AG, Scientific Affairs, Holzkirchen, Germany 3 Clinique de Genolier, Multidisciplinary Institute of Oncology, Genolier, Switzerland Introduction Biosimilars will improve the sustainability and affordability of cancer treatments globally. For approval, biosimilars must demonstrate they are highly similar to approved biological reference products. Approval is based on a ‘totality of evidence’ concept to confirm no clinically meaningful differences from reference product in quality, safety, purity and efficacy, demonstrated using an appropriate ‘sensitive’ population. This methodology differs from that for non-biosimilars, but must be understood for optimal biosimilar use. Objectives Explain the rationale and methodology used to demonstrate clinical equivalence of biosimilar G-CSF to reference product. Methods ‘Sensitive’ population must be representative of approved reference indication, and sensitive for detecting difference. Early breast cancer, typified by (neo)adjuvant, non-metastatic disease, is a suitable, homogeneous model population. Extrapolation to other indications of the reference product may be scientifically justified based on totality of evidence (physicochemical, functional in vitro, pharmacokinetic/pharmacodynamic and clinical studies). Results Guidelines and biostatistical considerations were used to establish clinically relevant and sensitive surrogate endpoints, justify an equivalence margin and identify a sample size powered to show equivalence (Table 1).

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Clinical equivalence of biosimilar and reference G-CSF regarding duration of severe neutropenia, febrile neutropenia/sepsis incidence, infection frequency and safety was successfully demonstrated in several RCTs in the (neo)adjuvant, non-metastatic breast cancer. Conclusions Final confirmation of biosimilarity in a sensitive population, followed by subsequent extrapolation to further indications, is a robust approach. G-CSF treatment arm with at least 86 patients is required to confirm therapeutic equivalence (power of 90%). Clinical equivalence between reference and biosimilar G-CSF can be demonstrated through the ‘totality of evidence’ concept.

eP086 UTILIZING EDUCATIONAL MATERIALS AS A MEAN FOR IMPROVING PSYCHOSEXUAL HEALTH OF BREAST CANCER WOMEN S. Abasher1 1 King Faisal University, College of Education /Psychology division, Alhassa, Saudi Arabia Introduction The psychological factors for Breast Cancer BrCa are very important, as they assist in improving the adaptation of the new situations they have to deal with. Objectives This study is to provide psycho-educa- tional materials as intervention tools in enhancing coping with the psychosexual problems faced by Sudanese BrCa women. Methods Study sample of 89 BrCa women were randomly selected to either educational group (n = 30), intervention group (n = 29), or control group (n = 30). To be eligible for the study, women were married, sexually active with their husbands, and inhabitant in Khartoum state during the implementation of the study. Two scales were been filled by all the participants as measurements for this study and those are: Watts Sexual Function Questionnaire (WSFQ) which measures and provides a total sexual function score and subscale score for desire, arousal, orgasm and satisfaction. Hospital Anxiety and Depression Scale (HADS) is the other measurement that used in this study. Results Significant difference has been found in regard to HADS and WSFQ preand post-test analysis for the experiential group. Women assigned to the educational materials group had significant higher posttest scores on both HADS and WSFQ scales than women assigned to psychosexual intervention program. Conclusions It is in generally difficult for health-care providers to detect problems and hence to intervene. Information giving in form of educational materials goes beyond the period of treatment as many patients continue to have problems and need to be preparing for handling them.

eP087 EFFECTS OF SUPPORTIVE CARE IN TERMINALLY ILL CANCER PATIENTS AT THE OBAFEMI AWOLOWO TEACHING HOSPITAL NIGERIA O. Agboola1 1 Obafemi Awolowo University Teaching Hospital -nigeria, Gynae Oncology, Ile Ife, Nigeria

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Introduction It cannot be over emphasised that cancer and its destructive effects are very much in developing countries like Nigeria,the scourge and its ravaging effects have long been a recurring decimal, Supportive care in cancer is aimed at improving quality of life of cancer patients and provide comfort this discipline is relatively new in my country, patients with cancer diagnosis face a great deal of hardship during diagnosis and treatment thus supportive care is needed to provide comfort and improved quality of care of patients. Objectives The study considers the general approach to supportive care of cancer patients attending the hospital by health workers and seek to give improved supportive care to reduce anxiety and fear of patients as much as possible offering psychological, social and emotional support. Methods Fifty consenting patients with breast, cervical, colon, and prostrate cancers attending the hospital were recruited into the study primary source of data were used to obtain substantial information through personal interviews on the challenges, fear and expectation of the patients, clear and substantial information were given to them using clear and simple language as most patients were illitrate, allowing them to verbalize their fears counselling were done, families and loved ones were involved in decision making, psychological support given, home visits done and last wishes of patients were met as much as possible. Results The interventions reduced the fear, anxiety usually expirienced by patients because they opened up discuss their fears and anxiety and nurseclient-relative was established. Conclusions Supportive cancer care is a holistic approach that improves quality of life of patients facing terminal cancer.

eP088 IMPLEMENTATION OF FATIGUE MANAGEMENT MODEL TO QUALITY OF LIFE IN CHILDREN WITH CANCER: INDONESIA EXPERIENCE A. Allenidekania1, E. Nurachmah2, Y. Rustina3, T. Eriyando4 1 Universty of indonesia, Pediatric Nursing, Depok, Indonesia 2 University of Indonesia, Medical Surgical Nursing Department, Depok, Indonesia 3 University of Indonesia, Pediatric Nursing Department, Depok, Indonesia 4 University of Indonesia, Faculty of Public Health, Depok, Indonesia Introduction Children with cancer benefit from the fatigue management education to increase their quality of life, however limited data to children in Indonesia Objectives This research aims to measure the effectiveness of fatigue management education to quality of life among children with cancer. Methods Quantitative methods using repeated measure applied to two groups. Fatigue management model focused on self-efficacy mothers of children with cancer Fatigue management education consisted of six topics (pain management, nutrition management, sleep hygiene, anxiety management, light exercise and energy conservation) were given to intervention group. The control group received nursing care standard. Intervention group consisted of 43 children undergoing cancer therapy, 38 children assigned to control group. All samples recruited by consecutive sampling techniques in three cancer centers in Jakarta and West Java. Samples were measured four times for T0 (pre education), T1 (week 1), T2 (week 3), and T3 (week 5) for quality of life using PedsQl fatigue multidimensional scale, PedQl generic scale and PedsQl cancer module.

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Results Characteristics children in two groups were mostly boys, diagnosed ALL, and children were undergoing chemotherapy, After T3 (week 5) children with cancer in the intervention group decreased their fatigue score, better quality of life for generic and cancer module compare to control group. Child’s age be a factor that contribute to quality of life for generic and cancer module. Conclusions Fatigue management model focused on self-efficacy mothers of children with cancer is effective declining multidimensional fatigue, improving quality of life for cancer and quality of life for generic in children with cancer.

eP089 GOOD FUNCTIONING OF MANY SUBSTANCES TO KILL CANCER CELLS IN HUMANS AND THE ARRIVAL OF AN EFFECTIVE DRUG H. Ambroise1 1 Institut Cerveau du Monde ICERMO, West, Port-au-Prince, Haiti Introduction The Medical Science claims that many substances kill cancer cells in the laboratory or in animals but do not work well in humans. To solve this problem, we will apply "THE LAW OF THE SAME PLACE". That's why this year's conference is really special, important and urgent for us in terms of accumulating more knowledge to better fight cancer and then bringing more discoveries into the medical world, especially an effective cancer drug. To be done, I need your knowledge, wisdom and intelligence. Because only we go faster, together we go further. Objectives 1-Allow substances to work wonderfully in humans for a complete cure. 2-Find an effective drug to fight cancer. 3-Cooperate with MASCC in mutual agreement to experiment our research, because the lack of equipment prevents us to verify our discoveries. Methods Imagination and intuition. N.B Because the lack of equipment prevents us to verify our discoveries, but we think to have solution for that with MASCC/ISOO. Results Provide education and an effective drug and eliminate cancer cells in humans. Conclusions A brand new page will make its appearance in the medical world for the good of humanity. For The World Great Powerful Brain Institute (WGPBI) and The Health Center and Research (HCR) will bring an effective drug to fight cancer and others diseases of the world with harmony of the ANNUAL MEETING ON SUPPORTIVE CARE IN CANCER (MASCC/ISOO)

eP090 “CANCER, SEXUAL HEALTH AND INTIMACY”: THE FIRST GENERAL GUIDELINE ON MANAGEMENT AND TREATMENT APPROACHES FOR HEALTH CARE PROFESSIONALS REALIZED BY THE FRENCH-SPEAKING AFSOS P. Bondil1, D. Habold2, F. Farsi3, E. Huyghe4, E.G. AFSOS5 1 general Hospital Metropole-Savoie, Urology-Andrology, Chambery, France 2 general Hospital Metropole-Savoie, Supportive Cancer Care, Chambery, France 3 Reseau Espace Sante Cancer, Reseau Regional de Cancerologie, Lyon, France 4 centre Hospitalier Universitaire, Urology-Andrology, Toulouse, France 5 Association Francophone Soins Oncologiques de Support, groupe expert cancer et sexualite, Paris, France

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Introduction Knowledge and skills gaps concerning oncosexuality require a careful effort of information/training adapted to different health professionals (HCPs) during the cancer care continuum (CCC). Objectives To set up a specific clinical practice guideline (CPG) on “Cancer, sexual health and intimacy”: a) to integrate this care dimension into daily practice, b) to share a common language and clinical judgment aiming to detect and distinguish simple/complex problems; c) to organize the prevention/treatment of sexual dysfunctions at each CCC stage, d) to clearly define the role and field of HCPs. Methods This CPG concerns exclusively non reproductive sexuality and outlines the minimum pre-requisite that each HCP must know regardless of the primary cancer diagnosis/treatment. The development group was multidisciplinary. The peer review was realized during 2 different national workshops. Results a) difficulty of evidence reviews owing to the absence of transversal guidelines, b) development mainly based on a strong expert/ professional consensus as this multi-thematic topic cannot be analyzed using other recommended methods, c) limited scientific data explaining its level rating (D grade 3), d) true clinical value as it points up several key-points as why a CPG, for whom, which cancers, for which treatments, who is involved, when to tackle it with the patient/couple, who should speak about it and how... Conclusions Owing to its real usefulness for the daily care response, its national implementation is ongoing. Rather than development de novo, its translation may serve as a relevant basis for different countries according to both their national sociocultural aspects and health systems.

eP091 HOSPICE NURSES’ EXPERIENCES OF CARING FOR TERMINAL CANCER COLLEAGUES Y. Chen1, Y.W. Chen1, S. Cheng1 1 Changhua Christian Hospital, Nursing, Changhua, Taiwan R.O.C. Introduction Colleagues are very much like extended family, if they become terminal cancer patients, it can be particularly knotty to professional helper. As professionals’ age, gender, characteristics, and job attributes is consistent with patients, who unconsciously project inner thoughts and feelings onto patients in the relationship. Objectives The objectives of this study are to explore the experiences of caring for terminal cancer colleagues. Methods Semi-structured, open-ended interviews were conducted with thirteen hospice nurses who are women and work over two years in the unit from a medical center in central Taiwan. Results Hospice nurses experience complicated feelings, which are divided into three themes — sadness and powerless emotion, professional self-doubt, and intimate or alienated nurse-patient relationship. Sadness and powerless emotion showed that it is not easy to treat the colleague as a patient. If pain and suffering of patient have not been relieved, it could afflict nurses feeling helpless and guilty. Professional self-doubt represents that nurses worry whether or not patients trust themselves, and feel uncertainly about their own abilities to provide the best care and the death issue. Intimate or alienated nurse-patient relationship indicated that because of various emotions and cognitions resulting in close or aloof intentionally. Some spend more time with the patient, others decrease interaction.

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Conclusions The study provides important information that helpers must be strongly awareness of negative countertransference reactions. It need to join selfawareness educational trainings on-going support groups and case study meetings are able vented feelings, share particular stresses and problems to maintain mutual trust relationship with terminal patients.

eP092 THE IMPACT OF BREAKING BAD NEWS ON ONCOLOGIST BURNOUT AND HOW COMMUNICATION SKILLS CAN HELP: A SCOPING REVIEW S. Cheon1, W. Fu1, A. Agarwal1, A. Wan1, E. Chow1, B. Henry1 1 Sunnybrook Health Sciences Centre, Radiation Oncology, Toronto, Canada Introduction Breaking bad news is a particularly complex communication task, and discomfort surrounding the disclosure of negative information may contribute to higher burnout rates among oncologists relative to other medical specialties. As such, improving communication skills among oncologists has been identified as an effective means to reduce burnout. Objectives To review the impact that breaking bad news may have on oncologists, and how enhancing communication skills may help reduce burnout. Methods A literature search of Cochrane CENTRAL, Ovid Embase, and Ovid MEDLINE was conducted to identify relevant studies. Studies were included if: a) the primary subjects were oncologists; b) one of the primary causes of oncologist burnout discussed was breaking bad news; and c) both the impact of breaking bad news on oncologist burnout and the effect of communication skills on burnout were reported. All non-original research, including literature reviews, editorials, and commentaries were excluded. Results Out of 106 identified hits, 4 studies were deemed eligible for inclusion. Findings suggested oncologists experienced burnout from breaking bad news to their patients, as measured on the Maslach Burnout Inventory. The overall assessment of communication skills training showed varied yet positive responses. Conclusions Burnout is frequently characterized by feelings of emotional exhaustion, depersonalization, and low personal accomplishment. Enhancing communication skills to assist in improving the way negative information is disclosed can provide oncologists with skills to mitigate stress and ultimately reduce burnout.

eP093 NEEDS ASSESSMENT OF PRIMARY CARE PHYSICIANS IN T H E C H R O N I C PA I N M A N A G E M E N T I N C A N C E R SURVIVORS R. Chow1, K. Saunders2, H. Burke3, A. Belanger4, E. Chow1 1 Odette Cancer Centre - Sunnybrook Health Sciences Centre - University of Toronto, Institute for Evaluative Clinical Sciences, Toronto, Canada 2 Seven Oaks General Hospital, Medical Director Wellness Institute, Winnipeg, Canada 3 University of Toronto and Queen's University, Lakeridge Health Corporation, Bowmansville, Canada 4 Hotel-Dieu de Levis, Hotel-Dieu de Levis, Courcelotte, Canada Introduction Cancer patients live longer with effective systemic anti-cancer therapy and supportive care. About 30% of cancer survivors (non-palliative

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cancer patients who completed treatment) suffer from chronic pain (CP), which will be managed by their primary care physician (PCP). Objectives To assess the practice patterns and treatment barriers in the management of CP in cancer survivors among PCPs. Methods A survey was sent to PCPs across Canada. Results A total of 161 responses were collected. The majority of participants were in group (59%) or solo (33%) practices, with an average of 25 years of clinical experience. 71% of PCPs were practicing in communities of 10,000 to 1,000,000 people. Respondents were treating approximately 10 cancer survivors with CP per month. The majority of PCPs (59%) reported having “little knowledge” or “some understanding” of CP management in cancer survivors. They did not usually refer these patients to other specialists. Patient comorbidities (79%), pain medication side effects (78%), previous pain treatment (76%), effect of pain on daily functioning (75%) and drug interactions (71%), were identified as factors that guided PCP treatment choices. The major barriers included medication cost (54%), concerns about opioid abuse (51%), and patient noncompliance (46%). PCPs indicated that treatment guidelines (74%), knowledge of pharmacological (64%) and non-pharmacological (62%) treatment options would help their CP management. Conclusions Most PCPs report a lack of knowledge in the management of CP in cancer survivors but are keen to receive medical education on treatment options and clinical practice guidelines.

eP094 INTER-RATER RELIABILITY OF EXAMINERS IN THE PALLIATIVE MEDICINE EXAMINATION ORGANIZED BY THE HONG KONG COLLEGE OF RADIOLOGISTS R. Chow1, L. Zhang1, I.S. Soong2, O. Mang3, L.C.Y. Lui4, K.H. Wong3, S.W.K. Siu5, S.H. Lo6, K.K. Yuen5, Y.S.H. Yau7, K.Y. Wong4, C. Leung3, S.Y. Wong6, R. Ngan3, E. Chow1, R. Yeung2 1 Odette Cancer Centre - Sunnybrook Health Sciences Centre - University of Toronto, Institute for Evaluative Clinical Sciences, Toronto, Canada 2 Pamela Youde Nethersole Eastern Hospital, Department of Clinical Oncology, Chai Wan, Hong Kong S.A.R. 3 Queen Elizabeth Hospital, Department of Clinical Oncology, JordanKowloon, Hong Kong S.A.R. 4 Princess Margaret Hospital, Department of Oncology, Lai Chi KokKowloon, Hong Kong S.A.R. 5 Queen Mary Hospital, Department of Clinical Oncology, Pokfulam, Hong Kong S.A.R. 6 Tuen Mun Hospital, Department of Clinical Oncology, Tuen Mun, Hong Kong S.A.R. 7 Prince of Wales Hospital, Department of Clinical Oncology, Shatin, Hong Kong S.A.R. Introduction The Palliative Medicine Subspecialty Board aims to train oncology specialists for palliative medicine through a 4-year accreditation program. At the end of the program, trainees undergo a Board Examination involving subjective ratings by examiners. Objectives The aim of this study was to analyze the inter-rater reliability of oral scores during the fourth Board Examination. Methods Each candidate rotated through two panels during the one-day exam – one panel involved the written dissertation and questions pertaining to symptom management (Viva 1) and the other about psychosocial issue (Viva 2) and ethics (Viva 3). They were evaluated on four occasions using a 10point scale by examiners and observers. Intra-class correlation coefficient

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was calculated to determine inter-rater reliability between examiners, between observers, and between examiners and observers. The interpretation criteria for ICC values are poor (<= 0.20), fair (0.21 – 0.40), moderate (0.41 – 0.60), good (0.61 – 0.80) and very good (0.81 – 1.00). Results Concordance among examiners was overall good at different stations. Among observers, concordance was fair to very good across different stations. Fair to moderate concordance was noted between examiners and observers at 2 stations. Across all stations, there was good concordance between examiners and observers (ICC = 0.619). Conclusions This study highlights the good inter-rater agreement at the Board Examination administered by the Palliative Medicine Subspecialty Board of the Hong Kong College of Radiologists. These findings identify the reliable nature of the examination in accrediting practitioners for subspecialty certification.

eP095 A SURVEY ON THE PALLIATIVE MEDICINE TRAINING PROGRAM ORGANIZED BY THE PALLIATIVE MEDICINE SUBSPECIALTY BOARD OF HONG KONG COLLEGE OF RADIOLOGISTS R. Chow1, L.C.Y. Lui2, R. Ngan3, S.W.K. Siu4, E. Chow1, S.H. Lo5, K.K. Yuen4, Y.S.H. Yau6, K.Y. Wong2, R. Yeung7 1 Odette Cancer Centre - Sunnybrook Health Sciences Centre - University of Toronto, Institute for Evaluative Clinical Sciences, Toronto, Canada 2 Princess Margaret Hospital, Department of Oncology, Lai Chi KokKowloon, Hong Kong S.A.R. 3 Queen Elizabeth Hospital, Department of Clinical Oncology, JordanKowloon, Hong Kong S.A.R. 4 Queen Mary Hospital, Department of Clinical Oncology, Pokfulam, Hong Kong S.A.R. 5 Tuen Mun Hospital, Department of Clinical Oncology, Tuen Mun, Hong Kong S.A.R. 6 Princes of Wales Hospital, Department of Clinical Oncology, Shatin, Hong Kong S.A.R. 7 Pamela Youde Nethersole Eastern Hospital, Department of Clinical Oncology, Chai Wan, Hong Kong S.A.R. Introduction The Palliative Medicine (PM) Subspecialty Board is a subspecialty under the Hong Kong College of Radiologists. Its mission is to provide advanced PM training for oncology specialists to hence improve the quality of palliative care for cancer patients. Objectives To review the PM training program organized by the Palliative Medicine Subspecialty Board of Hong Kong College of Radiologists (HKCR). Methods A survey among three groups of oncology specialists was carried out from January to March 2016. They were invited to rate the different aspects of the local PM training. Results Questionnaires were sent to chiefs of service (COS) of six Departments of Clinical Oncology, 20 past successful candidates of Palliative Medicine Board Examination, and 28 trainees of recent cycle (2013-2016). The response rates were 83%, 70% and 32% respectively. The COSs and past candidates recognized the value of the PM training program. They made some suggestions to improve the training. The current trainees also raised some concerns on the coursework and examination. Their opinions were reviewed in Subspecialty Board meeting and changes will be made in the coming new cycle of training in order to maximize learning experiences. Conclusions The merit of PM training program organized by the Palliative Medicine Subspecialty Board is recognized by most oncologists. Further

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improvement can be made by close supervision and guidance on the progress on coursework, encouraging related readings and active participations in international/local PM conferences. It is expected that the palliative care service for our cancer patients will be enhanced through high-quality training of our specialists.

eP096 ASSESSING THE EFFICACY OF CHAMOMILE GEL AS A PROPHYLACTIC AGENT FOR RADIATION DERMATITIS P.E. Diniz dos Reis1, E. Barros Ferreira1, C. Inocêncio Vasques1, P.S.M. Bontempo1 1 University of Brasilia, Nursing Department, Brasilia, Brazil Introduction Radiation dermatitis is common in patients treated with radiotherapy for head and neck cancer. Many topical agents are being used for the prevention and management of radiation dermatitis. However, no therapeutic option proved to be truly effective. Objectives To assess the efficacy of gel of chamomile in the prevention of acute radiation dermatitis, in head and neck cancer patients undergoing radiotherapy. Methods Mono-institutional single-arm prospective observational study. Patients were treated with radiotherapy to the head and neck cancer. Gel of chamomile was applied daily, starting on the first day and ending on the last day of radiotherapy or when occurred the development of dry desquamation. Skin assessments were performed, weekly, by nurses. Outcome measures such as erythema and the degree of radiation dermatitis were assessed using a Radiation-induced Skin Reaction Assessment Scale (RISRAS) and Radiation Therapy Oncology Group (RTOG), respectively. Common Terminology Criteria for Adverse Events (CTCAE) was used to evaluate skin symptoms like itchiness and hyperpigmentation. Results Seventeen patients used gel of chamomile. The average patient age was 52 years, and 82% were male. Thirteen patients received chemotherapy concomitant with radiotherapy. Most patients developed erythema (grade 1) at week 3 (76%). According to CTCAE, 59% (10 patients) had hyperpigmentation and 35% (6 patients) itchiness at week 3. Conclusions A prophylactic effect in the prevention of radiation dermatitis may be hypothesized, and the evaluation of gel of chamomile in a randomized clinical trial may be recommended.

eP097 BREAST CANCER AWARENESS AND SELF BREAST EXAMINATION AMONG ADULT WOMEN ATTENDING A RURAL HEALTH CENTRE IN NIGERIA Y. Fadipe1, B. Fadipe1, A. Olagunju2,3, A. Ojeyinka2 1 Lagos University Teaching Hospital, Family Medicine, Lagos, Nigeria 2 Lagos University Teaching Hospital- Lagos- Nigeria, Psychiatry, lagos, Nigeria 3 College of Medicine- University of Lagos, Psychiatry, Lagos, Nigeria Introduction Cancer is a leading cause of mortality worldwide. Developing countries like Nigeria, while still battling the health burden posed by infectious diseases, have also seen a remarkable increase in the prevalence. Cultural beliefs have a major influence on health seeking behavior, early diagnosis, and mortality rates. Breast cancer has been the focus of awareness programs in this environment.

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Objectives This study aimed at assessing the awareness of breast cancer and self breast examination among women in a rural community. Methods The study was a cross-sectional study among 38 adult women attending a primary care clinic in a rural community in Nigeria. An interviewer administered questionnaire was used to obtain information on their awareness of breast cancer, causes and symptoms of breast cancer, as well as self breast examination and other forms of screening tests for breast cancer. Results The mean age of the respondents was 30.87 with average parity of 3.58. Among the respondents, 35(92.1%) were aware of breast cancer while 14( 36.84%) attributed the cause of breast cancer to evil influences. Only 12(31.58%) of the respondents practiced self breast examination, out of which 75% examined their breasts at least monthly. Conclusions There is a need to increase efforts at improving the awareness of breast cancer and self breast examination in the rural communities using culturally acceptable methods in order to improve the early diagnosis, treatment and prognosis of breast cancer.

eP098 DEVELOPING AN INTEGRATIVE MEDICINE EDUCATIONAL PROGRAM TO SUPPORT ONCOLOGY PATIENTS THROUGH RADIATION TREATMENT: A FEASIBILITY STUDY

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eP099 PERCEIVED VALUE OF NURSING EDUCATION IN HEAD AND NECK CANCER CARE: OUTCOME OF PRACTICING SURVEY N. Gosh1, T. Mughal2, G.C. Wall3, M. Sridhar1 1 WEbRx Lifesystems India Private Limited, Medical Affairs, Bangalore, India 2 Alpine Oncology Foundation, Oncology, Sils Maria, Switzerland 3 Drake University, College of Pharmacy and Health Sciences, Des Moines, USA Introduction Oral health and oral care are crucial aspects of oncology nursing practice. However, very few studies concentrate on oral care in head and neck cancer (HNC) patients undergoing radiotherapy and nursing practice in India. Objectives We aim to determine the nurses’ knowledge and education on nutritional management in HNC patients during treatment and decision-making processes. Methods We reviewed the current and evidence-based nursing education during HNC treatment, supportive care, decision-making, and implications for practice and research. Results Our study describes the significance and uniqueness of nursing education in HNC patients (Figure 1). Majority (≈50%) of the nurses had poor knowledge, with most of them (≈70%) not having received basic education in nutritional care for HNC patients. Nursing education on HNC care monitors patients across the cancer trajectory (Figure 2), which includes site care, monitoring for complications, and administration of enteral feedings, patient education, and associated challenges.

K. Fakhoury1, M.J. Stavas1 1 Vanderbilt University Medical Center, Department of Radiation Oncology, Nashville, USA Introduction Radiation therapy is associated with situational anxiety in many patients due to a perceived lack of control. In contrast, integrative medicine uses complementary health approaches (CHAs) to improve self-efficacy in pursuing wellness. Patients acknowledge a need for improved education on CHAs and have shown interest in attending a hospital-based educational program. Objectives We collaborated between an academic institution's integrative medicine center and radiation oncology department to develop a novel, interactive lecture series. Our objective was to assess the feasibility of this program in improving self-efficacy. Methods A structured curriculum of four one-hour lectures covered topics of meditation, yoga, massage therapy, and nutrition, each led by a topic expert. Lectures included didactic and interactive components. The primary outcome was self-efficacy measured by 5 items on 9-point Likert scales via pre- and post-lecture surveys. Results Overall, 43 surveys were completed. Between pre- and post-lecture surveys, median scores of agreement with the statements “I have tools to manage my disease on my own”, “I have control over my cancer”, and “I believe achieving wellness is due to my efforts” increased from 6/9 to 7/9, 5/9 to 6/9, and 7/9 to 8/9, respectively. Conclusions Survey results demonstrate significant benefit to participants. However, the study posed major costs and barriers. Substantial time was needed to plan lectures and coordinate logistics. Additionally, patient attendance was limited by timing and transportation issues. To increase reach and minimize cost, we suggest further study on an educational program that is integrated into the oncology clinic visit or available in an online format.

Conclusions Identification and management of maladaptive dietary strategies are important for long-term health. Implications for practice include use of evidence-based nursing interventions to improve patient outcomes related

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to treatment decisions; assessment of nutritional needs of the patient during and after treatment; and tailoring nursing interventions based on the patients’ needs. Lack of knowledge suggests the need to develop and implement continuing nursing education programs on HNC care in order to render comprehensive care to the patients.

eP100 MAKING GUIDELINES TO OUR PRACTICAL DAILY ROUTINE T. Granot1, J. Dreyer2, H. Ferman3, A. Zlotogorski-Hurvitz Dr.4, N. Sela5, G. Perl Dr.6, Y. Stern7, M. Lahav Prof.8, B. Rubinovitch Dr.9, B. Brenner Prof.10 1 Davidoff Cancer Center- Rabin Medical Center- Beilinson Hospital, Breast Cancer Unit, Petach Tiqva, Israel 2 Davidoff Cancer Center- Rabin Medical Center- Beilinson Hospital, Head Nurse, Petach Tiqva- - 49100, Israel 3 Davidoff Cancer Center- Rabin Medical Center- Beilinson Hospital, Head and Neck, Petach Tiqva-, Israel 4 School of Dentistry- Tel Aviv University- Rabin Medical Center, Oral Pathology & Oral Medicine- Oral & Maxillofacial Surgery Dept., Petach Tiqva-, Israel 5 Davidoff Cancer Center- Rabin Medical Center- Beilinson Hospital, Yovel- Survivors Clinic, Petach Tiqva-, Israel 6 Davidoff Cancer Center- Rabin Medical Center- Beilinson Hospital, Gastrointestinal Unit, Petach Tiqva, Israel 7 Davidoff Cancer Center- Rabin Medical Center- Beilinson Hospital, Gastrointestinal Unit, Petach Tiqva-, Israel 8 Staff member- Institute of Hematology, Davidoff Cancer Center- Rabin Medical Center- Beilinson Hospital, Petach Tiqva, Israel 9 Rabin Medical Center- Beilinson Hospital, Infection Prevention and Contol Unit- Head, Petach Tiqva, Israel 10 Davidoff Cancer Center- Rabin Medical Center- Beilinson Hospital, Davidoff Cancer Center- Head- Institute of Oncology- Head, Petach Tiqva, Israel Introduction The oncology field is affluent with guidelines, both for treatments protocols, supportive and palliative care. The primary goals of these guidelines are to create standards and good clinical practices at the daily routine work. Non-adherence to clinical guidelines can become a major barrier to the successful practice of evidence-based medicine. Studies reveal that adherence to guidelines and recommendations, especially regarding symptom management are below 60%. Searching the literature shows that barriers include lack of local organizational support, physicians and nurses' unwillingness to embrace change, financial constraints, and the impracticality or complexity of the guidelines. Objectives Describe our experience of guidelines adaptation to daily practice and staff adherence. Methods All projects shared the same algorithm. Nurses created an ad-hock team which included physicians from the institute and an expert from relevant field. Participants read the relevant literature, especially the guidelines (MASCC, ASCO, NCCN and ESMO). Questions regarding lack of evidence were considered; new local guideline were written, sent to participants and changed if needed. After administration approval, protocol was distributed to staff. Adherence to new protocol was followed and documented. Results To present 5 guidelines have been adapted by our cancer center (Bone modify agents, chemotherapy safety standard, oral anti-cancer agents, mouth wash and vaccination policy). All Protocols are well supported by the administration, and staff adherence to new policy is easy to follow (will be presented).

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Conclusions Clear working algorithm enhances the process of international guidelines adaptation to the local institute. Working in accordance with these guidelines contributes to good clinical practice.

eP101 ADDITIONAL ONE-ON-ONE EDUCATION AND SUPPORT SESSIONS PRIOR TO RADIATION THERAPY REDUCES PATIENT ANXIETY G. Halkett1, M. O'Connor2, S. Aranda3, M. Jefford4, S. Merchant5, D. York1, R. Kane2, R. Moorin6, D. Yoeuns6, P. Schofield7 1 Curtin University, School of Nursing- Midwifery and Paramedicine, Perth, Australia 2 Curtin University, School of Psychology and Speech Pathology, Perth, Australia 3 Cancer Council Australia, Chief Executive Officer, Sydney, Australia 4 Peter MacCallum Cancer Centre, Medical Oncology, Melbourne, Australia 5 Royal Adelaide Hospital, Radiation Oncology, Adelaide, Australia 6 Curtin University, School of Public Health, Perth, Australia 7 Swinburne University, Department of Psychological Sciences- School of Health Sciences, Melbourne, Australia Introduction Patients present for radiation therapy with anxiety. Objectives To determine whether a radiation therapist (RT) led education intervention for women with early breast cancer reduced anxiety and depression, decreased concerns about radiotherapy, increased patient knowledge of radiotherapy and improved patient preparedness. Cost effectiveness was also assessed. Methods A multiple baseline study was conducted. The intervention comprised two consultations with an RT: prior to treatment planning and on the first day of treatment. Consultations focused on providing sensory and procedural information and reducing pre-treatment anxiety. Measures were collected on four occasions: after consultation with radiation oncologist, prior to treatment planning, on the first day of treatment and after treatment completion. Outcome measures included anxiety and depression, patient preparedness, concerns about radiotherapy and patient knowledge of radiotherapy. Generalised Linear Mixed Models were used to test between group comparisons. Cost effectiveness was determined by calculating the incremental cost effective ratio for delivering the intervention. Results Usual care was received by 218 participants and 190 received the intervention. Significant between group differences were found for anxiety at the commencement of treatment and after treatment completion (p<0.05). There were no significant differences for depression. Additional significant differences were found for patient preparedness, patient concerns about radiotherapy and knowledge about RT (p<0.05). Intervention costs were low; the equivalent of a one-point reduction in anxiety was recorded for every $510 of expenditure. Conclusions This intervention was effective in reducing breast cancer patients’ anxiety, preparing patients for treatment and it was low-cost. Future work needs to focus on implementation.

eP102 M Y K I T E W I L L F LY: B U I L D I N G R O U T I N E A N D COMMUNICATION IN FAMILIES THREATENED BY PARENTAL MALIGNANCY C. Holland1 1 Melbourne, Australia

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Introduction Patient families experience many difficulties in communication following diagnosis of life-threatening parental cancers. Often unable to effectively plan with parents and children, health professionals acknowledge that building effective family programs remains a critical research responsibility. Objectives The My Kite Will Fly (MKWF) program was built to assist with clinical communication tools and therapeutic interventions for children living with life-threatening parental malignancy. Methods Data was gathered at Diagnosis, Treatment and Palliative Care from patient families attending two Australian Gynae-Oncology hospitals. At Phase 1, 79 patient families including 53 children undertook mixedmethod data collection. At Phase 2, n = 36 children and parents drawn from 19 families completed structured interview, survey and art therapy activities. Cross-case thematic analysis of all interviews and children’s workbooks were compiled as descriptive case studies. Fisher’s Exact Test was employed to confirm sample representativeness. Results Five key themes encapsulating vulnerability and patient family concerns were clearly evidenced in case study profiles. Parents and children rated 70.6% positive evaluation of workbook content at Diagnosis. 94.4% better understood what radiotherapy and chemotherapy treatments offered with MKWF tools. Palliative families rated commemorative program tasks as critical to stabilizing family routines and illness coping. Conclusions MKWF program results confirm the importance of enhanced parent-child communication and stabilised family routines. Current results provide an important platform for future evaluative research with larger patientfamily populations across multi-site Oncology settings, aimed at ensuring enhanced program fidelity and reliability.

eP103 THE PROTECTIVE EFFECT OF MAGNESIUM OXIDE ON PANITUMUMAB-RELATED HYPOMAGNESEMIA H. Ishikawa1, K. Yamazaki2, Y. Sugiyama1, K. Yamamoto1, H. Masujima1, R. Tanaka1, T. Kamoshida1, M. Kaneko1, M. Shino1 1 Shizuoka Cancer Center Hospital, Department of Pharmacy, SuntoNagaizumi-, Japan 2 Shizuoka Cancer Center Hospital, Division of Gastrointestinal Oncology, Sunto-Nagaizumi-, Japan Introduction Hypomagnesemia, a side-effect of anti-EGFR antibody treatment, is caused by inhibition of EGFR-mediated magnesium reuptake in the renal tubule by anti-EGFR antibodies, such as panitumumab (Pmab). However, there are no reports regarding the effect of magnesium oxide (MgO) on Pmab-induced hypomagnesemia. Objectives To investigate the effect of MgO on Pmab-related hypomagnesemia. Methods From April 2010 to March 2016, 86 patients with KRAS wild-type unresectable colorectal cancer were treated with Pmab and concomitant MgO (concomitant group; n=24) or with Pmab alone (non-concomitant group; n=62). Effects of these treatments were retrospectively and comparatively examined with respect to hypomagnesemia incidence rates and severity during the first 6 weeks and the entire treatment period. Results The median number of Pmab administrations was 10. The median dose of MgO was 990 mg/day. During the first 6 weeks, incidence rates of hypomagnesemia were 16.7% and 41.9% for the concomitant and the nonconcomitant groups, respectively (p=0.042). In contrast, during the entire treatment period, significant differences were not observed in either the

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incidence rates (41.7% vs. 51.6%; p=0.475). No MgO treatment-related adverse events were observed, and there were no patients of treatment period prolongation, dose reduction, or discontinuation of Pmab associated with hypomagnesemia. Conclusions Concomitant treatment with MgO may protect the patient from Pmabrelated severe hypomagnesemia during the first 6 weeks; however, longterm protection was not observed. Additional study is needed to understand these discrepancies and develop reliable treatment options for hypomagnesemia. MgO treatment for Pmab-related hypomagnesemia may be useful for short-term, but not long-term protection.

eP104 RANDOMIS ED CONTROL LED T RIAL COMPARI NG N I C O T I N E R E P L A C E M E N T T H E R A P Y ( N RT ) A N D COUNSELLING ON SMOKING CESSATION IN PATIENTS PRONE TO LUNG CANCER USING BED FONT MICROSMOKERLYZER D. Johns1 1 DM Wayanad Institute Of Medical Science, Clinical Research, Meppady, India Introduction Tobacco use is the greatest preventable morbidity and mortality. Cessation interventions requires pharmacotherapy and behavioural supportive care. Objectives To determine whether a brief counselling or counselling intervention given with NRT, is more effective than usual care in promoting smoking cessation. Methods Patients who were prone to lung cancer were randomised to receive either usual care (no additional advice at admission), counselling alone (20 minute intervention with written materials), or NRT plus counselling (counselling intervention with a 6 week course of NRT). Inclusion Criteria-Previous lung disease, a family history of lung cancer, Past cancer treatment, Lowered immunity, Previous smoking related cancers, Exposure to certain chemicals and radon gas. Continuous and point prevalence abstinence from smoking (validated by exhaled carbon monoxide <10 ppm) was measured at 3 and 12 months, and self-reported reduction in cigarette consumption in smokers was assessed at 3 and 12 months. Results 300 smokers were enrolled. Abstinence was higher in the NRT plus counselling group (n=100) than in the counselling alone (n=100) or usual care (n=100) groups. The difference between the groups was significant for validated point prevalence abstinence at 3 months (65%,33%, 27% respectively, p=0.045) and at 12 months (27%, 16%, 14%, p=0.03). There was no significant difference between counselling alone and usual care, or in reduction in cigarette consumption between the treatment groups. The NRT preferred was Nicotine transdermal patch 43%,nicotine gum 27%, Nicotine inhalator 12%, Nicotine sublingual tablet 11%, Nicotine nasal spray 7% Conclusions NRT given with brief counselling to patients prone to lung cancer is an effective smoking cessation intervention.

eP105 CANCER SUPPORTIVE CARE IN THE CORRECTIONAL SETTING J. Kamath1 1 University of Connecticut Health Center, Psychiatry, Farmington, USA

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Introduction There has been a significant rise in cancer diagnosis in inmate populations and cancer has become a leading cause of death in this population. Correctional facilities have become a critical frontier for acute, chronic and end of life care of inmates with cancer. Cancer Supportive Care in correctional settings remains disjointed and has not kept pace with significant advances in the community setting. Objectives The present project describes findings of an evidence-based literature review, a proposed model for adaptation of coordinated, cost-effective, and compassionate Cancer Supportive Care in the correctional environment and a planned pilot project in the Connecticut Department of Correction. Methods The review included current evidence on successful implementation of cancer supportive care in the community and current cancer care in the correctional setting. Results The present review identified essential elements for adaptation of Cancer Supportive Care in the correctional setting. The major findings suggest that the development of Cancer Supportive Care Team is the most critical element for such adaptation. The proposed model for adaptation of cancer supportive care to the correctional setting describes reorganization of available resources, education/training requirements, and use of innovative technology. The model delineates unique challenges and opportunities in the correctional environment. Conclusions Changes in the mindset/philosophy of cancer care and education/training of the correctional staff are critical foundations for adaptation of cancer supportive care to the correctional setting.

eP106 THE EFFECTIVENESS OF A PERSONAL HEALTH RECORD SYSTEM USING SMART DEVICES IN CANCER PATIENTS RECEIVING CHEMOTHERAPY: A KOREAN SOUTH WEST ONCOLOGY GROUP S.T. Kim1, W.K. Bae2, H.W. Lee3, S.C. Lee4, E.K. Song5, H. Shim6, J. Song7, S. Seo7, K.H. Lee1, H.S. Han1 1 Chungbuk National University College of Medicine, Internal Medicine, Cheongju-Si, Republic of Korea 2 Chonnam National University Hwansun Hospital, Department of Internal Medicine, Hwasun-Gun, Republic of Korea 3 Ajou University School of Medicine, Department of Internal Medicine, Suwon, Republic of Korea 4 Sonnchunhyang University Cheonan Hospital, Department of Internal Medicine, Choenan, Republic of Korea 5 Chonbuk National University Medical School, Department of Internal Medicine, Jeonju, Republic of Korea 6 School of Medicine- Wonkwang University, Department of Internal Medicine, Iksan, Republic of Korea 7 Turbosoft Inc, U-healthcare, Cheongwon, Republic of Korea Introduction A personal health record (PHR) system can be helpful for patients with chronic diseases requiring strict daily care and treatment. Objectives The objective of this prospective multicenter study was to evaluate the effectiveness of a PHR system in cancer patients receiving chemotherapy. Methods The proposed PHR system obtains daily PHR data of cancer patients through smart devices. An analysis report of cumulative PHR data is provided to medical staff in a format suitable for electronic medical records (EMRs). Cancer outpatients who received at least two cycles of chemotherapy were enrolled.

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Results Between February, 2015, and December, 2016, 111 patients were screened and 100 of these patients were included. The number of symptoms recorded in EMRs (mean ± standard deviation) increased from 0.98 ± 0.83 to 1.72 ± 1.73 (P<0.001) and the numeric rating scale of pain increased from 0.20 ± 0.72 to 0.99 ± 1.55 (P<0.001) after applying the PHR system. The number of adverse events (AEs) related to chemotherapy recorded in EMRs increased from 0.92 ± 0.80 to 2.26 ± 1.80 (P<0.001) and grading of AEs increased from 0.81 ± 0.69 to 1.00 ± 0.62 (P=0.029). A patient questionnaire revealed that 64.2% of patients were satisfied with the PHR system. Patient’s satisfaction with their treatment and the quality of life of patients did not significantly change. Conclusions This study suggests that the proposed PHR system using smart devices provides an effective means to assess symptoms or AEs in cancer patients receiving chemotherapy.

eP107 THE DEVELOPMENT OF AN EVIDENCE-BASED CONSULTATION GUIDE DESIGNED TO SUPPORT PATIENTS PRESCRIBED CAPECITABINE FOR COLORECTAL CANCER: A QUALITATIVE STUDY E. Kitetere1, V. Auyeung2, K. Kantilal3, C. Oakley4 1 King's College London, The Florence Nightingale Faculty of Nursing & Midwifery, London, United Kingdom 2 King's College London, Institute of Pharmaceutical Science, London, United Kingdom 3 Guy's and St Thomas' NHS Foundation Trust, Pharmacy, London, United Kingdom 4 Guy's and St Thomas' NHS Foundation Trust, Oncology, London, United Kingdom Introduction Recent years have seen a shift in cancer treatment from inpatient-managed, intravenous systemic anticancer therapy (SACT) to outpatient-managed, oral SACT; placing complete responsibility of medicine-taking on patients. There is evidence of non-adherent behaviour in patients prescribed oral SACT, including capecitabine. Objectives To design an evidence-based consultation guide for healthcare professionals to support patients prescribed capecitabine for colorectal cancer. Methods Following a robust literature review, three focus groups were conducted to yield an in-depth understanding of the experiences of patients prescribed capecitabine for colorectal cancer, their carers and healthcare professionals and to design an evidence-based consultation guide. Results Four patients, two carers and five healthcare professionals participated. Focus groups lasted 105-120 minutes. Major themes that emerged from the data related to what constitutes to an optimal consultation and best prepares patients for capecitabine therapy. The quality of the healthcare professional-patient interaction and discussing the patients’ ability to selfmanage therapy day-to-day were identified as key determinants of an optimal consultation. Drug and side effect information were the key foci for the content of the consultations. These findings informed the design of the consultation guide. Conclusions A consultation guide was developed but more evaluation is needed to determine utility and usability once implemented in practice. The evidence-based consultation guide developed in this study can be implemented in the training and the standard practice of healthcare professionals and its use monitored and audited. The guide may have applicability for other oral SACTs but further research is needed to evaluate its use.

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eP108 USE OF MULTIMEDIA IN PATIENT AND CAREGIVER EDUCATION FOR CANCER PAIN MANAGEMENT: A LITERATURE REVIEW M. Lam1, M. Choi1, H. Lam1, A. Agarwal1, R. Chow1, S. Chow1, L. Rowbottom1, R. McDonald1, H. Lam1, S. Chan1, A. Wan1, E. Chow1, B. Henry1 1 Sunnybrook Health Sciences Centre- University of Toronto- TorontoOntario- Canada, Rapid Response Radiotherapy Program- Department of Radiation Oncology- Odette Cancer Centre, Toronto, Canada Introduction Pain is one of the most commonly-reported symptoms by cancer patients. Patient and caregiver-targeted educational interventions addressing the proper use of pain management may provide significant clinical value. Objectives To examine the literature surrounding the use of multimedia interventions for patient and caregiver education (PCE) on pain management compared to traditional educational interventions. Methods A literature search was conducted in Ovid MEDLINE (1946–July Week 2, 2016), Embase (1947–2016 Week 29), and Cochrane Central Register of Controlled Trials (up to June 2016). Paired reviewers conducted title and abstract screening and full-text screening to identify experimental, quasi-experimental and cohort studies evaluating one or more multimedia-based PCE interventions focused on cancer pain and pain management and targeting patients and/or caregivers. Findings were extracted by paired reviewers and synthesized qualitatively. Results Seven studies were deemed eligible for inclusion, of which 5 were RCTs and 2 were observational studies. We found limited but convincing quantitative data to suggest that the use of multimedia use in pain management education for patients/caregivers has greater value-added benefit compared to standard education. Conclusions While there is evidence suggesting a positive effect on pain-related outcomes with the use of multimedia-based patient and caregiver-targeted interventions, it is limited to a small number of lower-quality studies. More robust and large-scale studies are needed to supplement existing evidence and provide more insight regarding the usability and userfriendliness of these tools in practice.

eP109 WHAT IS KNOWN IN THE COSTA RICAN’S WOMEN ABOUT BREAST CANCER METASTASIS? A NEW WEBSITE-BASED PROGRAM TO EDUCATE OUR POPULATION D.U. Landaverde1, C. Zuniga2, I. Gonzalez2 1 Hospital Mexico, Medical Oncology, San Jose, Costa Rica 2 Hospital San Juan de Dios, Medical Oncology, San Jose, Costa Rica Introduction Costa Rica is a small Country located in Central America. The National Health Care System covers about 95% of the population, and breast cancer is the leading cause of death among women. Until now is unknown how women in our Country conceive metastatic breast cancer (MBC) Objectives We decided to conduct a study to evaluate the knowledge about MBC in women within the Grant Metropolitan Area (GMA). And also using the data collected to create a website-based educational program utilizing social media to deliver better information to women about MBC. Methods ACOMED (Costa Rican Medical Oncology Society) decided to conduct a face-to-face survey to 300 women randomly at the GMA, from April 7th

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to June 11th 2016. Descriptive statistics were used. A website was created (www.nuncasolas.com) Results The mean age was 32 years, 48% had completed high school, and 15% university. 52% knew the meaning of breast cancer metastasis. 26% had satisfactory information about MBC. 47% expressed the need of emotional support. A Facebook® page and also a website was launched Conclusions We found a need of information about MBC at GMA, most of the women considered emotional support essential. Based on these findings we created a website called “You will never walk alone” (NUNCA CAMINARAS SOLA). The website www.nuncasolas.com is dedicated to educate our population about MBC and share opinions with patients and general population about this disease and how to cope with.

eP110 IMPACT OF THERAPEUTIC WORKSHOPS ON THE QUALITY OF LIFE OF PATIENTS AFTER BREAST CANCER J. LE FEL1, S. CASTELAIN2, P. FLEURY2, V. BLAZEJEWSKI2, O. RIGAL3 1 Henri Becquerel Cancer Institute, Supportive Care, Rouen, France 2 Henri Becquerel Cancer Institute, Oncology, Rouen, France 3 Henri Becquerel Cancer Institute, Supportive Care- Oncology, Rouen, France Introduction Thanks to improved therapeutics, the survival of patients with breast cancer increases and they can quickly find an active, social, and professional life. At the end of the treatments, the patient often finds herself left to herself in this complicated phase that is "after cancer". Objectives We know many questions about their quality of life remain outstanding and would need to be shared with patients. That's why we've created Therapeutic Education Workshops after cancer. Methods In 2014, we have established therapeutic education workshops for patients with breast cancer who have completed their treatment. These workshops involve various professionals trying to address the main concerns of patients in post-cancer. Thus, we organize different workshops: dietetics, socio-aesthetics, Hypo estrogenic, sexology, resumption of professional activity, psychological, neuropsychology, post-surgery complications, hormonal treatment, meditation, sophrology, physical activity, and physiotherapy. Patients participate in these workshops in groups of 10 over a period of 7 weeks, with an average of 4 different workshops per week. Results Since 2014, 54 patients have participated in the various workshops. We evaluated the impact of these workshops on their quality of life using the QLQ-C30. We note an overall improvement in the quality of life of the patients following the workshops regarding the side effects or fatigue (results will be presented at the congress). In addition, we can note a satisfaction of more than 75% of the patients in all the workshops. Conclusions Therapeutic education workshops seem to be a suitable way for patients to improve the quality of life after cancer.

eP111 THE PERCEPTION OF SEXUAL BEHAVIOR IN TAIWANESE WOMEN AFTER TREATMENT FOR GYNECOLOGICAL CANCER J.T. Lee1 1 Chang Gung University, School of Nursing, Taoyuan, Taiwan R.O.C.

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Introduction Gynecological cancer survivors experience a broad range of sexual concerns after diagnosis and treatment, their perception about sex after treatment for gynecological cancer may influence their sexual adaptation and sexual relationship. Objectives The aim of this study was to explore the perception of sexual behavior and sexual myths of Taiwanese women after treatment for gynecological cancer. Methods Data for this phenomenological study were collected during in-depth, semi-structured interviews with 14 women purposively recruited from outpatients of the gynecological clinic of a medical center in northern Taiwan. Interview data were analyzed using Colaizzi’s method. Results Data analysis yielded two subthemes: “Interpretations of the appropriateness of sexual behavior during cancer treatment” and “Uncertainty about the appropriateness of sexual behaviors”, and recognized the sexual myths as below: sex might threaten the cancer survivor’s health, sex leads to cancer recurrence or death, and sex might negatively affect the sexual partner’s health. Conclusions This woman-centered view of the perception and sexual myths of Taiwanese gynecological cancer survivors can help healthcare professionals understand and educate their clients about women’s sexual expression during and after cancer treatment.

eP112 DEVELOPMENT AND ASSESSMENT OF AN INTERVENTION PROGRAM FOR UNMET SUPPORTIVE CARE NEEDS OF CANADIAN MELANOMA PATIENTS AND SURVIVORS ATTENDING AN OUTPATIENT CLINIC M. Lemonde1, R. Koneru1, J. Chang1, J. Mundluru1, M. Subasri1 1 Durham Regional Cancer Centre, Medical Oncology, Oshawa, Canada Introduction Rapid development in melanoma treatment options have significantly improved overall survival, but complementary patient education is not available. An environmental scan also confirmed a lack of formal educational programs and support groups for melanoma patients and survivors in the Durham region. Objectives Identify the supportive care needs of melanoma patients and survivors, develop an intervention program to address these needs, and seek feedback on the program prior to its implementation. Methods Utilizing a cross-sectional mixed method design, patients were recruited both prospectively and retrospectively. Participants completed a sociodemographic questionnaire and "Supportive Care Needs Survey"; those who consented also took part in a focus group. Descriptive statistics and Likert summated scale analysis were completed to identify the highest reported needs. ANOVA, t-tests, and chi-square were conducted to investigate relationships between needs and sociodemographic information. Finally, focus group data was thematically analyzed. Results 75 patients and survivors completed the questionnaires. The sample was composed up of 46 males and 29 females, with an average age of 63. Most patients identified their needs were being met, however significant unmet needs were identified in three constructs: psychological, health system and information, and melanoma specific. Specifically, the highest reported needs involved fears or uncertainty about their prognosis and of recurrences. Conclusions Based on these identified high needs, a multifaceted program to address the three constructs was developed. Focus group feedback further

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reinforced the benefits of the intervention program. Currently the intervention program is in the process of being implemented and the intent is to complete a one-year post evaluation.

eP113 CONTEMPORARY PATIENT AND HEALTH CARE PROVIDER ATTITUDES AND PERSPECTIVES TOWARDS TRUTHTELLING AND THE DISCLOSURE OF DIAGNOSIS AND PROGNOSIS IN ASIA M.Y. Lim1, L.L.H. Sutanto2 1 , Hong Kong, Hong Kong S.A.R. 2 Chiness University of Hong Kong, Medical Facaulty, Hong Kong, Hong Kong S.A.R. Introduction Emphasis on patient autonomy and informed decision-making is a highly valued principle in Western medical tradition. However, this influence is not shared in other areas where illness is a shared familial experience versus an individualistic one. This is particularly true in most Asian populations which traditionally have stronger family-based culture. Objectives This review looks at the contemporary literature to better understand current practice of truth telling and disclosure in Asia. Methods A scoping review was undertaken using MEDLINE, PubMed and Google scholar. Inclusion criteria are patients living with cancer diagnosis, specific to Asian population, adult patients only and English language. Results A total of 16 studies were reviewed. A high preference of over 70% patients agreed on direct cancer diagnosis disclosure was demonstrated consistently in all studies. Prognostic disclosure preference was lower at around 50-70%. Most patients preferred being informed immediately at time of diagnosis and by the physician-in-charge. Heath care providers showed greater variation on agreement of information disclosure to patients ranged from 8% to over 90%. Concerns about patients’ understanding and acceptance of disease, and accede to families’ wish were factors that affect physicians’ disclosure preference. Conclusions Given the impact of globalization, increasing rates of physicians being trained in abroad, and increases in international collaborations, it is not surprising to see that in some Asian cultures beliefs and practices towards truth telling and disclosure of diagnosis and prognosis are changing such that sharing information is now being viewed as a means of strengthening a trusting relationship between patients and medical professionals.

eP114 AMINO ACID MIXTURE: A NEW APPROACH TO REDUCING CANCER THERAPY-INDUCED GASTROINTESTINAL TOXICITY L. Luque1 1 Entrinsic Health Solutions, Clinical Research, Norwood, USA Introduction Gastrointestinal (GI) toxicity is common during cancer therapy, Treatment options are often unsatisfactory. Preclinical studies using an amino-acidmixture (enterade®) suggest reduced GI toxicity by reducing mucositis. Objectives This observational study was the first clinical assessment of enterade® in reducing cancer-therapy induced GI toxicity. Methods Patients were eligible for this study if they developed GI toxicity during chemotherapy or radiotherapy. Enterade® was provided for 14 days.

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Patients completed a questionnaire before starting Enterade and at 14 days. Patient tumor and treatment characteristics were recorded. Type and severity of GI symptoms, other adverse effects (weight loss, dehydration, malaise) and current weight were requested. Individual symptom severity changes and a composite score of patient reported outcomes were recorded. This study was approved by the appropriate Institutional processes. Results 155 patients enrolled. 118 completed the questionnaires at 0 and 14 days. Of these, 15 patients used no Enterade®, 43 used Enterade® for 1-6 days, and 60 patients for ≥7 days. A 78% improvement in composite score was reported in patients who used the product for >7 days, compared to 44% improvement in patients who used enterade® for 1-6 days, and 7% improvement in patients who did not use enterade®. There was a statistically significant improvement in diarrhea, dehydration and weight maintenance (univariate analysis p<0.001, p<0.009 p<0.002 respectively). Conclusions Patient reported improvement after Enterade® correlates with preclinical data that revealed reduced cancer induced GI mucositis. Further studies to assess the efficacy of enterade® consumption in reducing GI side effects of cancer therapy are warranted.

eP115 PERCEPTION OF PALLIATIVE CARE COURSE AMONG OTHER PROGRAMS IN A GOVERNMENT LEARNING INSTITUTION G. Kimani1, F. Maina2, S. Rithara2 1 Nairobi University, Rsearch, Nairobi, Kenya 2 Kenya medical training college, Nursing, Nairobi, Kenya Introduction Kenya medical training college started a higher diploma course in palliative care nursing in September 2013 as a new program in Nairobi Campus. The program runs in 18 months as distance learning with clinical placements at Hospices and Palliative care units as well as general wards Objectives To find out challenges experienced enrolling palliative care nursing among other programs Methods A survey done across KMTC campus offering eight (8) higher Diploma courses.included critical care, preoperative, pediatric, anesthesia, psychiatric, Community HIV/AIDS, Ophthalmology and palliative care Results palliative is a multidisciplinary course and scaling to nurses raised lot of challenges toward enrollment of students. 80% students focused the course as dealing with death, 70% as draining program, 75% preferred full time unlike distance learning, 60% lack of county recognizing palliative care as one of key areas, 20% applied but denied course approval, 40% lack of awareness of the program. Not all hospital has palliative care units and there are few active hospices. 70% clinical areas are very far from their working stations. Lack of continues education on the palliative care needs by the trained nurses. 30% indicated the challenges uncounted by their colleagues and hard to cope with, like lack of Opioids and other palliative care materials. Health workers fear of Opioids drugs and care involved in caring of palliative patients. 30% giving Opioids 4 hourly demanding Conclusions Nursing Department to Introduce short course certificate to offer overview of the course. Sensitize the importance of the course to all health institution across the country

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eP116 EVALUATION POST TRAUMATIC GROWTH AMONG BREAST CANCER SURVIVORS AT FARAJA CANCER SUPPORT TRUST IN KENYA P.O. Ouma1 1 Faraja Cancer Support Trust, Psycho-oncology, Nairobi, Kenya Introduction Cancer diagnosis and treatment is a life-transforming event that can negatively affect individual’s self-concept and belief. However, the latest research indicates the positive impact of cancer diagnosis. Positive life changes have been documented as side effects of dealing with range of traumatic events. Tedeschi and Calhoun define this experience as “ a positive cognitive process that is initiated to cope with traumatic events that extract an extreme cognitive and emotional toll” (Tedeschi & Calhoun, 1995.5). The research study focuses on posttraumatic growth by breast cancer patients and its effects on the coping process. Objectives - Evaluate if there is post traumatic growth among breast cancer survivors in Kenya Methods The study was carried out at Faraja Cancer support trust in Kenya. The respondents were a homogeneous group of breast cancer patients from age 30-75. The population sample was 35 patients. Results The study shows over 80% of the patients sampled had undergone radiotherapy treatment. Result indicative that cancer diagnosis despite its negative impact can be a positive life experience too. Data indicates that 75% of the survivors across the age of 20-55 years completely changed their outlook to life. Their optimism also reflected in their sense of hopefulness and changes in life purpose. Conclusions The change of focus from negative impact of cancer diagnosis and treatment is key in fostering growth-oriented studies. Whilst this does not ignore the negative and painful impact of the disease the shift in focus can enhance patients coping capacity and transform the pain to personal growth.

eP117 PREDICTORS OF DISTRESS TRAJECTORIES IN THE FIRST YEAR AFTER A BREAST CANCER DIAGNOSIS J.H. Park1, S.H. Bae1 1 Ajou University, College of Nursing, Suwon, Republic of Korea Introduction Breast cancer diagnosis and treatment are stressful times for many women. Breast cancer is an emotionally distressing condition despite improvements in treatment and survival. Distress was identified by the National Comprehensive Cancer Network as an effective umbrella term representing “the range of emotional concerns patients with cancer experience.” Objectives The purposes of this study were to (a) identify distinct trajectories of distress in the first year after a breast cancer diagnosis in women treated with adjuvant therapy and (b) explore possible predictors of these trajectories, that is, demographic and medical characteristics, and problem lists. Methods The 117 patients were assessed after surgery, after adjuvant treatment, in the reentry phase, and in the survivorship phase (6 months after the end of treatment) using the Distress Thermometer scale and problem lists. In order to identify sub-groups of women with breast cancer with distinct patterns of distress, it was used the TRAJ finite mixture model procedure, which allows modeling of censored normal distribution variables.

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Results There were two trajectories of distress: a group that experienced distress only in the active treatment phase (80.6%), and a group that experienced chronic distress (19.4%). Multivariate logistic regression analysis revealed that age (OR=1.69), amonorhea (OR=26.56), depression (OR=14.02), nervousness (OR=31.06) and pain (OR=14.15) were independent predictors for distinguishing the distress trajectories. Conclusions Most patients were only distressed temporarily in response to breast cancer. But, some patients became or remained distressed after the end of treatment. Healthcare professionals involving nurses should provide patients-centered care to these patients.

eP118 QUALITY OF SUPPORTIVE CARE IN CANCER PATIENTS ON CHEMOTHERAPY–AN EXPERIENCE FROM A DEVELOPING COUNTRY H. Patel1, P. Gurumurthy1 1 JSS College of Pharmacy, Clinical Pharmacy, Mysore, India Introduction Supportive care is essential in cancer patients to prevent and manage drug toxicities. Objectives This study was conducted to assess quality use of supportive care prescribed to patients on cancer chemotherapy. Methods This was a prospective study conducted for a period of twelve months at private academic oncology care setting. Medical records of the patients on chemotherapy were reviewed and patients were interviewed to study the use of supportive care. Evaluation of supportive care included reviewing quality use of anti-emetics, colony stimulating factors (CSF), analgesics and antibiotics. Quality use of supportive care was reviewed with respect to standard international recommendations and clinicians’ consensus of the study hospital. Results A total of 868 patients were enrolled in this study. Majority patients on highly emetogenic regimen (48%) were prescribed with combination of metoclopramide and dexamethasone followed by combination of 5-HT3 antagonist and dexamethasone (46%). Use of neurokinin receptor antagonist was highly restricted (6%). Only 144 (30%) of 480 patients who were on highly myelosuppressive chemotherapy were prescribed with prophylaxis of Filgrastim or Pegfilgrastim. Majority of the patients were prescribed with tramadol with or without non-steroidal analgesics (86%) for cancer related pain (VAS score: 8-10). Ceftriaxone and Cefoparazone were commonly used antibiotics for prevention of and actual neutropenic fever. Conclusions Use of supportive care was not in well compliant with standard recommendations. Poor quality of supportive care delayed treatment schedules due to drug toxicities in our patients. Majority patients treated under public cancer schemes had poor quality of supportive care compare to private patients.

eP119 A COMMUNITY BASED SIMULTANEOUS BREAST SELF EXAMINATION SCREENING PROGRAM FOR DETECTION OF BREAST CANCER IN RURAL INDIA D. Pawar1, A. Suresh2, C. Sunkavali3 1 Biocon Limited, Medical Affairs and Clinical Development, Bangalore, India 2 Continental Hospital and Grace Cancer Foundation, Oncology, Hyderabad, India 3 Apollo Hospital and Grace Cancer Foundation, Oncology, Hyderabad, India

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Introduction Breast cancer is the second most common cancer worldwide and the fifth cause of cancer mortality. It accounts for 19-34% of all cancer cases among women in India. Mortality rates are high due to late stage diagnosis as patients usually present at an advanced stage because of lack of awareness and nonexistent breast cancer screening programs. The early discovery of breast lumps through breast self-examination (BSE) is important for the prevention and early detection of breast cancer. Objectives Train rural women for Breast self-examination Determine the effectiveness of teaching program among rural women on BSE Detect prevalence of breast cancer in a rural community through BSE Methods The breast cancer screening was conducted for 2,970 women. A total of 3000 cubicles were erected for simultaneous BSE. Audio visuals were used for training on examination of breasts and training was given for self-examination. The participants were observed and supervised by doctors to complete the procedure successfully. The results of BSE were documented Results BSE was successfully done by 2790 participants out of which 320 participants reported to have found lump. Upon physician’s examination hundred suspected participants were referred for mammography at the mobile cancer detection van and malignancies were detected in thirty participants Conclusions Health education programs should be initiated to improve women’s practice of BSE especially in the rural India where medical facilities are poor. According to this screening program, BSE is the best and economical option for screening women. This event has become the Guinness book of world record

eP120 A POPULATION BASED SURVEY OF GENERAL CANCER AWARENESS IN RURAL ANDHRA PRADESH, INDIA D. Pawar1, C. Sunkavali2, A. Suresh3, S. Sangha4, N. Pathare5 1 Biocon Limited, Medical Affairs and Clinical Development, Bnagalore, India 2 Apollo Hospital and Grace Cancer Foundation, Oncology, Hyderabad, India 3 Continental Hospital and Grace Cancer Foundation, Oncology, Hyderabad, India 4 Grace Cancer Foundation, Medical, Mumbai, India 5 Biocon Limited, Medical Affairs, Bangalore, India Introduction In the present survey it was an attempt to assess the knowledge, attitude and practices in the rural population of Andhra Pradesh pertaining to various aspects of cancer among males and females so that it form a baseline for further interventional studies. Objectives The present survey aimed to provide information on beliefs on general awareness of cancer causes, risk factors, warning signs and incidence among rural population of Andhra Pradesh (AP) Methods A statewide representative sample of 869 Indians aged 20 or older were asked about their perception about various risk factors associated with cancer, sign and symptoms as well as their general belief in relation to cancer incidence, as a part of an population based Survey. Interviews were conducted with 869 participants (188 men and 681 women) to determine the knowledge about the common cancers in the region, their signs and risk factors. Results The general awareness, knowledge of signs and risk factors of the cancers considered were found to be low. 70% of respondents were not able to correctly name the commonest cancer in males and females.

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Conclusions The study revealed lower general awareness and knowledge of the signs and risk factors of the common cancers in the region. These points to the need for greater emphasis on these aspects in the various public education programmes and increasing the awareness in masses by collaborative action of public health specialists and health professionals

eP121 A CUSTOMIZED TRAINING CURRICULUM FOR CONDUCTING DIFFICULT CONVERSATIONS IN CANCER CARE D. Portman1, S. Thirlwell1, B. Lubrano di Ciccone1 1 H. Lee Moffitt Cancer Center, Supportive Care Medicine, Tampa, USA Introduction Difficult conversations in cancer care are frequent and the need to train learners is commonly acknowledged. The different emphases of Oncology learners from varied surgical and medical subspecialties pose a challenge for communications skills education within multidisciplinary cancer centers. Objectives To provide an effective communications skills workshop customized to multiple Oncology disciplines. Methods AVitalTalk curriculum was approved for learners from multiple specialties within Oncology and facilitated by an Anesthesiologist and Psychiatrist with subspecialty in Palliative Care Medicine. An Oncology nurse actor was chosen as a patient simulator. Seven ½ day workshops were conducted, consisting of 4-6 learners each. The sessions included didactics, facilitated encounters using relevant clinical scenarios, discussion and debriefing. Before each workshop, the facilitators and nurse actor met to craft cases customized to the individual learners’ area of Oncology. Learner postsession feedback surveys (34) were obtained. Results The customized sessions have been well received by participants, including 21 fellows, 2 faculty, 6 residents and 5 APPs from 10 different Oncology subspecialties. All participants agreed that the program and teaching strategies were effective in meeting their learning needs. All learners responded that the content expanded their knowledge, was relevant and met or exceeded their expectations. Their comments highlighted the interactive nature of the workshop and the perception that the encounters felt authentic. Conclusions This communications skills workshop was accepted and integrated in a Cancer Center’s educational curriculum by leveraging facilitator knowledge of specialty-specific challenges of trainees, making the cases discipline-specific, and utilizing the actor’s clinical experience.

eP122 MANAGING ADVANCED CANCER PAIN TOGETHER B. Quinn1, D. Lueftner2, M. Di3, S. Dargan4, L. Dal Lago5, D.C. Lawrence6 1 Chelsea and Westminster NHS Foundation Trust, Cancer, London, United Kingdom 2 Charite Hospital, Palliative Care, Berlin, Germany 3 Gustave Roussy- Cancer Campus, Oncology, Villejuif, France 4 Ashford & St Peters NHS Trust, Palliative Care, Chertsey, United Kingdom 5 Bordet Hospital, Cancer, Brussels, Belgium 6 King's College NHS Foundation NHS Trust, Surgery, London, United Kingdom Introduction There is general agreement that despite great improvements in cancer treatments that pain is not consistently well managed in the advanced cancer

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setting. While guidelines and recommendations exist for the management of cancer pain, some focusing on a particular aspect of care including assessment tools, pharmacological and/or non-pharmacological treatments approaches, there is little available specifically focussing on the management of pain associated with metastatic cancer. Objectives A group of experts 'Managing Advanced Cancer Pain Together' (MACPT) developed guidance on the management of metastatic related pain. The guidance was developed from a person centred, multi-focal and multi-professional perspective, with the aim of improving pain management. Methods The guidance considers the physical, social, emotional and spiritual components of pain including pain as a disruption in key relationships. This innovative project addresses under treatment and patient empowerment using a creative multi-modal approach. The guidance includes a newly developed 'pain management conversation tool' to support the clinical meeting and to help the patient communicate the more hidden aspects of pain. Results The guidance and tool are available in German, French ad English and are available to download on the group website www.macpt.eu. The guidance and tool have been reviewed by clinical experts and patient groups and seen as an innovative and improved person centred approach to managing the personal experience of pain. Conclusions Having developed the guidance and the conversation tool the MACPT group are working on further training materials and research exploring this innovative approach to supporting patients and clinicians in the field of advanced cancer.

eP123 IDENTIFYING PRACTICE GAPS AND EDUCATION NEEDS FOR THE INTERPROFESSIONAL CARE TEAM THROUGH MULTIPLE SURVEY ANALYSES: A CASE STUDY IN CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING (CINV) L. Ritter1, C. Carey1 1 Medscape Education, Oncology Medical Education, New York, USA Introduction CINV can lead to dehydration, malnutrition, hospitalization, and delays in or discontinuation of chemotherapy. Despite availability of effective therapy, suboptimal control of CINV is often reported. Interprofessional continuing education (IPCE) promotes team-based care, whereby all members of the healthcare team coordinate planning and delivery of patient-centered care to improve outcomes. Objectives Identify barriers that prevent optimal management of CINV, and investigate IPCE as an effective solution to improve communication between members of the care team, and between the team and the patient/family, to advance patient care. Methods US healthcare professionals were surveyed (N=100 physicians; N=748 nurses; N=226 pharmacists) to identify knowledge and clinical practice gaps regarding optimal management of CINV. To determine if IPCE would be an effective solution to identified gaps related to care coordination, a second survey is being developed to identify possible relationships between these gaps and a desire to participate in IPCE. Results Preliminary Surveys: The following barriers to optimum management of CINV were identified: Physicians ○ Suboptimal communication between clinician and patient-32% ○ Ineffective collaboration with interprofessional team members-24%

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○ Lack of confidence in ability to collaborate with interprofessional team members-68% Nurses and Pharmacists ○ Care coordination with interprofessional team members-44% ○ Lack of confidence in ability to effectively communicate with patients57% ○ Ineffective counseling of patients on importance of reporting CINV35% IPCE Survey: IPCE survey results are being collected and will be presented at the meeting. Conclusions Preliminary surveys indicate that poor communication and ineffective interprofessional collaboration are barriers to optimal CINV management. IPCE may be an effective solution for improving collaboration and delivery of patient-centered care.

eP124 NICOTINE DEPENDENCE ASSESSMENT USING FAGERSTROM TEST AND NICOTINE REPLACEMENT THERAPY (NRT) RECOMMENDATION TECHNIQUES FOR SMOKING CESSATION AMONG PANIYA TRIBES H. Rozario1 1 Kochi, India Introduction Tobacco is a highly addictive substance. Tribes are a special population with smokng prevalence. Most people who try to stop smoking do so unassisted, and many return to smoking within a few months. There is evidence that pharmacotherapy, such as nicotine replacement therapy (NRT), can significantly increase an individual’s chances of stopping. Objectives To investigate the effectiveness of nicotine replacement therapy (NRT) for smoking cessation among paniya tribes. Methods PARTICIPANTS AND SETTING:200 paniya tribal smokers from South India, aged 18 years and older with a Fagerstrom score of 1 and above were included in the study. INTERVENTIONS:The scoring of the tribal patients was done using Fagerstrom test for nicotine dependence. The NRT recommendation chart was used to give the appropriate intervention according to the scoring criteria. MAIN OUTCOME MEASURES:Self-reported abstinence assessed by questionnaires at 1, 2, 3 and 6 months and by exhaled carbon monoxide using a Bedfont Micro-Smokerlyze Results Of the 200 patients approached, 165 (82.5%) agreed to participate; five of these were later excluded. Among the 160 tried NRT during the study period. At 30-day follow-up, 82 (51.25%) who had used NRT planned to continue using them, it reduced to 74,52 and 30 at the end of 2 ,3 and 6 months respectively. Average cigarette consumption decreased from 15.6 per person/d to 7.6 over the study period (P < .001). Conclusions Pre existing traditions and customs, superadded with illiteracy in paniya tribes have resulted in reduction in the success rate of NRT therapy. However the therapy have paved the way in reduction of daily tobacco use

eP125 THE DEVELOPMENT OF A PEER SUPPORT PROGRAM FOR LEUKAEMIA PATIENTS AT THE OLIVIA NEWTON-JOHN CANCER WELLNESS AND RESEARCH CENTRE, AUSTRALIA P. Sanderson1, T. O'Neill1, E. Cohen1 1 The ONJ Centre, Cancer Services, Heidelberg, Australia

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Introduction Acute leukaemia is a group of heterogenous diseases requiring immediate intensive treatment and multiple lengthy inpatient admissions across the course of their illness/treatment trajectory. Patients with leukaemia have unique needs. Shared experiences are the foundation of peer support as they foster trust and credibility essential to promoting holistic wellbeing. While patients with leukaemia already informally support each other, there are risks involved for both peer support providers and recipients when access to, and the nature of support is ad hoc. Objectives This paper will report on the innovative, collaborative process taken to introduce and embed a robust peer support program, purposefully tailored for newly diagnosed leukaemia patients, into an inpatient setting. Methods A steering committee including key stakeholders from community agencies, clinicians, consumers and volunteers was convened to oversee the program development. Two focus groups were also conducted to explore the acceptability and fidelity of embedding peers into the ward and establish an evaluation framework for continuous quality improvement. Results The data from the focus groups were analysed according to intended outcomes and risks. Clinical champions proved crucial to the integration of peers and providing opportunities for regular “check-ins” of the program. Conclusions Integration of volunteer peers into the acute care sector requires commitment from the executive through to point-of-care staff. Clinician engagement, support and understanding of the training program was central to generating high levels of trust in the peer program. It is also fundamental to managing the dynamic between clinicians and peers, many of whom received care in the same inpatient setting.

eP126 PERCEIVED BARRIERS TO IMPLEMENTATION OF CURRENT GUIDELINES ON LONG-TERM OPIOID THERAPY: RESULTS OF AN OPIOID POST-COURSE SURVEY P. Sloan1 1 , Lexington, USA Introduction Opioids for long-term therapy of chronic pain (CP) have recent guidelines that recommend reduced opioid doses, and caution for prescribing.1,2 These guidelines strongly endorse physician opioid education to change provider practice.3 Objectives The objective of this study was to evaluate changes to practice that physicians plan to implement following a 3-day opioid education course, and any perceived barriers to implementation of current opioid guidelines for CNMP. Methods A 3-day course on prescribing of long-term opioids for CP was attended by 220 health professionals. The topics covered opioid pharmacology; opioid prescribing; risks and side effects of opioid therapy; and current recommendations of recent guidelines. A post-course survey was given to attendees to evaluate any perceived increase in competence, specific plans which would change clinical practice, and any perceived barriers to future changes in practice. Results 147 attendees completed the course evaluation, including 55% practicing physicians and 16% nurse practitioners. 88% believed the opioid course increased their clinical competence and 89% believed they were better able to use best practices for long-term opioid therapy. 81% planned to change their current practice, with 44% as revising protocols and policies,

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and 35% changing patient medication management. However, most (92%) attendees perceived significant barriers to implementation of current opioid guidelines, including patient compliance (33%), lack of time (26%), and lack of resources (27%).

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eP128 CANCER SURVIVORSHIP FOCUSED EDUCATION IN FILIPINO NURSES IN FLORIDA: ASSESSMENT OF UNDERSTANDING AND TAKE HOME- MESSAGES /IMMEDIATE RECALL W. Tan1 1 Mayo Clinic, Hematology oncology, Jacksonville, USA

Conclusions 1) Most health professionals, following an opioid education course, planned to change their clinical management of opioid therapy. 2) However, most attendees perceived significant barriers to implementation of current opioid guidelines.

eP127 CORRELATIONS OF SMOKING STATUS VS CANCER MORTALITY AND OTHER HEALTH STATUSES AND DEMOGRAPHICS AMONG 5919 CANCER SURVIVORS J. Song1 1 University of Virginia, School of Arts and Science, Yorktown, USA Introduction It has been estimated that smoking causes a third of all cancer deaths, decreases treatment effectiveness, and increases cancer reoccurrence. However, many survivors continue to smoke, and very limited research has been conducted on this topic. Objectives SPSS was used to find correlations between survivor's smoking status and demographics given by the 2014 CDC BRFS. Methods Logistic regression compared current smokers with formal smokers, current smokers with nondaily smokers, and those that tried to quit with those that did not. Results Compared to current smokers, former smokers are associated with better mental condition (OR=2.15), health care coverage (OR=2.06), additional exercise( OR=1.58), better dental care (OR=1.82), stable marriages (OR=2.07), overweight (OR=1.97) or obesity (OR= 3.20), being male (OR=1.75), and receiving flu vaccine as recommend (OR=1.60). Current asthma (OR=1.79) and history of COPD (OR=2.93) also are associated with current smoking. Having a higher mortality cancer caused higher chance of quitting (OR=2.31). Poor physical health( OR=3.14), financial problem to see provider (OR=2.07), additional exercise (OR =1.85), past medical history of asthma (OR =9.26), employment (OR=2.60), being out of work for more than one year (OR=6.21), and having smoking related cancer (OR=2.69) are independently associated with the intent to quit smoking. Conclusions Data shows those with mental conditions are more likely to continue smoking. Non-daily smokers are associated with financial difficulty and poor physical health. Past medical history of cardiovascular disease, stroke, and diabetes has no significant effects on survivor’s smoking status. Smoking’s association to patient’s cancer results in wanting to quit but not actual quitting while cancer mortality results in actual quitting but not intent.

Introduction Cancer education in health care workers is important in any aspect of clinical care of patients today. With the increasing incidence of cancer, there are multiple cancer patient encounters each day and the knowledge about general concepts for cancer care would be useful for every clinician. Objectives To assess knowledge and retention of topics discussed in a conference. Describe the potential areas that are practice changing. Methods Filipino nurses as part of their Annual conference were asked to participate. Topics included nutrition, genomics, neuropathic pain, survivorship issues, psychological/spiritual issues and novel targeted treatment/personalized care of cancer. This was held April 23, 2016 Jacksonville Florida. Results 37 individuals attended the meeting, 21 (56%) individuals filled up the survey. Age range was 30-67, majority of the participants were between 45-60, participants had extensive nursing care experience 21-40 years 15/21 (71%). Participant worked in different areas of clinical care including intensive care unit, case management, medical/surgical floor, primary care, research and only one worked in oncology. The topics that were actionable or topics that were pertinent for clinical practice/practice changing for the participants include cancer prevention through screening and vaccination 13/21 ( 62% ), pathogenesis of cancer 10/21 (48% ), novel biomarkers and that cancer can be treated with targeted pills instead of Intravenous chemotherapy 15/21 (71%), nutrition 2/21(10%), emotional and spiritual support 2/21(10%) Conclusions Focused education program In Filipino nurses lead to good immediate recall of topics discussed and potentially can lead to actionable practice behavior that can be relevant for clinical care.

eP129 PA R T I C I PA N T E VA L U AT I O N O F A N A D VA N C E D PRACTITIONER CANCER EDUCATION PROGRAM FOR NEW APP IN HEMATOLOGY/ONCOLOGY W. Tan1, M. Diaz2 1 Mayo Clinic, Hematology oncology, Jacksonville, USA 2 Florida Cancer Specialist, Hematology/Oncology, Clearwater, USA Introduction There will be a significant need for Advance practice Providers (APP) to fill the gap of the increasing demand for Hematology/oncology services for the millennial generation. New practitioners are graduating with inadequate training to integrate into clinical practice Objectives Describe how a symposium had an impact on education of APP as far as improvement of knowledge, confidence and goal oriented competence in hematology/oncology. Methods The Florida Society of Clinical Oncology (FLASCO) formed a task force to pilot an education program that is relevant, practical and evidenced based for APP. A one day course was conducted February 27, 2016 in Tampa, Florida. Assessment of educational goals, participant satisfaction and goal/task oriented competence were evaluated through a post course survey and a 6 month survey. Results A total of 26 individuals participated in the course representing 18 different practices in the state of Florida. 21/26 participants agreed to fill up the survey.

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17/21 (81%) were nurse practitioner, 4/21 (19%) physician assistants. 16/20 rate it as practice changing, it filled a professional knowledge gap 23/23 (100%), change competence significantly and moderately 21/23 91%, change and motivate them to change patient care 19/21 (83%).Post course survey at 6 months, 3/21 answered the survey. All were able to apply what they learned from the conference, at least one topic changed the way they managed patient. Conclusions An education program for new APP organized by experienced faculty fill up a gap in knowledge and increased knowledge, change competence, and motivated APP to change practice.

eP130 ANALYSIS OF DRUG INTERACTION POTENTIAL OF RIBOCICLIB WITH COMMONLY USED MEDICINES AND HERBAL SUPPLEMENTS IN PATIENTS WITH ADVANCED BREAST CANCER R. Hunter1 Texas Southern University College of Pharmacy and Health Sciences, Pharmacy, Houston, USA 1

Introduction Ribociclib, an orally bioavailable, selective inhibitor of cyclin-dependent kinases 4 and 6 that is primarily metabolized by and inhibits cytochrome P450 3A (CYP3A), can exhibit variable exposure with medicines that induce or inhibit CYP3A. Objectives To assess the potential for drug-drug interactions between common medicines/supplements and ribociclib. Methods This single-center retrospective chart review of patients (n=42) with advanced breast cancer identified the most commonly used drugs and supplements from 2/1/2016 to 1/31/2017, categorized by comorbidity. The potential for drug interaction and/or QT interval prolongation was assessed using available clinical pharmacology information listed in the Lexicomp Online, Natural Products, and Memorial Sloan Kettering Cancer Center Integrative Medicine databases. Results The most common 120 prescription medicines and 32 herbal supplements to treat acute symptoms, including nausea, pain, and infections, and chronic comorbidities including diabetes, hypertension, and cardiovascular disease were identified. Common medications such as fluoroquinolones, pure opioid agonists, and 5-HT3 antagonists for acute symptoms and angiotensin II receptor blockers, factor Xa inhibitors, and dipeptidyl peptidase 4 inhibitors for chronic comorbidities would potentially not interfere with ribociclib metabolism. Additionally, commonly used supplements had varied potential effect on ribociclib metabolism. Herbal supplements such as St John’s wort and echinacea should be avoided, and fish oil and cranberry extract would likely not affect ribociclib exposure. Conclusions Although CYP3A inhibitors and inducers affect ribociclib exposure, these results describe therapies that treat common comorbidities and can likely be administered with ribociclib, thus providing useful guidance to health care professionals for proper long-term care.

eP131 DOCUMENTATION OF DRIVING RECOMMENDATIONS FOR PATIENTS RECEIVING WHOLE BRAIN RADIOTHERAPY M.H. Wang1, M. Hwang1, S. Ghosh2, D. Severin1, T. Nijjar1, K.P. Chu1, Z. Gabos1, B. Debenham1, D. Yee1, K. Tankel1, W. Roa1, R. Pearcey1, K. Joseph1, B. Danielson1, A. Fairchild1 1 Cross Cancer Institute, Radiation Oncology, Edmonton, Canada 2 Cross Cancer Institute, Experimental Oncology, Edmonton, Canada

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Introduction Brain metastases (BM) may cause persistent or episodic neurocognitive impairments which impact on a patient’s ability to drive safely. The national standard for licensure requires sufficient motor, sensory and cognitive function and a seizure-free period of at least six months. Assessment of whether a patient meets these criteria often relies on a physician’s judgement. Objectives To investigate documented recommendations regarding driving in a population receiving whole brain radiotherapy (WBRT). Methods Demographic, symptom, disease and treatment-related data were abstracted for consecutive adult patients receiving palliative WBRT for BM at our institution (01-12/2015). Prophylactic cranial irradiation, stereotactic and partial brain radiotherapy were excluded. Descriptive statistics were calculated, and a logistic regression model was used to identify factors predictive of documentation of discussion of driving restrictions. Results For the 126 eligible patients, median age was 64.6 years, 47.6% were male, and 63.5% had extracranial metastases. Median KPS was 60 (range 10-100) with 32.5% RNFC class 1-2 and 62.7% RNFC class 3-4. 46.0% had >1 motor symptom, 29.4% had >1 sensory symptom, 28.6% had >1 cognitive symptom, and 14.3% had >1 reported seizure (SZ). Overall, 27 patients (21.4%) had been advised to stop driving; 6/18 with SZ were so advised. Worse RNFC (p=0.009) was predictive of recommending driving cessation. However, age, SZ, KPS, extracranial metastases, and presence of cognitive, motor, or sensory impairment was not. Conclusions Although it is an important public health issue, there is a lack of documentation regarding assessment of driving safety in our cohort of patients receiving WBRT for BM.

eP132 MOTHERS’ EXPERIENCES IN DEALING WITH FATIGUE IN CHILDREN WITH CANCER A. Allenidekania1, E. Nurachmah2, Y. Rustina1, T. Eryando3 1 Universty of indonesia, Pediatric Nursing, Depok, Indonesia 2 Universty of indonesia, Medical Surgical Nursing, Depok, Indonesia 3 Universty of indonesia, Faculty of Public Health, Depok, Indonesia Introduction Cancer-related fatigue has been known as the most cancer and therapy consequences experienced by patients. One out of two children in Indonesia complained fatigue. Children needs mothers help to manage their fatigue effectively, unfortunately mothers’ self efficacy needs to be improved. Objectives This research aims to explore mothers’ experiences in dealing with fatigue in children with cancer. Methods Qualitative research using phenomenology approach applied to ten mothers recruited by purposive sampling technique. Interview held in children oncology wards in one cancer centre. Semi structure interview applied to each participant and verbatim until data saturated. Data analyzed use theme analysis. Ethical clearance as well as ethical principal applied during and after data collection. Each participant was invited to validate the results as themes and categorizes. Symptom management model revised (UCSF) use as the research framework, especially in symptom experience domain. Results Mother’s age ranged were 36-50 years old, average education 13.8 years, 7 out of 10 were housewife. Six out of 10 children were girls; average education was 3.3 grades, Cancer diagnosis were Leukemia Lymphocyte Acute (3), Lymphoma Non Hodgkin (4) and others. Mostly children have

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chemotherapy sessions. Six themes identified children experience fatigue (1) before therapy, (2) during cancer therapy, (3) after therapy, (4) conditions that aggravate the symptoms, (5) conditions that alleviate the symptoms, and (6) fatigue impact. Conclusions In conclusion, nurses should pay attention to mothers’ experiences in dealing with fatigue and develop nursing care to empower mother in helping their children reducing fatigue.

eP133 PREVALENCE OF FATIGUE IN HEAD AND NECK CANCER SURVIVORS P. Bossi1, R. Granata1, P. Di Pede2, M. Guglielmo2, R. Miceli3, G. Infante3 , S. Alfieri1 , N.A. Iacovelli4, E. Orlandi 4, M. Guzzo5, R. Bianchi5, C. Ripamonti2 1 Fondazione IRCCS Istituto Nazionale dei Tumori, Head and Neck Medical Oncology, Milano, Italy 2 Fondazione IRCCS Istituto Nazionale dei Tumori, Supportive Care Unit, Milano, Italy 3 Fondazione IRCCS Istituto Nazionale dei Tumori, Clinical Epidemiology and Trial Organization Unit, Milano, Italy 4 Fondazione IRCCS Istituto Nazionale dei Tumori, Radiotherapy unit, Milano, Italy 5 Fondazione IRCCS Istituto Nazionale dei Tumori, Head and Neck Surgery, Milano, Italy Introduction In Head and Neck cancer (HNC) patients (pts), fatigue is present throughout the course of treatment and during follow up. There are limited data about the prevalence and factors associated with fatigue in HNC survivors. Objectives To assess the prevalence of fatigue and its interference with daily life activities; to examine the association between fatigue and gender, age, HPV status, previous oncologic therapy, primary tumor site, and time since end of treatment. Methods Locally advanced consecutive HNC pts having completed curative treatment since at least one year and free of disease were asked to fill in the Brief Fatigue Inventory (BFI) questionnaire. Fatigue was categorized according to BFI score in absent (0), mild (1-3), moderate (4-7) and severe (8-10). Results From 2/2015 till 7/2016, 129 pts (median age 60 years old; 67% male) were evaluated. Primary sites of cancer were oropharynx (45%, with 4 out of 5 pts HPV positive), nasopharynx (23%), larynx/hypopharynx (15%), oral cavity (13%) and paranasal sinus or salivary gland (4%). Oncologic treatment was completed 12 to 45 months earlier (median 34 months). Fatigue was reported as absent in 16% of the pts, mild in 66%, moderate in 11% and severe in 7%. No association between BFI score and the analyzed variables was identified. Conclusions Moderate and severe fatigue was reported in 18% of HNC survivors. Further research is needed to assess its causes and to improve therapeutic management.

eP134 P S Y C H O M E T R I C P R O P E RT I E S , M E A S U R E M E N T EQUIVALENCE AND MINIMAL CLINICALLY IMPORTANT DIFFERENCE OF THE MULTIDIMENSIONAL FATIGUE SYNDROME INVENTORY-SHORT FORM (MFSI-SF) IN ASIAN CANCER PATIENTS A. Chan1, X. Wang1, T. Ng1, C. Lew1, T. Yo1, K.M. Foo2, A. Yeo1, M. Shwe1, Y. Gan3, R. Ng3

1

National University of Singapore, Pharmacy, Singapore, Singapore K.K. Women’s and Children’s Hospital, Pharmacy, Singapore, Singapore 3 National Cancer Centre Singapore, Pharmacy, Singapore, Singapore 2

Introduction The Multidimensional Fatigue Syndrome Inventory-Short Form (MFSISF) is a 30-item tool designed to measure cancer-related fatigue (CRF) in patients with cancer. However, its psychometric properties has not been evaluated among Asian patients. Objectives This study is designed to examine the psychometric properties, measurement equivalence of different language versions and to quantify the minimal clinically important difference (MCID) of the MFSI-SF. Methods This is a prospective, cohort study of 222 Asians diagnosed with breast cancer and lymphoma. Patients completed MFSI-SF and various questionnaires at two time points (before chemotherapy and 3 weeks later). Validity, reliability and responsiveness were evaluated to determine the psychometric properties, and the MCID was calculated using both anchor- and distribution-based approaches. Multiple regression was used to compare the subscale and total scores of the different language versions of MFSI-SF. Results High correlation was observed between the emotional and mental fatigue subscales of the MFSI-SF and the emotional and cognitive functioning domains of the EORTC QLQ-C30 (r = -0.81 and r = -0.76, respectively). Known group validity analysis suggested that patients with depression, pain and insomnia experienced worse fatigue (p < 0.001). There was also high internal consistency observed (a = 0.75 to 0.94). Measurement equivalence between the English and Chinese versions was established for all subscales, except the emotional and vigour subscales. The MCID was calculated to range from 4.5 to 10.2 points. Conclusions This study supports the use of MFSI-SF to measure and quantify the clinical significance of CRF within the Asian cancer population.

eP135 INTERRELATIONSHIP BETWEEN IMPROVEMENTS IN AEROBIC CAPACITY AND CANCER-RELATED-FATIGUE IN PROSTATE CANCER PATIENTS C. Cole1, L. Peppone1, C. Kamen1, C. Fung2, K. Loh2, R. Dunn2, I. Kleckner1, P.J. Lin1, M. Asare1, M. Janelsins1, K. Mustian1 1 University of Rochester Medical Center, Department of Surgery, Rochester, USA 2 University of Rochester Medical Center, Department of Hematology/ Oncology, Rochester, USA Introduction Cancer-related fatigue (CRF) is one of the most prevalent adverse effects of cancer and its treatments. Exercise reduces CRF; however the relationship between aerobic capacity (AC) and CRF are unclear. Objectives To examine the effect of exercise on AC and CRF in prostate cancer patients. Methods A secondary data analysis was performed on a two-arm randomized controlled trial investigating the influence of exercise on prostate cancer patients treated with hormone (androgen deprivation therapy) and/or radiation therapy. Exercise for Cancer Patients (EXCAP©) is a 6-week home-based program that includes progressive aerobic and resistanceband training. Participants were randomly assigned to usual care with EXCAP© or usual care only (UC). AC was measured using a VO2 max treadmill test. CRF was evaluated using the Multidimensional Fatigue Symptom Inventory (MFSI) at pre-/post-intervention.

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Results Participants included 57 sedentary prostate cancer patients (EXCAP© = 34; UC = 23), average age 67 ± 8 years. The EXCAP© group showed a trend-level increase in AC compared to the UC group (VO2 change score: EXCAP = 1.74 vs. UC = .03; p=.08). Exercise significantly improved CRF (p<0.01) in the EXCAP© group compared to the UC group. In the EXCAP© group those individuals who experienced the greatest increases in AC (change score < 1.5) reported greater improvements in CRF (change = -10.46; p<0.01), no association was found in the UC group. Conclusions Exercise-induced improvements in CRF may be associated with enhanced AC in prostate cancer patients. Additional research should investigate the exercise-induced mechanisms that improve CRF. NCORPUG1-CA189961, R25-CA102618, DOD-PC061518

eP136 FATIGUE, SYMPTOM BURDEN AND HEALTH-RELATED QUALITY OF LIFE OF PATIENTS WITH MYELODYSPLASTIC SYNDROME C. Escalante1, S. Chisolm2, J. Song3, M. Richardson4, E. Salkeld5, T. Lam6, E. Aoki4, G. Garcia-Manero7 1 University of Texas MD Anderson Cancer Center, General Internal Medicine, Houston, USA 2 Bladder Cancer Advocacy Network, Director of Education and Research, Bethesda, USA 3 The University of Texas MD Anderson Cancer Center, Biostatistics, Houston, USA 4 The University of Texas MD Anderson Cancer Center, General Internal Medicine, Houston, USA 5 Aplastic Anemia & MDS International Foundation, Sr. Director of Research and Health Professionals Program, Bethesda, USA 6 The University of Texas MD Anderson Cancer Center, Internal Medicine, Houston, USA 7 The University of Texas MD Anderson Cancer Center, Leukemia, Houston, USA Introduction Fatigue is common and distressing among patients with myelodysplastic syndrome (MDS), affecting their quality of life (QoL). Often, this is combined with other symptoms such as pain, depression, anxiety, and stress. Limited data exist on the perceived level of fatigue, QoL and related symptoms in MDS. Objectives The objectives are to describe fatigue, QoL and related symptoms in patients with MDS by prospectively assessing using the Functional Assessment of Cancer Therapy-Anemia (FACT-An) for fatigue and subscales within FACTAn (QoL), pain using the Brief Pain Inventory (BPI), depression, anxiety and stress using the DASS-21, and to define management strategies used. Methods Surveys were administered via the Aplastic Anemia and MDS International Foundation’s database from 10/2014-1/2015 via a secure internet portal associated with the Foundation’s website. Descriptive statistics were utilized. Results 145 patients with MDS had a mean age of 67 years and 92 (97%) white. The mean fatigue score was 25 (severe; range 1-52),and the QoL score 69 (range 10-104; higher score, better QoL). The ranges for stress were normal, pain, depression and anxiety were mild. Management strategies most helpful were preserving energy 103 (90%), physical activity 81 (79%) and eating healthy 77 (79%) with utilization 3 or more times/ week of 80 (65%), 51 (41%), and 78 (64%), respectively. Conclusions There are few patient reported outcomes of fatigue, QoL and related symptoms in MDS. Fatigue and QoL are challenges. Further focus on strategies to improve fatigue and QoL is necessary.

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eP137 DETERMINING MITOCHONDRIAL BIOENERGETICS PROFILES IN FATIGUED MEN WITH PROSTATE CANCER RECEIVING LOCALIZED RADIATION THERAPY C.P. Hsiao1, B. Daly1, C. Hoppel2 1 Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland- OH, USA 2 Case Western Reserve University, Department of Pharmacology- School of Medicine, Cleveland- OH, USA Introduction Fatigue is one of the most common burdensome symptoms with the greatest adverse effect on quality of life, but arguably is the least understood. We proposed a mitochondrial bioenergetics mechanism of radiationinduced fatigue (RIF) based on molecular-genetic approaches, linking impaired ATP production as a consequence of radiation therapy (RT). Objectives To determine associations between mitochondrial bioenergetics and fatigue in non-metastatic prostate cancer patients receiving localized RT. Based on preliminary findings, we hypothesized that decreased BCS1L leads to a decrease of Rieske iron-sulfur protein incorporation into complex III. This incomplete complex III leads to a defect in complex III activity, causing impaired mitochondrial oxidative phosphorylation (OXPHOS) resulting in decreased ATP production, contributing to fatigue. Methods This was a prospective, hypothesis testing project with a longitudinal research design. Mitochondrial bioenergetics profiles were measured from human lymphocytes using high resolution respirometry system and the revised Piper Fatigue Scale was utilized to measure fatigue at baseline, midpoint, and endpoint. This is an ongoing project. Twenty subjects have completed the study and the data were analyzed using linear mixed model. Results Fatigue is intensified at midpoint and remained elevated at the completion of RT (p=0.04). Decreased OXPHOS was detected at midpoint and endpoint of the RT compared to baseline. Furthermore, increased fatigue scores appear to be associated with decreased OXPHOS. Conclusions This is the first study to determine the role of mitochondrial bioenergetics in development of RIF. Our findings identify potential targets for pharmacological and nutraceutical interventions and initiate a new direction for design of nursing interventions for RIF.

eP138 FATIGUE IN PATIENTS WITH LYMPHOMA: A CROSSSECTIONAL STUDY C. Inocencio Vasques1, A.C. Mendonça Mota1, B.K. Dourado Gaia1, M.C. Toscano de Campos1, E. Barros Ferreira1, S. Roque Mazoni1, P.E. Diniz dos Reis1 1 Univesity of Brasilia, Nursing Department, Brasília, Brazil Introduction Cancer-related fatigue (CRF) is a common symptom, reaching 50-90% of patients diagnosed with neoplasia. This symptom is defined as physical, emotional and/or cognitive exhaustion, disproportionate to recent activity, which does not improve with rest and sleep. Objectives To evaluate the prevalence of fatigue and the existence of depression and anxiety in patients with lymphoma. Methods Cross-sectional, descriptive study. Were included patients who have been diagnosed with lymphoma, who were 18 years old or more at the moment of the study, and who have cognitive capacity preserved. Patients diagnosed with anemia or hypothyroidism were excluded. The Piper Fatigue

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Scale reviewed and Anxiety and Depression Rating Scale were applied to the patients during chemotherapy sessions. Results Twenty three patients were enrolled; however, two of them were excluded because of anemia, and the final sample was consisted of 21 patients with a mean age of 55.4 years. Most of the participants were diagnosed with Hodgkin's Lymphoma. Only 6 of the 21 participants were performing the first chemotherapy session at the time of the research. According to Piper's Fatigue Scale, it was possible to identify a predominance of mild fatigue among patients (n = 9), especially in those who were performing the first chemotherapy session. Regarding the evaluation of anxiety and depression, six of the 21 patients (28.5%) presented anxiety and only two presented depression. Conclusions FRC is prevalent in patients with Non-Hodgkin Lymphoma and Hodgkin's Lymphoma. The results are not sufficient to suggest that there is a relationship between anxiety and intense fatigue in the evaluated patients.

eP139 GENE EXPRESSION PROFILING OF EVENING FATIGUE DIFFERS BY CANCER DIAGNOSIS IN ONCOLOGY PATIENTS UNDERGOING CHEMOTHERAPY K. Kober1,2, E. Flowers1, J. Mastick1, S. Paul1, C. Miaskowski1,2 1 UCSF, Physiological Nursing, San Francisco, USA 2 UCSF, Helen Diller Family Comprehensive Cancer Center, San Francisco, USA Introduction Investigation of molecular mechanisms associated with fatigue severity in oncology patients may identify new therapeutic targets. However, findings are inconclusive as to whether or not a patient’s cancer diagnosis influences the phenotypic and molecular characteristics associated with fatigue severity. Objectives Compare differential gene expression (GE) between patients with Moderate and Very High levels of evening fatigue for the sample as a whole (W, n=257) and for patients with breast cancer (BC, n=103). Methods Outpatients receiving chemotherapy (CTX) were assessed 6 times over two CTX cycles. Three groups of patients with distinct evening fatigue trajectories were identified (i.e., Moderate (20.0%), High (21.8%), and Very High (58.2%)). GE in peripheral blood was assayed using the Illumina HumanHT-12 microarray. Differentially expressed (DE) genes and pathways were identified between Moderate and Very High classes for W (n=63, n=194) and BC (n=17, n=86) samples. Results Patients who were younger, had poorer functional status, and higher BMI were more likely to be in the Very High class for both the Wand BC samples. For the W sample, 29 DE genes and 162 DE pathways were found related to immune function, inflammation, neurotransmission, energy metabolism, and circadian rhythms. In the BC sample, 30 DE genes and 152 pathways were found. While none of the DE genes were the same, all of the DE pathways found in the BC sample overlapped those found in the W sample. Conclusions Findings suggest that in a sample of patients with different cancer diagnoses both common and cancer specific mechanisms for CRF exist.

eP140 ADVANCED HEALTHCARE PROFESSIONAL SURVEYS IDENTIFY UNMET MEED FOR TREATMENT OF WEIGHT LOSS IN ADVANCED CANCER PATIENTS J. Koeller1, W. Vogel2 1 UTHSC, Medicine-MC-6220, San Antonio, USA 2 Wellmont Cancer Institute, Nursing, Kingsport, USA

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Introduction Involuntary weight loss in advanced cancer patients is a precursor to cancer cachexia, which is a syndrome that is defined by ongoing muscle atrophy and sarcopenia. Objectives Hematology/Oncology Pharmacy Association (HOPA) and the Advanced Practitioner Society of Hematology and Oncology (APSHO; NP, PA, CNS, PharmD) members were surveyed to understand how these two groups view weight loss and it's management in advanced cancer patients. Methods Online 4-item surveys were conducted between Oct., and Nov., of 2015 for all HOPA members and Jan., and Feb., 2016 for all APSHO members. Respondents were questioned about how their practice monitors weight loss over time in advanced cancer patients and about their views toward the sufficiency of currently available treatments for weight loss. Results A total of 152 members (77 HOPA & 75 APSHO) responded to these surveys. Sixty-five percent of both groups reported having a system/ program for identifying body weight changes over time. HOPA respondents reported common treatments to include nutritional supplements (47%), progestin’s (17%), cannabinoids (14%), and with 9% indicating they do not treat weight loss. APSHO respondents identified cannabinoids (32%), steroids (30%), progestin’s (21%) as the more common treatment options, with 5% not treating. However, only 9% of HOPA and 17% of APSHO respondents respectively, agreed that current treatments are effective and have an acceptable safety profile for long-term management of advance cancer patients with weight loss. Conclusions These pilot surveys identified a lack of safe, effective treatment options for cancer-related weight loss and that this is a major unmet need in advanced cancer patients.

eP141 A NEW PERSPECTIVE ON CANCER-RELATED FATIGUE: NEGATIVE AFFECTIVITY AND INFLAMMATION LEADING TO INCREASED EFFORT EXPENDITURE T. Lacourt1, E. Vichaya1, C. Escalante2, E. Manzullo2, B. Gunn3, C. Heijnen1, R. Dantzer1 1 The University of Texas- MD Anderson Cancer Center, Symptom Research, Houston- TX, USA 2 The University of Texas- MD Anderson Cancer Center, General Internal Medicine, Houston- TX, USA 3 The University of Texas- MD Anderson Cancer Center, Radiation Oncology, Houston- TX, USA Introduction Fatigue is a common, debilitating condition in cancer patients that still remains poorly understood. Negative affectivity (NA; a disposition to experience aversive emotional states) and inflammation have both been associated with fatigue but the mechanisms are unknown. Objectives We focused on incentive motivation, the amount of effort one is willing to engage in to obtain a reward, as a possible link between NA, fatigue, and inflammation. Methods Self-reported NA and fatigue were assessed with validated questionnaires in 47 cancer patients and survivors. Incentive motivation was assessed with a validated computerized task in which participants repeatedly chose between a high effort/high reward and a low effort/low reward task. Plasma concentrations of IL-1ra, TNF-α, TNFRII, IL-6, and sIL-6r were measured using ELISAs. Results NA and fatigue were correlated (r=.36, p<.001). In separate generalized estimating equation (GEE) models, higher fatigue, NA, and sIL-6

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concentrations were all associated with higher percentages of high effort choices (p-values=.018, .024, and .038). Entering both NA and fatigue in one model attenuated the effects of both to non-significance (Figure 1).

Conclusions Both NA and fatigue were associated with higher motivation to exert effort. However, these associations were not independent. NA is a stable personality trait, whereas fatigue is a state that fluctuates over time. The association of NA with increased motivation for effort expenditure probably makes cancer patients more vulnerable for developing fatigue. In agreement with our preclinical data, inflammation was also associated with increased effort expenditure, indicating that inflammation can also contribute to fatigue through this effort investment pathway.

eP142 DIFFERENTIAL MECHANISMS OF CANCER- VERSUS CANCER THERAPY-RELATED FATIGUE IN PATIENTS WITH ACUTE MYELOID LEUKEMIA T. Lacourt1, A. Kavelaars1, S. Shelburne2, D. Kontoyiannis2, A. Futreal3, C. Heijnen1 1 The University of Texas- MD Anderson Cancer Center, Symptom Research, Houston- TX, USA 2 The University of Texas- MD Anderson Cancer Center, Infectious Disease- Infection Control- and Employee Health, Houston- TX, USA 3 The University of Texas- MD Anderson Cancer Center, Genomic Medicine, Houston- TX, USA Introduction Fatigue is a common, debilitating symptom in patients with acute myeloid leukemia (AML). Although several mechanisms of fatigue have been proposed including inflammation, stress, and the gut microbiome, it is unclear whether these mechanisms pertain to cancer- or cancer therapyrelated fatigue. Objectives We aimed to identify the relative contribution of inflammation to fatigue before and during remission induction chemotherapy for AML and to study the predictive value of clinical factors, stress, and stool microbiome factors for expression of fatigue. Methods Weekly fatigue and stress reports, plasma levels of 14 inflammationrelated biomarkers, gut microbiome factors, and clinical laboratory values were obtained from patients (n=102) before (baseline) and during chemotherapy (week1-3). Results Stress was associated with fatigue at every time point (r=.40-.64). Clinical laboratory values, microbiome diversity, and abundance of specific microbiome strains were not associated with fatigue, although cancer therapy changed the microbiome diversity. Multiple regression models for inflammation predicting fatigue showed that inflammation became a stronger predictor during chemotherapy: explained variances increased from 7% at baseline to 39% at week 3. Adding stress to these models increased explained variances at baseline and week 1. However, the contribution of stress was severely diminished during chemotherapy when inflammation was taken into account (Figure 1).

Conclusions Inflammation is an important driver of chemotherapy-related fatigue whereas stress is a strong and independent predictor of AML-related fatigue. Controlling for inflammation reduced the contribution of stress during chemotherapy, suggesting that stress contributes to fatigue during chemotherapy via inflammatory pathways.

eP143 CANCER RELATED FATIGUE: THE ROLE OF MOBILE TECHNOLOGY IN ASSESSMENT B. O'Connor1, M. Markicevic2,3, C. O'Higgins1,2,4, L. Newman2,3, R. Kallidil2,3, P. Ui Dhuibhir1, S. Cuffe5, E. Hanrahan6, R. Reilly2,3,4, D. Walsh7,8 1 Our Lady's Hospice & Care Services, Academic Department of Palliative Medicine, Dublin, Ireland 2 Trinity College Dublin, Trinity Centre for Bioengineering, Dublin, Ireland 3 Trinity College Dublin, School of Engineering, Dublin, Ireland 4 Trinity College Dublin, School of Medicine, Dublin, Ireland 5 St James's Hospital, Department of Medical Oncology, Dublin, Ireland 6 St Vincent's University Hospital, Department of Medical Oncology, Dublin, Ireland 7 Levine Cancer Institute, Department of Supportive Oncology, Charlotte, USA 8 Carolinas HealthCare System, Professor of Medicine, Charlotte, USA Introduction Cancer related fatigue (CRF) is common (25-99%). The pathophysiology remains poorly understood. Aetiology may be central or peripheral and originate anywhere from brain to muscle fibre. Objective measurement is complex and requires specialised laboratories. Mobile electroencephalography (EEG) and electromyography (EMG) may enhance objective measurement in the routine clinical environment. Objectives 1. Determine feasibility and acceptability of mobile EEG-EMG to evaluate CRF 2. Correlate subjective and objective fatigue Methods Prospective observational study in the oncology outpatient department. 10 participants (PT) with pre-treatment non-small cell lung cancer were compared to 10 healthy volunteers (VT). All completed a sustained isometric hand-grip contraction at 30% maximal level (S30) until self-perceived exhaustion. 128 channel EEG and 2-channel EMG signals of forearm muscles were recorded throughout. Subjective fatigue was assessed by Brief Fatigue Inventory (BFI). Device acceptability evaluated by questionnaire. Results Fatigue task evaluated in 2 stages; first and last 20 secs. PT reported worse fatigue on BFI (p=0.043). PT perceived exhaustion earlier (mean/SD: 137.4 ± 76.2 secs v 208.3 ± 51.2 secs in VT). EMG amplitude increased

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significantly (VT: p=0.04; PT: p=0.02) in both cohorts. Increase was less in PT (amplitude: p=0.032). EEG β-band power in contralateral motor cortex increased significantly (VT: p=0.019; PT: p=0.03) in both but greater (p=0.024) in cancer. BFI >3 correlated poorly with objective fatigue measurements. PT reported 100% device acceptability. Conclusions 1. Lab-based CRF assessment successfully adapted for outpatient settings 2. High acceptability supports clinical utility 3. There was more central fatigue in cancer than healthy volunteers 4. Peripheral abnormalities also evident 5. Subjective fatigue correlated poorly with objective measurement

eP144 OBJECTIVE AND SUBJECTIVE MEASURES OF CANCERR E L AT E D FAT I G U E C O M PA R E D W I T H M YA L G I C ENCEPHALOMYELITIS C.M. O'Higgins1, D. Joyce2, A. Rice3, B. O'Connor4, D. Walsh1,4, R.B. Reilly1,5 1 Trinity College Dublin, School of Medicine, Dublin, Ireland 2 University College Dublin, School of Medicine and Medical Sciences, Dublin, Ireland 3 Trinity College Dublin, Trinity Center for Bioengineering, Dublin, Ireland 4 Our Lady's Hospice and Care Services, Academic Department of Palliative Medicine, Dublin, Ireland 5 Trinity College Dublin, School of Engineering, Dublin, Ireland Introduction Cancer-Related Fatigue (CRF) is a prevalent, highly debilitating symptom, as is Myalgic Encephalomyelitis (ME/CFS). Current assessment of CRF and ME/CFS is by subjective questionnaires (e.g. Brief Fatigue Inventory (BFI)) as no effective objective measures exist for fatigue. In this study, overall fatigue score was assessed using the BFI, and then compared to objective measures of muscular fatigue. Differences between CRF and ME/CFS sufferers were assessed using these measures. Objectives 1. If and to what extent can MVC and ET be used as objective measures in CRF and ME/CFS 2. To assess the differences of these measures between both groups Methods 10 pre-chemotherapy patients with NSCLC (age 64.0 ± 11.64),11 ME/ CFS volunteers (age 50.85 ± 10.53) assessed fatigue through BFI. They then performed sustained contraction of the right forearm at 30% maximal level until self-perceived exhaustion. MVC and ET were recorded. Results

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1. BFI for cancer group but not ME/CFS was strongly and significantly correlated to MVC strength 2. Controlling for age, ME/CFS group reported significantly higher mean fatigue on the BFI (6.90 vs 3.35) (p=0.005) compared to CRF group. 3. Linear regression analysis with MVC & ET as predictors of BFI resulted in an R2 value of .653 for CRF group and .064 for ME/CFS group. Conclusions There was strong correlation between MVC & BFI for cancer patients suggesting this could be used as an objective measure of fatigue. This was not the case with ME/CFS group, suggesting there may be a difference in underlying mechanisms.

eP145 INFLUENCE OF EXERCISE ON BIOMARKERS OF MUSCLE IMMUNE RESPONSE AND MITOCHONDRIAL DAMAGE AND THEIR RELATIONSHIP WITH CANCER-RELATED FATIGUE (CRF): A URCC NCORP STUDY A. Peoples1, L. Peppone1, P.J. Lin1, C. Cole1, C. Heckler1, M. Janeslins1, S. Rousey2, A. Onitilo3, M. Melnik4, K. Mustian1 1 University of Rochester Medical Center, Surgery, Rochester, USA 2 Metro Minnesota Community Oncology Research Consortium, Metro Minnesota Community Oncology Research Consortium, Saint Louis Park, USA 3 Wisconsin NCORP, Wisconsin NCORP, Marshfield, USA 4 Cancer Research Consortium of West Michigan NCORP, Grand Rapids, USA Introduction Chemotherapy via inflammation can cause muscle and mitochondrial damage, resulting in the release of cell components into circulation; this in turn can cause CRF. Immune response gene HLA-DQB1 is upregulated in muscle under highly inflammatory states. Mitochondrial gene MT-CO2 is involved in energy metabolism and mitochondrial function. Objectives We investigated the (i) effect of an individualized, home-based, aerobic and resistance exercise program, Exercise for Cancer Patients (EXCAP), on mRNA gene expression levels of HLA-DQB1 and MT-CO2 and (ii) their associations with CRF. Methods In this nationwide, multicenter, phase III RCT conducted through the URCC NCORP Research Base, cancer patients (N=350; mean age=55.7) were randomized to 2 groups: (i) chemotherapy and (ii) chemotherapy + 6-week EXCAP. Gene expression and CRF were assessed pre- and post-intervention from whole blood by qPCR and from patientreport by MFSI, respectively. Results T-tests revealed significant upregulation of HLA-DQB1 and MT-CO2 following chemotherapy in controls, but less up-regulation in exercisers (all p≤0.005). ANCOVA showed a trend for significant differences between controls and exercisers for HLA-DQB1 (9.2% vs 5.4%; p=0.059) and MT-CO2 (16.3% vs 12.7%; p=0.061). Pearson correlations revealed that increases in HLA-DQB1 and MT-CO2 were significantly associated with increase in CRF in controls (r=0.21; r=0.19; both p≤0.05), but not in exercisers. Conclusions Chemotherapy alters muscle immune response and mitochondrial gene expression causing muscle and mitochondrial damage, which may be mediators for CRF. EXCAP is a promising intervention that may reduce both muscle and mitochondrial damage via its positive effects on HLADQB1 and MT-CO2. Funding: NCI UGCA189961, R25CA102618. ClinicalTrials.Gov: NCT00924651

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eP146 ADVANCING THE SCIENCE OF SUPPORTIVE CARE MANAGEMENT: INNOVATIVE MEASUREMENT AND APPLICATION L. Saligan1, T. Armstrong2, S. Mitchell3, M. Bevans4 1 National Institutes of Health, National Institute of Nursing Research, Bethesda, USA 2 National Institutes of Health, National Cancer Institute- NeuroOncology Branch- Center for Cancer Research, Bethesda, USA 3 National Institutes of Health, National Cancer Institute- Outcomes Research Branch- Division of Cancer Control and Population Sciences, Bethesda, USA 4 National Institutes of Health, National Institute of Nursing ResearchClinical Center- Nursing Research and Translational Science- Nursing Department, Bethesda, USA Introduction An increased emphasis on person-centered healthcare delivery has simultaneously produced an expanded interest in the use of patient-reported outcomes (PROs) in research, population surveillance, and clinical practice. Objectives To illustrate innovative uses of PROs to advance the science of supportive care, and to review current approaches to standardize the collection, analysis and interpretation of PROs. Methods The panel will demonstrate varied applications of PROs in contemporary research and practice settings. Project outcomes to determine feasibility and usability of a PRO web-based measurement system will be presented and the methodological and technical issues to consider when investigating symptoms, and directions for innovation in CRS collection. Results PROs are important endpoints in understanding the impact of disease and treatment in therapeutic studies for clinical outcomes assessment as evidenced by recent examples in neuro-oncology. PROs also improved the identification of CRS phenotypes and permitted exploration of their proposed biologic attributions, such as the role of synergetic expressions of metabotropic glutamate receptor and pro-inflammatory markers in fatigue following peripheral radiotherapy and the role of circadian pathways in CNS irradiation-related fatigue. Publicly available measurement systems and data resources provide the means to standardize PRO data collection and to improve care delivery, conduct population surveillance, and generate research hypotheses. Operational, methodological and analytic challenges are examined to optimize collection and meaningful interpretation of PROs. Conclusions Inclusion of PROs in an expanding array of initiatives, including advancing the science of supportive care, requires knowledge of available and emerging approaches to optimize the rigor and the yield of these activities.

eP147 CHANGES OF FATIGUE, MUSCLE STRENGTH, AND QUALITY OF LIFE IN PATIENTS IN PANCREATIC CANCER WITHIN SIX MONTHS AFTER SURGERY S.C. Shun1, Y.J. Chou1, Y.T. Liou2, Y.W. Tien3 1 National Taiwan University, Schoo of Nursing, Taipei City, Taiwan R.O.C. 2 National Taiwan University Hospital, Department of Nursing, Taipei City, Taiwan R.O.C. 3 National Taiwan University Hospital, Department of Surgery, Taipei City, Taiwan R.O.C. Introduction Patients with pancreatectomy generally suffer from fatigue, decreasing physical activity and impact their quality of life (QOL). However, there

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is limited evidence about the changes of fatigue, muscle strength, and QOL focusing on patients after pancreatectomy. Objectives The aim of this study was to explore changes of fatigue, muscle strength and skeletal muscle mass (SMM) and their relations with QOL after six months of pancreatectomy. Methods A longitudinal design was used to recruit patients with undergoing pancreatic or periampullary cancer in a medical center. Data were collected within one month prior to operation (T0), and at the first (T1), third (T2), and six months (T3) post-operation. The questionnaires included Fatigue Symptom Inventory, and Functional Assessment of Cancer Therapy-General Scale were used. SMM was measured by Bioelectrical Impedance Analysis and muscle strength included handgrip strength and sit-to-stand test. Results Forty-five patients were recruited. The level of fatigue reached peak at T1 (M = 30.05) and then decreased by time and its level at T3 (M = 11.67) lower than T0 (M = 22.42). The lowest number of sit-to-stand test at T1. SMM kept the same level during four times. The level QOL improved at T3. Fatigue was the only significant factor related to QOL. Conclusions Fatigue decreased 3 months after surgery and it was only significant factor to affect QOL. It is suggested to encourage cancer patients to exercise as early as possible after receiving surgery to manage fatigue. Larger sample size is suggested to confirm the results for the future studies. eP148 FAT I G U E I N W O M E N W I T H B R E A S T C A N C E R I N CHEMOTHERAPY: INTEGRATIVE LITERATURE REVIEW M.J. Nascimento Silva1, J. Rodrigues Alvares1, N. Ferreira Cunha1, R. Godoy Cabral1, A.C. Yokoyama dos Anjos1 1 Universidade Federal de Uberlândia, Faculdade de Medicina, Uberlândia, Brazil Introduction Fatigue is considered by patients the most important adverse reaction related to chemotherapy. Objectives To analyze and to integrate results of national and international scientific qualitative studies that have investigated effects of fatigue on the lives of women with breast cancer undergoing chemotherapy. Methods Integrative literature review performed in PUBMED, CINHAL, SciELO, LILACS and BVS. For the analysis of the studies was used COREq. Results The final sample was composed of four studies published in the period 2010 to 2015, which evidenced two major themes: Fatigue experience; Interventions for fatigue management. Conclusions Despite the small number of articles found, this study highlights the need for further studies to investigate and produce publications on experiences of fatigue in patients with breast cancer undergoing chemotherapy, so that women are able to face it and handle it safely and effectively. In addition, it is desired with this study, that health professionals know the experience of women with fatigue to provide better care. eP149 C A N C E R R E L AT E D FAT I G U E A M O N G PAT I E N T S RECEIVING CANCER CHEMOTHERAPY H. Singh1, R.P.S. Banipal2 1 , SADIQ ROAD- FARIDKOT, India 2 Guru Bobind Singh Medical College- Faridkot, Oncoration, FaridkotPunjab, India

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Introduction Cancer prevalence in India is estimated around 2.0-2.5 million, 0.7-0.8 million new cases identified every year, and cancer deaths reported per year is 0.4-0.5 Million. The objective of this study was to estimation of the cancer related fatigue (CRF) among patients on chemotherapy. Objectives The estimation of the cancer related fatigue (CRF) in our cancer patient populations. Correlation of CRF severity with different personal and demographic parameters. Methods The Brief Fatigue Inventory scale questionnaire for estimation of CRF was provided to cancer suffering subjects in their respective understandable language. The BFI is a screening tool which measures the severity of fatigue over the previous 24 hours. Results A total of 126 patients diagnosed with cancer, including 46 males and 80 females participated in this observation study. The study established the high prevalence (80%) of fatigue in cancer patients. We observed statistical correlation of CRF with chemotherapy cycle and Fatigue with specific drugs like vinblastine, decarbazine and Cyclophosphamide. Conclusions CRF is a very prevalent and upsetting symptom experienced by the majority of our patients in current study together during treatment for cancer and in the period following completion of treatment. Assessing CRF before and after treatment will facilitate health care practitioner about treating this severe distress symptom.

eP150 MULTIMODAL THERAPY FOR CANCER RELATED FATIGUE IN PATIENTS WITH PROSTATE CANCER RECEIVING RADIOTHERAPYAND ANDROGEN DEPRIVATION THERAPY S. Yennu1, K. Basen-Engquist2, V.K. Reed3, C.L. Carmack4, M. Usama3, S. Choi3, K.R. Hess5, J. Wu5, Z. Lu1, D.A. Kuban3, E. Bruera11 The University of Texas MD Anderson Cancer Center, PalliativeRehabilitation- and Integrative Medicine, Houston, USA 2 The University of Texas MD Anderson Cancer Center, Behavioral Sc, Houston, USA 3 UT MD Anderson Cancer Center, Department of Radiation Oncology, Houston, USA 4 UT MD Anderson Cancer Center, Palliative Care- Rehabilitation- and Integrative Mediciane, Houston, USA 5 UT MD Anderson Cancer Center, Department of Biostatistics, Houston, USA Introduction There are limited studies to evaluate treatments that target causative mechanisms of Cancer-related-fatigue (CRF) using validated tools in a defined population. Objectives To determine the feasibility, and the preliminary estimates of the effects of various combinations of standardized exercise, cognitive behavioral therapy (CBT), and methylphenidate (multimodal therapy, or MMT) on CRF as measured by AUC of FACIT-F subscale in Pts with prostate cancer receiving radiotherapy with androgen deprivation therapy. Methods Prostate cancer Pts with CRF scheduled to receive radiotherapy with androgen deprivation therapy were eligible. Using a double blind (patient, investigators) randomized factorial study design, eligible Pts were randomized into 1 of the 8 arms, which included all possible combinations of exercise, CBT, and methylphenidate, and/or their corresponding placebo's for 8 weeks.

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Results 62/69 (89%) randomized Pts were evaluable. There were no differences in the demographics and baseline fatigue between groups. The adherence rates for pills, exercise and CBT were 96.5%, 67%, and 90% respectively. The study was feasible and there was no significant difference in adverse events by groups. Table 1 shows the comparison of AUC by treatment. For Pts receiving drug compared to placebo, the median FACIT-F AUC was 2328 vs 2095. The drug effect (estimate, 95% CI) in Pts who received Exercise was 596 (68.3, 1125); CBT was 354 (-121, 830); combined Exercise and CBT was -187 (-802,427); and control Exercise, control CBT was 294 (-192,781).

Conclusions Methylphenidate containing combinations were superior to no drug combinations. Methylphenidate + Exercise provided the best signal and should proceed to large randomized control trials.

eP151 FREQUENCY AND FACTORS ASSOCIATED WITH PLACEBO RESPONSE AND NOCEBO EFFECTS IN CANCER RELATED FATIGUE TREATMENT TRIALS S. Yennu1, K.H. Lim1, J.L. Williams1, E. Bruera1 1 UT MDAnderson Cancer Center, Palliative Care- Rehabilitation- and Integrative Medicine, Houston, USA Introduction Placebo and Nocebo effects have significant impact on cancer related fatigue (CRF) treatment trials. Objectives To determine the frequency and predictors of placebo and nocebo effects in CRF treatment trials. Methods Pooled analysis of the placebo arm in five randomized placebo controlled fatigue trials with similar eligibility criteria using Methylphenidate, Dexamethasone, Donepezil and Panax ginseng were performed. Baseline patient characteristics, symptoms (FACIT-F, and ESAS) and adverse side effects (CTC criteria). Placebo effect was defined as improvement in FACIT-F fatigue subscale score of ≥ 11. Nocebo effects was defined as more than the median number (3) of side effects. Results A total of 266 advanced cancer patients who received placebo were evaluable. 86/266 (33%) patients had a placebo response. 150 patients (56%) with side effects ≥ 3 had a nocebo effect. Multivariate analysis shows (OR, P value): Female gender (5.46, 0.001), married status (0.62, 0.034), poor ESAS appetite (0.83, 0.042), and ESAS sleep disturbance

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(0.81, 0.027) scores were associated with placebo response. Median number of nocebo effects were 3. The most common nocebo effects were gastrointestinal (47%), sleep disturbances (46%) and cardiovascular (35%). ESAS depression (0.63, 0.003) and poor ESAS well-being (1.3, 0.036) scores were significantly associated with nocebo effects. Conclusions We found Placebo response in 33%, and nocebo effect in 56% patients enrolled in CRF trials. Female gender, married status, better appetite and sleep scores were significantly associated with placebo response. Lower depression and poor well-being scores were significantly associated with nocebo effect.

eP152 METRONOMIC ORAL PALLIATIVE CHEMOTHERAPY WITH METHOTREXATE/CAPCITABINE AND C Y C L O P H O S P H A M I D E I N C H E M O - R E F R A C T O RY METASTATIC ELDERLY TRIPLE NEGATIVE BREAST CANCER PATIENTS : A SINGLE CENTRE EXPERIENCE FROM INDIA A. Gogia1, V. Raina2 1 AIIMS, Medical Oncology, New Delhi, India 2 FMRI, Medical Oncology, Gurgoan, India Introduction Triple negative breast cancer (TNBC) constitute 30 % of all breast cancer and in elderly( >65 years), it constitute 10% of all cases. TNBC patients have short progression free survival (PFS) and overall survival (OS), is major concern in our country Objectives The purpose of this study was to evaluate the efficacy and safety of an oral combination of metronomic cyclophosphamide (CTX) plus capcitabine (C) and methotrexate (MTX) plus CTX for women with anthracycline, taxane, and platinum pretreated metastatic elderly TNBC Methods This analysis ( 50 patients, June 2007-April 2013) were carried out with the aim to determine efficacy in terms of overall response rate (ORR), control of tumor-related symptoms, outcome, and toxicity in 2 regimen. 25 patients received oral C- 500 mg twice in a day , oral CTX at 50 mg/ day and 25 patients received oral MTX 2.5 mg twice in a day (day 1&4)/ week , CTX at 50 mg/day, until disease progression. Results The median follow-up was 18 months. ORR was 35% and stable disease was achieved in 25%, resulting in a 60% clinical benefit response rate in both the groups. Median PFS and OS were 7 and 8.5 months respectively . Toxicities (grade 3 ) were : leukopenia (10%), neutropenia (10%) and transaminitis (12%) in both group. Conclusions The oral combination of palliatve metronomic CTX/MTX plus capecitabine is an effective,convenient and well-tolerated regimen for pretreated elderly TNMBC. MTX-CTX is significantly cost effective and considered as treatment option for refractory elderly TNMBC in limited recourse country.

eP153 DOES THE VULNERABLE ELDERS SURVEY (VES-13) IDENTIFY WHICH OLDER ADULTS WITH CANCER WOULD BENEFIT MOST FROM A GERIATRIC ONCOLOGY ASSESSMENT? S. Alibhai1, R. Jin2, A. Loucks2, M. Puts3 1 Princess Margaret Cancer Centre- University Health Network, Medicine, Toronto, Canada 2 Princess Margaret Cancer Centre- University Health Network, Supportive Care, Toronto, Canada 3 University of Toronto, Faculty of Nursing, Toronto, Canada

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Introduction The VES-13 is commonly used to identify frailty/vulnerability in older adults. Patients scoring ≥3 are higher risk for adverse outcomes and may benefit from a Geriatric Oncology (GO) assessment. While GO clinics can optimize older adults with cancer and change a median of 39% of treatment decisions, they are resource-intensive and not readily available. Objectives We examined whether the VES-13 can identify older adults with cancer most likely to benefit from GO assessment. Methods The VES-13 was administered to consecutive patients referred to the GO clinic at the Princess Margaret Cancer Centre. All patients underwent a structured comprehensive geriatric assessment (CGA). Abnormalities in CGA domains (cognition, comorbidities, function, falls, medication issues, social vulnerability, malnutrition, and depression) were collected prospectively. Among patients referred pre-treatment, we examined whether the VES-13 predicted changes in the final treatment plan after GO clinic assessment. Descriptive statistics were used to describe the VES-13 scores and CGA results. Results From July 2015-December 2016, 150 new patients were seen in the GO clinic. 45% were frail (score 3+). Frail patients had more abnormalities in every CGA domain than fit patients. Among 50 patients seen pre-treatment, final treatment plans were intensified (n=3), reduced (n=16), or otherwise modified (n=6) in 50% of patients; all treatment modifications occurred in those with VES-13 scores of 3+. Conclusions The VES-13 identified patients with more abnormalities on CGA and predicted treatment modifications after CGA. In situations with limited resources, the VES-13 may help identify patients age 65+ who would benefit most from a CGA.

eP154 A MULTIDISCIPLINARY GERIATRIC SUPPORTIVE CARE M O D E L F O R PAT I E N T S W I T H H E M AT O L O G I C MALIGNANCIES G. Bhatt1, H.P. Erdeljac2, R. Owens3, A.M. Bittoni4, A. Custer5, D. Jones6, A. Rosko6 1 The Ohio State University, Hematology/Oncology, Columbus, USA 2 The Ohio State University, Pharmacy, Columbus, USA 3 The Ohio State University, Physical Therapy, Columbus, USA 4 The Ohio State University, Nutrition, Columbus, USA 5 The Ohio State University, Audiology, Columbus, USA 6 The Ohio State University, Hematology, Columbus, USA Introduction The aging cancer population is estimated to double in the next 15 years. Elderly patients with hematologic malignancy represent 28% of newly diagnosed cancers. Treatment for hematologic malignancy is evolving. However, patients are prone to functional decline related to anemia, treatment, and disease associated fatigue. Identification and intervention are crucial for reducing chemotoxicity, improving outcomes, and quality of life (QOL). Geriatric Assessment (GA) is the gold standard to assess geriatric syndromes, but incorporation into routine clinic can be time and resource consuming. Here we address a multidisciplinary care model for aging adults with Blood Cancer. Objectives 1. To identify potentially modifiable geriatric syndromes using a GA. 2. To implement interventions to improve QOL and clinical outcomes. Methods We have developed and implemented a multidisciplinary care model for elderly blood cancer patients (≥70 years) with evaluations by subspecialist team: physician, pharmacist, case manager, nutritionist, physical therapist, and audiologist, in on a visit.

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minority (18.8%) uses a pharmacological oral (iPDE5) or local (vacuum or intracavernous injection) treatment, c) 85 years appears as a limit as all patients > 84 have an ED and no one wants or uses a treatment, d) 37.7% of the 75-79 and 20.5% of the 80-84 are treated or interested by an information or a treatment. Conclusions Unexpectedly, almost 1/3 of our ageing consulting PC population remains either interested in sexuality or asking at least for information. In older patients, the interest for sexual life is too often under-estimated owing to false representations underlying the importance of health care professional proactive attitude. Results Elderly functional decline and falls are associated with depression, tinnitus induced imbalance, malnutrition, and a 3-fold increase in mortality. Hearing loss results in social isolation and cognitive decline with improvement when corrected. Performing activities of daily living and good social support are critical to autonomous QOL. GA includes evaluations of function, cognition, psychological status, social support, nutrition, and medications. A physician summarizes recommendations for the patient, family, and primary hematologist.

Conclusions A multi-disciplinary consultative geriatric hematology clinic lends valuable insight into patient frailty, chemotoxicity, and QOL. This care model illustrates how a consultative geriatric hematology clinic can be used in clinical practice.

eP155 AGEING MEN HAVING A PROSTATE CANCER ARE STILL INTERESTED BY SEXUAL LIFE IF PROACTIVELY ASKED P. Bondil1, D. Habold2, D. Carnicelli2 1 General Hospital Metropole-Savoie, Urology-Andrology, chambery, France 2 general Hospital Metropole Savoie, Urology-Andrology, Chambery, France Introduction The sexual capacity of old patients treated or followed for prostate cancer (PC) is currently bad-known. Objectives To analyse the erectile dysfunction (ED) of men > 74 years old having a PC. Methods A) sample: non selected prospective observational study of all PC outpatients up to 74 years, successively seen during 8 months, whatever the PC treatment, stage, follow-up, B) 6 parameters proactively analysed: age, CP treatment, erectile capacity using the Erection Hardness Score (EHS: ED if < 3), specific ED treatment, eventual ED treatment demand or not and survey well-founded. RESULTS: n = 122 (mean age = 79.8). PC treatment: heterogeneous (mainly radiotherapy, hormonal treatment, HIFU and surveillance). Results a) 92.6% have an ED but when proactively asked, a majority is interested since a strong majority (90.2%) agrees to be questioned and to be informed about the possibility of specific ED care, b) a non negligible

eP156 PAIN ASSESSMENT TOOLS FOR OLDER ADULTS WITH DEMENT IA IN LONG-TE RM CAR E FACILI TIES : A SYSTEMATIC REVIEW S. Chow1, R. Chow1, M. Lam1, L. Rowbottom1, D. Hollenberg1, O. Nadalini1, H. Lam1, C. DeAngelis2, N. Herrmann1 1 Sunnybrook Health Sciences Centre- University of Toronto, Division of Geriatric Psychiatry, Toronto, Canada 2 Sunnybrook Health Sciences Centre- University of Toronto, Department of Pharmacy, Toronto, Canada Introduction Dementia reduces seniors’ ability to articulate their pain, causing pain to be under-reported and undertreated in long-term care residents. Objectives To document pain assessment tools used for older adults in long-term care facilities and compare self-report and observer-rated tools. Methods A literature search was conducted in Ovid MEDLINE (1946 to June 2016, Week 1), EMBASE Classic and EMBASE (1947 to 2016, Week 24), Cochrane Central Register of Controlled Trials (May 2016) and PsycINFO (1806 to June 2016, Week 2). Results Of 1033 references, 23 articles were included. Six of the documented tools were self-rated, while the other 18 tools were administered by an observer. Self-report assessment tools typically feature the fewest items in the form of questions, probing at presence of pain, severity of pain and occasionally effect on well-being. Observer-rated tools comprise of more components that heavily rely on observations of vocalization, nonverbal expressions (such as facial expression), and physical behavior for pain assessment. Components of observational tools were scored on severity scales, categorical scales or simply evaluated dichotomously (present or absent). Of the 23 studies included, 13 evaluated the reliability/validity of their scales, and four studies compared different scales against each other. Conclusions Pain is highly prevalent in institutionalized older adults and requires reliable and valid measures in order for optimal symptom control to be implemented. Self-report should be the first-line approach when possible, with observational assessment used as a supplementary tool. Reliable observational tools have been shortened, and shown to maintain high reliability/validity, and positive psychometric properties.

eP157 UNMET HEALTH SERVICE NEEDS FOR CANCER PATIENTS: DOES AGE MATTERS? D. Tremblay1, E. de Castro Hillman2, B.L. Nguyen1 1 Université de Sherbrooke, Faculty of Medicine and Health SciencesNursing School, Sherbrooke- Qc, Canada 2 Université de Sherbrooke, Faculty of Medicine and Health SciencesProgram of Research in Health Sciences, Sherbrooke- Qc, Canada

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Introduction A cancer diagnosis can mean more complex health services delivery for older adults, and a greater risk that they will experience unmet needs. The literature describes unmet needs related to supportive care, but not much is known about unmet health service needs (UHSN). An UHSN is defined as a perceived need for healthcare services that are not obtained. Objectives This study aims to compare patient-reported UHSN between four age groups (one younger and three older). Methods This cross-sectional study gathered data from a convenience sample of 1361 cancer patients across nine outpatient cancer clinics in Quebec, Canada. A self-administered questionnaire covering eight topics designed to assess the main causes, types, and consequences of unmet needs was used (Lévesque et al. 2012). Chi-square analyses were performed to compare UHSN between age groups. Statistical significance was assumed at p<0.05. Results A total of 240 out of 1361 patients reported UHSN. No statistical difference (p=0.417) was observed between age groups in the proportion of patients reporting UHSN (Figure 1). However, significant differences were found in both >70 groups regarding the type of UHSN: daily activity limitations (p=0.002) and non-cancer related health problems (p=0.018). The latter was the main reason for seeking health services that were not received.

Conclusions Although a greater intensity of UHSN for older adults makes intuitive sense, our results suggest that more responsive healthcare services are required for all age groups. However, for patients aged 70 years and older, improvements should be considered particularly with regard to noncancer related health issues and functional autonomy.

eP158 SUPPORTIVE CARE FOR ELDERLY CANCER PATIENTS AT THE ISTITUTO NAZIONALE TUMORI, MILANO M. Guglielmo1, D. La Carpia1, P. Di Pede1, M.L. Ferrara1, C. Di Cristo2, F. Ravagnani3, C.I. Ripamonti1 1 Fondazione IRCCS- Istituto Nazionale Tumori- Milano, Supportive Care Unit- Dept. Haematology and Pediatric Onco-Hematology, Milano, Italy 2 Fondazione IRCCS- Istituto Nazionale Tumori- Milano, Management Control Department, Milano, Italy 3 Fondazione IRCCS- Istituto Nazionale Tumori- Milano, Immunohematology and Transfusion Medicine Service SIMT, Milano, Italy Introduction A dedicated Supportive Care in Cancer Unit (SCCU) was born on June 2009 at Istituto Nazionale Tumori di Milano (INT) and since July 21st 2016 a geriatrician has been working with the aim of integrating expertise in elderly care in the team with oncologists, internal medicine specialist, RNs, health technicians, volunteers. Objectives To estimate retrospectively the prevalence of elderly patients (age ≥65) at SCCU and to identify the most frequent medical therapies required.

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Methods Data was obtained from the administrative registries of the Management Control Department, from the Immunohematology and Transfusion Medicine Service of the INT in the period from July 21st, 2016 to Janury 21st, 2017. Results During the six months examined, 809 patients were taken in charge at our SCCU: 421 patients (52%) were older than 65. While 60.7% of the blood component units were transfused to elderly patients, infusions (fluids and drugs) were prescribed more frequently in younger patients (55.2 % of total). The administration of anti-osteoporotic drugs was more prevalent in patients older than 65 (62.2% Vs 37.8%;). Zoledronate was prescribed more frequently than Denosumab in elders (63% Vs 37%). Conclusions If the aim of supportive care is to ease the patient's burden throughout their cancer journey and “make excellent cancer care possible”, this is particularly true for older who often are at high risk of toxicity and treatment discontinuation due to adverse events and complications. Therefore supportive care interventions can be strategically integrated by a geriatric expertise in order to provide a personalized treatment plan for elderly patients.

eP159 DELIRIUM IN OLDER ADULTS RECEIVING CHEMOTHERAPY: A SCOPING REVIEW OF THE LITERATURE P. Jung1, M. Puts2, S. Toubasi2, C. Rosario1, D. Yokom3, A.P. Ayala4, S. Alibhai5 1 University of Toronto, Department of Medicine, Toronto, Canada 2 University of Toronto, Lawrence S. Bloomberg Faculty of Nursing, Toronto, Canada 3 University Health Network and University of Toronto, Department of Medical Oncology and Hematology, Toronto, Canada 4 University of Toronto, Gerstein Information Science Centre, Toronto, Canada 5 University Health Network and University of Toronto, Department of Medicine and Institute of Health Policy- Management- and Evaluation, Toronto, Canada Introduction Older adults with cancer are at increased risk of delirium given their advanced age, potential for pre-existing or evolving dementia, and possibly cancer treatment. In this population, delirium has been examined mostly in the post-operative and terminal periods. The link between delirium and chemotherapy is unclear. Objectives 1) To determine if chemotherapy increases the risk of delirium in older adults with cancer; and 2) to identify any strategies that may prevent or treat delirium in older adults precipitated by chemotherapy. Methods We are conducting a scoping review using the framework of Arksey and O’Malley. We systematically searched peer-reviewed journal articles from Medline and Embase to identify studies that examined delirium in patients receiving chemotherapy. Results Among the over 6000 titles and abstracts screened so far, only two studies (1 US, 1 Japanese) were appropriate. One study found an incidence of delirium of 8.6% during outpatient chemotherapy treatment, though retrospectively it reported rates between 31% and 43.5%. One study found exposure to chemotherapeutic agents that crossed the blood-brain barrier was associated with a higher risk of delirium compared to other chemotherapy or no chemotherapy. No studies were found that addressed strategies to prevent or treat delirium in this patient population. Conclusions Delirium appears to be a likely under-recognized occurrence in patients receiving chemotherapy. This scoping review highlights the dearth of

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knowledge in the area and emphasizes the need for high-quality studies examining the incidence, prevention, and treatment of delirium in the oncology setting, particularly with a focus on older adults.

eP160 HOSPITALIZATION-ASSOCIATED PHYSICAL INACTIVITY IN ELDERLY PATIENTS WITH ADVANCED NON-SMALLCELL LUNG CANCER A. Morikawa1, T. Naito2, T. Okayama3, T. Aoyama4, M. Sugiyama1, H. Yamada1, K. Kunitomo1, Y. Isogai1, N. Yamada1, K. Yamamoto1, Y. Oguma1, M. Kaneko1, R. Uehara3, H. Murakami1, K. Omae5, K. Mori5, A. Tanuma3, T. Takahashi2 1 Shizuoka Cancer Center, The nursing department, Shizuoka, Japan 2 Shizuoka Cancer Center, The division of thoracic oncology, Shizuoka, Japan 3 Shizuoka Cancer Center, The division of rehabilitation medicine, Shizuoka, Japan 4 Shizuoka Cancer Center, The division of nutrition, Shizuoka, Japan 5 Shizuoka Cancer Center, The clinical research center, Shizuoka, Japan Introduction In older patients, hospitalization is often associated with new or worsening disability. Cancer patients may need multiple hospitalizations for cancer treatment or supportive care. However, there is little information about the impact of hospitalization on their physical activity (PA) after discharge in elderly patients with advanced cancer. Objectives The aim of this study is to explore changes in PA before and after hospitalization. Methods This is the prospective observational study approved by the institutional review board. Patients aged >=70 years with advanced non-small-cell lung cancer (stage IV) scheduled to start first-line chemotherapy were enrolled. The PA change was evaluated by the mean values of steps per day (SPD) before and after each hospitalization, which were measured by the accelerometer (LifecorderGS, SUZUKEN, Japan) and compared. Results Among 25 patients (14 men and 11 women), median age and baseline PA were 75 (70-83) years and 3914 (803-19957) SPD. There were 59 hospitalizations. The mean PA changed from 3919 SPD before hospitalization to 3361 SPD after hospitalization with statistically significant difference (Wilcoxon signed-rank test p<0.05). Mean differences in PA were 502, -84, and -1649 SPD in hospitalization for chemotherapy (31 hospitalization, 52%), treatment of complications (19 hospitalization, 32%), and others (9 hospitalizations, 15%), respectively. Conclusions Elderly patients with advanced NSCLC are at high risk for physical inactivity after hospitalization. Appropriate planning of optimal length of hospital stay and inpatient exercise program would be needed to prevent hospitalization-associated physical inactivity and keep independence in this population. (Clinical Trials Registry No. UMIN000012845)

eP161 CHALLENGES AND COMPLICATION ENCOUNTERED W H I L E O F F E R I N G PA L L I AT I V E C A R E I N O U R COMMUNITIES? EXPERIENCE WORKING WITH ELDERLY WITH THEIR NEEDS E. Mukiri1, G. Kimani2, S. Rithara3 1 Ongata palliative care community, community health, Kajiado, Kenya 2 Nairobi University, Rsearch, Nairobi, Kenya 3 Kenya Medical Training College, Nursing, Nairobi, Kenya

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Introduction Elderly persons are citizen who are old and accompanied by several symptoms and illness. The number is increasing hence needing proper care and palliative services. Objectives To highlights the needs of palliative care for the elderly, palliative care experience in Kenya. Methods Experience for ten years working in palliative care setup with elderly persons Results There are common cancers which include prostate 60%, stomach 70%, Larynx 35% in men, cervix 80%, and breast 65% oesophagus40% in women. Most symptoms are arthritis, hypertension, Diabetic mellitus, dementia, end stage organ failure and visual and hearing impairment. Encountered distressing symposiums were Fatigue, Pain, Anxiety, Insomnia, Anorexia, Cough, and Vomiting. STRENGTHS; Centre of excellence, Palliative Care trained staff, Holistic approach, Home based care, Day care service, Access to pain relieving medications CHALLENGES; Faulty assumption about the needs of older patients, Language barrier, Underreporting of pain and other distressing symptoms, Caregiver systems, Ethical dilemmas, Sensory loss and dementia impede assessment, Fear of using strong opioids in the elderly, Loss of follow-up, Poor compliance, Increased disability, Limited resources Lack of awareness on palliative care, Lack of integration of palliative care in primary health care, Lack of policies, Palliative care for non-cancer patients Conclusions Sensitization, Training, Follow-up on those already trained, Attachment programmes, Research,Policy on palliative care, Decentralization of palliative care services. Conclusion: The number of elderly people in society is slowly increasing. The elderly have unmet palliative care needs hence training for health professional.

eP162 THE IMPACT OF CANCER CACHEXIA ON “DAYS SPENT AT HOME” IN ELDERLY PATIENTS WITH ADVANCED NONSMALL-CELL LUNG CANCER T. Naito1, T. Okayama2, T. Aoyama3, H. Shiozaki3, T. Ishii2, R. Uehara2, N. Mitsuhashi2, H. Murakami1, H. Kenmotsu1, A. Ono1, K. Wakuda1, K. Nakashima1, S. Omori1, H. Kobayashi1, Y. Masuda2, K. Omae4, K. Mori4, T. Inano3, A. Tanuma2, T. Takahashi1 1 Shizuoka Cancer Center, The Division of Thoracic Oncology, Shizuoka, Japan 2 Shizuoka Cancer Center, The Division of Rehabilitation Medicine, Shizuoka, Japan 3 Shizuoka Cancer Center, The Division of Nutrition, Shizuoka, Japan 4 Shizuoka Cancer Center, The Clinical Research Center, Shizuoka, Japan Introduction Cancer cachexia may have substantial impact on their physical function, nutritional status, and quality of life. “Days spent at home” is one of the patient-centered measures for quality of life. Objectives The aim of this study is to explore the association between the presence of cancer cachexia and “days spent at home” in the last 30 days of life. Methods This is the prospective longitudinal observational study. Patients aged >=70 years with advanced non-small-cell lung cancer (NSCLC, stage III-IV) scheduled to initiate first-line chemotherapy were enrolled. Cachexia was diagnosed by the international criteria (Fearon K, 2011). “Days spent at home” was calculated as 30 days minus the number of inpatient days. Results The patients comprised 10 women and 19 men, with a median age of 74 (range, 70-82) years. Cachexia was diagnosed in 18 (62%) patients. All

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patients died until the cutoff date (Apr 30, 2016) and there were a total of 40 hospitalizations in the last 30 days of their lives. The mean±SD of “days spent at home” was 8±10 and 19±10 days in cachectic and noncachectic patients, respectively (Wilcoxon test p = 0.0146). Purposes of hospitalization included inpatient hospice care (55%), treatment of complication (32%), palliative radiation (8%), and chemotherapy (5%). Conclusions Elderly NSCLC patients with cachexia had higher risks of hospitalizations and spent fewer days at home in the end-of-life period. Effective intervention of cancer cachexia may minimize inpatient care and improve quality of life. (Clinical Trials Registry No.UMIN000009768)

eP163 MAJOR DEPRESSION AND FALLS IN OLDER ADULTS WITH CANCER L. Pang1, X. Zhang1, B. Edwards1 1 UT MD Anderson Cancer Center, General Internal Medicine, Houston, USA Introduction Depression and falls are common in community-dwelling older adults. Objectives Our aim is to assess the relationship between major depression and falls in older adults with cancer. Methods This was a single site study at a major cancer center. Data was prospectively collected, and underwent retrospective analysis. All patients referred to geriatrics clinic underwent a comprehensive geriatric assessment. The assessment included evaluation and screening for frailty, functional dependence, malnutrition, cognitive deficits, social support and depression (January 2013 through December 2015). Depression was assessed by the Personal Health Questionnaire 9 (PHQ-9). Scores 10 and above were suggestive of major depression. If a patient did not have a prior diagnosis of major depression, a geriatrician further interviewed the patient to confirm the diagnosis. Patients reported falls within the past 6 months. Current diagnosis of major depression was compared to their falls history. Univariate analysis was performed (SAS 9.3, Cary) Results We evaluated 214 older adults. The mean age was 79.1 ± 7.2 years, with 105 male patients. 148 had solid tumors and 63 had hematologic malignancies. 26% (56/214) of the patients had major depression and 36% (78/ 214) had fallen in the past 6 months. Univariate analysis is seen in Table 1.

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eP164 A P H A S E I I R C T O F H I G H - D O S E V I TA M I N D SUPPLEMENTATION FOR ANDROGEN DEPRIVATION THERAPY (ADT)-INDUCED BONE MINERAL DENSITY (BMD) LOSS AMONG OLDER PROSTATE CANCER (PCA) PATIENTS L. Peppone1, A. Peoples1, J.E. Puzas2, E. Culakova1, K. Mustian1, C. Cole1, J. Reschke1, M. Asare1, C. Kamen1, M. Janelsins1, C. Fung3, H. Zhang4, S. Mohile3 1 University of Rochester School of Medicine, Surgery, Rochester, USA 2 University of Rochester School of Medicine, Orthopaedics, Rochester, USA 3 University of Rochester School of Medicine, Medicine, Rochester, USA 4 University of Rochester School of Medicine, Radiation Oncology, Rochester, USA Introduction ADT is the most commonly used systemic therapy for treating PCa, often resulting in BMD loss from osteoporosis and/or osteomalacia. Vitamin D (VITD) may protect against this; however it remains unclear if the recommended daily allowance (RDA) of VITD is sufficient to reduce BMD loss or whether higher doses are needed. Objectives To collect preliminary data on the effect of high-dose VITD on BMD in ADT-treated PCa patients compared to the RDA of VITD. Methods Older PCa patients (≥60 years old) with VITD insufficiency (<32 ng/ml), beginning ≥6 months of ADT were randomized 1:1 to high-dose VITD (hVITD; 600 IU/day+50,000 IU/week) or RDA of VITD (rVITD; 600 IU/day+placebo/week) for 24 weeks. BMD was assessed at the total hip (TH) and lumbar spine (LS) via DXA. ANCOVA was used to test the difference in T-score between groups, adjusting for baseline T-score and relevant covariates. Results 59 subjects were accrued (85% white; mean age=67.6). Serum analyses confirmed high compliance (25-OH VITD change: hVITD=+32.0ng/ml vs. rVITD =+4.3ng/ml; p<0.01). Final T-score was significantly greater for hVITD group compared to rVITD group for total hip (hVITD=0.0 vs. rVITD=−0.2; p=0.01) and femoral neck (hVITD=−0.8 vs. rVITD =−1.0; p=0.05). There was no difference between groups for LS (hVITD=+0.7 vs. rVITD=+0.7; p=0.81). Hypercalcemia was limited to 1 subject. Conclusions hVITD supplementation significantly reduced hip BMD loss among older PCa patients compared to rVITD. Clinically, higher doses of VITD may be necessary to prevent ADT-induced BMD loss. A phase III RCT is needed to confirm these findings. Funding: NCIR21CA175793/K07CA168911/UG1CA189961. Bio-Tech Pharmacal supplied VITD.

eP165 EXPLORING THE GERIATRIC NEEDS OF ONCOLOGY INPATIENTS AT AN ACADEMIC CANCER CENTRE

Conclusions We identified a correlation between major depression and a history of falls in older cancer patients. This was seen in solid tumors and hematologic malignancies. Going forward, we will conduct a multivariate analysis controlling for other covariates. Understanding geriatric syndromes within geriatric oncology will be helpful for optimizing care of older adults with cancer.

C. Rosario1, M. Puts2, R. Jang3, A. Bezjak4, D. Yokom5, S. Alibhai1 1 University of Toronto, Internal Medicine, Toronto, Canada 2 University of Toronto, Faculty of Nursing, Toronto, Canada 3 Princess Margaret Cancer Centre, Medical Oncology, Toronto, Canada 4 Princess Margaret Cancer Centre, Radiation Oncology, Toronto, Canada 5 University of Toronto, Medical Oncology, Toronto, Canada Introduction Geriatric Assessments (GAs) in older adults with cancer have informed treatment decision-making and refined survival prediction. However little is known about the geriatric needs of older inpatients with cancer.

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Objectives (1) to test the feasibility of a bedside GA for older cancer inpatients, and (2) to determine the prevalence of impairments in geriatric domains in older adult inpatients with cancer. Methods Cross-sectional observational single-centre pilot study. Structured GAs were performed on patients admitted to inpatient wards at Princess Margaret Cancer Centre. We used a validated questionnaire to examine the needs of older patients by assessing typical domains of the GA. The summary of GA findings was shared with the patient’s most responsible physician, who was then given a brief survey. Results 23 patients have been approached, 21 were enrolled and completion of the GA was possible in 95% (20/21). The median time to complete the assessment was 35 mins. The mean number of geriatric domains impaired per patient was 4, with polypharmacy (18/20), mood (15/20) and increased falls risk (15/20) being the most common abnormal domains. Attending physicians responded to our survey for 11 of 20 participants (55% response rate), and 9 of 11 indicated that the results of the GA provided helpful information for the management of their patients. Conclusions A structured GA is feasible in older inpatients with cancer and abnormal geriatric domains are commonly detected. Bringing these to the attention of the attending physicians is helpful in delivering comprehensive care to older adults with cancer.

eP166 COMPREHENSIVE GERIATRIC ASSESSMENT (CGA) FOR THE ELDERLY DIFFUSE LARGE B CELL LYMPHOMA (DLBCL) H. Sasaki1, K. Tamura2, Y. Naito1, R. Sakai3, I. Choi4, J. Tsukada5, Y. Takamatsu1 1 Fukuoka University, Division of Medical Oncology- Hematology and Infectious Diseases- Department of Medicine, Fukuoka, Japan 2 Fukuoka University, General Medical Research Center School of Medicine, Fukuoka, Japan 3 Kanagawa Cancer Center, Department of Medical Oncology, Kanagawa, Japan 4 National Hospital Organization Kyusyu Cancer Center, Department of Hematology, Fukuoka, Japan 5 University of Occupational and Environmental Health, Department of Hematology, Fukuoka, Japan Introduction In Japan, cancer incidence and mortality rate are increasing rapidly because of the elderly population is increasing. When performing chemotherapy for elderly people of cancer, it is often difficult to determine the indication, regimen and amount of chemotherapy with a decrease in physical and mental function. Therefore, multicenter collaborative research was conducted on whether or not Comprehensive geriatric assessment (CGA) could predict adverse events of patients who received chemotherapy for elderly DLBCL patients. Objectives Patients over 65 years who are newly diagnosed as histologicallyconfirmed DLBCL are eligible. Methods We carrying out CGA on all registered patients. After that R-CHOP or less toxic rejimen was selected and carried out according to the judgment of the attending physician. The content of CGA evaluated ADL, instrumental ADL (IADL), nutritional status, comorbidities and cognitive function. The relationship between CGA results and adverse events were analyzed. Results 86 patients registered from September 2013, 78 cases could be evaluated. Median age was 79(65-89), IPI-L and LI were 44, IPI-H and HI were 34.

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69 patients were treated with CHOP-like regimen, 9 were other lowtoxicity regimens. Dose reduction were performed for 42 patients (61%). The treatment effect was CR/PR/PD in 58/7/10 cases. ADL, IADL had problems with 21, 11 cases, Charlson score≥5 points, 11 cases respectively. In multivariate analysis results, IADL disorder was associated with G3/4 leucopenia and anemia, and the existence of comorbidities confirmed the association with G3/4 non-hematological toxicities. Conclusions In the elderly DLBCL, it was suggested that CGA may be useful as a prediction tool for adverse events expression.

eP167 THE IMPACT OF FALLS IN OLDER CANCER PATIENTS S. Sattar1, S. Alibhai2, S. Spoelstra3, M. Puts1 1 University of Toronto, Lawrence S. Bloomberg Faculty of Nursing, Toronto, Canada 2 University Health Network, Medicine, Toronto, Canada 3 Grand Valley State University, Kirkoff School of Nursing, Grand Rapids, USA Introduction Falls are a major health issue among older adults. Cancer and its treatment can heighten their risks for falls and fall-related injuries. However, little is known about circumstances of falls, how falls are assessed in oncology clinics, and how falls impact cancer treatment in older cancer patients. Objectives The objective of this study is to address the mentioned gaps in geriatric oncology. Methods This is an embedded mixed-methods cross-sectional study recruiting community-dwelling older cancer patients at the Princess Margaret Hospital in Toronto who have experienced ≥ one fall within the past 12 months. Data collection includes self-reported survey supplemented by chart review and oncologist survey. Results To date, 45 older patients have participated. The median age is 78 (range 66-92); 86% are male; 66% have ≥ one functional limitation; 54% use a walking aid, and 23% have peripheral neuropathies; over 50% experienced ≥ one fall. The most common diagnoses are prostate and hematological cancers. Injurious fall rate is 54%. The most common fall locations are staircase, sidewalk curb, and washroom. So far, no impact on cancer treatment by falls has been identified by patients or oncologists. Half the participants did not report falls to their oncologists; of those who did, few were assessed. Nearly half the participants express high concerns about falling. Conclusions Falls are uncommonly reported by older cancer patients, are rarely assessed by oncologists, and do not affect cancer treatment. More work needs to be done to assess whether cancer treatments are associated with falls risk.

eP168 I N T E G R AT E D E N D - O F - L I F E C A R E I N A D VA N C E D CONGESTIVEHEART FAILURE: WHERE ARE WE NOW? H. Senderovich1 1 University of Toronto/Baycrest Health Sciences, Family and Community Medicine, Toronto, Canada Introduction Congestive heart failure (CHF) is an increasingly prevalent terminal illness in a globally aging population. Despite optimal medical management, prognosis remains poor – a fact seldom communicated to patients

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and/or their families. Evidence suggests numerous benefits of palliative care consultation in advanced CHF but to date, their services remain woefully underutilized. Objectives To identify specific challenges to accessing and implementing palliative care in patients with advanced CHF, and to use this information to formulate recommendations for practice. Methods Literature review whereby recommendations for practice were formulated on the basis of primary quantitative/qualitative data and consensus expert opinion. Results Accessing palliative care services for patients with CHF remains a challenge for numerous factors including prognostic uncertainty, misconceptions about what palliative care is, and difficulty recognizing when a patient is suitable for referral. Strategies to improve access/delivery of palliative care to this population include education and proper discussion about prognosis/goals of care. A team-based approach is essential as we move towards a model where symptom palliation exists concurrently with active medical disease-modifying treatment. Conclusions Despite evidence that palliative care has a role in improving symptom control and overall quality of life in patients with end-stage CHF, a multitude of challenges exist and this ultimately hinders access to palliative care services. Education to abolish pre-existing misconceptions about the role of palliative care and a movement towards a team-based approach focused on simultaneous palliative and traditional medical care will undoubtedly improve access to, and benefit from, palliative care services in this population.

eP169 PREDICTING CHEMOTHERAPY TOXICITY IN ELDERLY JAPANESE PATIENTS WITH GASTROINTESTINAL CANCER S. Takada1, K. Huzikawa2, Y. Takahashi2, M. Endo1 1 Hokkaido Cancer Center, Department of Pharmacy, Sapporo, Japan 2 Hokkaido Cancer Center, Department of Gastroenterology, Sapporo, Japan Introduction To identify risk factors for initial chemotherapy toxicity in elderly patients with gastrointestinal cancer. Performance status and Karnofsky performance status are effective indicators for predicting chemotherapy toxicity in patients with cancer regardless of age.Hurria et al. constructed a new prediction model for chemotherapy toxicity of grade 3 or more in 2011; this model is called the Cancer and Aging Research Group (CARG) toxicity tool. Objectives We examined whether the CARG toxicity tool is useful for predicting serious risks from chemotherapy in elderly Japanese patients with gastrointestinal cancer. Methods In patients with gastrointestinal cancer who were 65 years of age or older, we examined only those who had started initial chemotherapy. We evaluated patient outcomes using this tool. Patients were divided into three risk groups (high, medium, and low). Chi-square statistics were used to verify differences among groups. Results Between January 2015 and December 2016, 112 patients with gastrointestinal cancer (65 males, 47 females) ≥65 years of age were included. In this sample, 47% patients had one or more grade ≥3 hematologic toxicity. In addition, 12% patients had one or more grade ≥3 non-hematologic toxicity. The rate of serious toxicity changed significantly between the risk groups (P <0.001). The type of disease in the risk factor was that pancreatic cancer was more detectable than gastric cancer.

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Conclusions The CARG toxicity tool can be used to more clearly distinguish the risk of initial chemotherapy toxicity of elderly Japanese patients with gastrointestinal cancer.

eP170 PAIN MANAGEMENT IN OLDER ADULTS WITH DEMENTIA – A SELECTIVE REVIEW V. Koo1, S. Jin1, S. Ahrari1, R. Chow1, S. Chow1, A. Wan1, S. Goodall1, C. DeAngelis1, H. Lam1, M. Lam1, R. McDonald1, S. Chan1, E. Chow1, A. Agarwal1, L. Rowbottom1 1 Odette Cancer Centre- Sunnybrook Health Sciences Centre- University of Toronto-, Radiation Oncology, Toronto, Canada Introduction Dementia affects over 47 million people globally, and is projected to exceed 100 million by 2050. Dementia in the elderly is characterized by progressive cognitive and functional decline and persistent pain. If left unmanaged, this significantly reduces quality of life and independence. As there is no cure for dementia, care is focused on pain management. However, clear guidance on evidence-based pain management strategies for dementia patients is lacking. Objectives To review the literature for pain management strategies for elderly individuals with dementia. Methods A selective literature search was conducted using Ovid, MEDLINE, Embase and Cochrane Central Register of Controlled Trials. Subject headings/keywords included: “older adults”, “dementia”, “pain”, and “pain management”. Results The search produced 926 articles, of which 15 were included in the final review. There is evidence that pharmacological pain management strategies employing acetaminophen as a first line treatment or as part of a steppedcare approach in patients with dementia reduced pain and dementia-associated behavioural symptoms, and improved activities of daily living (ADL). There is mixed or limited evidence regarding the use of other pharmacological agents including peripheral analgesics, NSAIDs, opioid agents, anticonvulsants, antidepressants, and other analgesics to manage pain. There is mixed or limited evidence to support non-pharmacological strategies such as reflexology, music intervention, chiropractic care, shiatsu therapy, and vitamin supplementation for pain management in this population. Conclusions Stepped-care approaches with acetaminophen show promise to reduce pain and dementia-associated behavioural symptoms. Other pharmacological/non-pharmacological management strategies require additional research to determine their effectiveness for managing pain.

eP171 PHYSICAL ACTIVITY AS A SELF-MANAGEMENT APPROACH TO IMPROVE HEALTH OUTCOMES IN ACUTE MYELOID LEUKEMIA: A PILOT STUDY T. Albrecht1, A. Sima2, D. Shafer3, E. Del Fabbro3, A. Starkweather4 1 Virginia Commonwealth University, School of Nursing, Richmond, USA 2 Virginia Commonwealth University, Department of Biostatistics, Richmond, USA 3 Virginia Commonwealth University, School of Medicine, Richmond, USA 4 University of Connecticut, School of Nursing, Storrs, USA Introduction Acute myeloid leukemia (AML) is an aggressive cancer that requires emergent intensive chemotherapy treatment. Initial treatment results in a

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high degree of symptoms that include: fatigue, anxiety, depression, distress and decreased health-related quality of life. These adverse effects may render individuals unable to function at pre-cancer levels. Objectives To determine the feasibility and preliminary effects of a physical activity self-management intervention to manage symptoms and quality of life in individuals initiating consolidation treatment for AML. Methods This pilot study used a quasi-experimental cohort control design with repeated measures over 3-months. Both the control (N=10) and the intervention group (N=10) completed symptom measures (HADS, Distress Thermometer, PROMIS- Fatigue, Sleep Disturbance) and completed physical function measures that included the 6-minute walk test at months 1, 2 and 3 of the study. Both groups were also provided fitness monitors to track steps taken during the 3-month study. The intervention group was provided personalized coaching weekly over 3 months. Results Preliminary findings show individuals undergoing treatment for AML were able to participate in physical activity. Means scores on 6-minute walk test increased by 36 meters in the intervention group, while a decline of 22 meters was observed in the control group. Additionally, those in the intervention group showed improved trends in symptom scores of depression, anxiety, distress and sleep disturbance. Conclusions A personalized self-management physical activity intervention in adults with AML is feasible and warrants a larger hypothesis testing trial to further evaluate the effects of this intervention on symptoms and quality of life in this understudied population.

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serious adverse events were reported, and most incidences of headache (100%) and constipation (60%) were mild.

eP172 A PILOT STUDY ON PALONOSETRON IN THE PROPHYLAXIS OF RADIATION INDUCED NAUSEA AND VOMITING (RINV) V. Ganesh1, C. DeAngelis1, M. Pasetka1, S. Ahari1, L. Zhang1, M. Tsao1, C. Danjoux1, E. Barnes1, S. Vuong1, N. Pulenzas1, B. Lechner1, R. McDonald1, L. Rowbottom1, S. Chan1, P. Zaki1, B.A. Wan1, L. Drost1, H. Chung1, K. Chan1, E. Chow1 1 Sunnybrook Health Sciences Centre, Odette Cancer Centre, Toronto, Canada Introduction Radiation induced nausea and vomiting (RINV) remains a common, undertreated threat to patient quality of life. Palonosetron is a second generation serotonin receptor antagonist currently used as an antiemetic in the chemotherapy setting. Objectives To investigate the efficacy and safety of palonosetron in the prophylaxis of RINV. Methods Patients undergoing palliative radiation (RT) to an emetogenic area were prescribed 0.5mg oral palonosetron before the start of RT and every other day until completion of treatment. Patients were categorized into two groups (Table 1) and followed during acute (day 1 of RT to day 1 postRT) and delayed (days 2-10 post-RT) phases. Results The mean age of patients was 73 years (Table 2). Response rates for 61 patients are summarized in Table 3. In group 1, the rates of overall control of nausea in the acute and delayed phases were 91% and 75% respectively. Similarly, the rates of overall control of vomiting were 87% and 82% in acute and delayed phases respectively. In group 2, there was 100% overall control of nausea and vomiting in the acute phase. Rates of overall control were 67% and 83% for nausea and vomiting respectively in the delayed phase. Headache and constipation were reported in 3% and 39% of patients at baseline, and in 13% and 74% during the study period. No

Conclusions Palonosetron displays satisfactory complete and overall control rates in the radiation setting. It is safe and well tolerated.

eP173 NUTRITION OUTCOMES FOR PATIENTS RECEIVING RADIOTHERAPY TO THE HEAD AND NECK S. Hofto1, E. Isenring1, J. Abbott2, J. Jackson3 1 Bond University, Nutrition and Dietetics, Gold Coast, Australia 2 Gold Coast University Hospital, Nutrition and Dietetics, Gold Coast, Australia 3 Radiation Oncology Centres Queensland- Bond University, Radiation Oncology, Gold Coast, Australia Introduction Patients with head and neck cancer (HNC) often struggle to meet nutrition and hydration requirements due to the cancer itself, and treatment-related toxicities. Previous research demonstrates HNC malnutrition rates as high as 74%, with patients likely to lose at least 10% of their body weight during treatment and gastrostomy patients likely to be dependent on tubes for greater than 6 months. Objectives The aim was to assess nutrition outcomes in radiotherapy patients receiving standard nutrition care in the on-treatment and post-treatment setting. Methods A retrospective cohort study was completed of patients treated with radiotherapy (>20 fractions +/- chemotherapy) to the head or neck area at an Australian hospital. The primary outcomes were change in body weight, nutrition status (Patient Generated Subjective Global Assessment) and gastrostomy dependence.

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Results Data from 209 patients was analysed. On average patients had lost 5.6kg (7.1%) at the end of treatment, 7.9kg (8.8%) one-month post-treatment and 8.9kg (10.4%) three months post-treatment. At baseline, 15% of patients were malnourished, compared to 56% at the end of treatment, 54% at one-month post-treatment and 30% three months post-treatment. A total of 60 patients received a gastrostomy tube, with 97% (n=58) proactively placed. The average weight loss for gastrostomy tube patients at the end of treatment was 9% and 13% three months post-treatment. Patients had their gastrostomy tube in-situ for an average of 5 months. Conclusions Patients experienced moderately-high rates of malnutrition and clinically significant weight loss that continues at three months post-treatment. Close dietetic monitoring then remains necessary and warranted in this population.

eP174 IMPACT OF AN INTERDISCIPLINARY ORAL CARE PROTOCOL ON ORAL HEALTH AND PAIN IN MUCOSITIS IN A PEDIATRIC ONCOLOGY WARD S. Sen1, R. Kale2, M. Menon3 1 Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Department of Pediatrics, Mumbai, India 2 Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Department of Nursing, Mumbai, India 3 Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Department of Pain Medicine and Palliative Care, Mumbai, India Introduction Pediatric mucositis is a challenging aspect of oncology. It may affect clinical outcomes in children by affecting nutrition or interfering with definitive treatment. Objectives To assess the immediate impact of an interdisciplinary protocol for the management of pediatric mucositis in an institution. Methods An interdisciplinary group comprising of Oncologists, Oncology nurses, Dieticians, Pain specialists and dentists designed an evidence based, preliminary protocol for the hospital's pediatric oncology ward for mucositis. Treatment modalities utilised were good oral care practices, dietary modifications, topical methods and pharmacological measures including opioid use/ patient controlled analgesia. Case papers were analysed retrospectively to assess the immediate impact of the protocol. Results Preliminary work suggests a significant reduction in pain scores in most cases. There may be an association with improved outcomes in such cases, which remains to be addressed as a research issue. Conclusions Pediatric oncology practice should integrate pain and palliative care, diet and nutrition therapy, nursing care in order to improve pain and possible outcomes in pediatric mucositis.

eP175 PATIENT AND PROVIDER PREDICTORS OF DISTRESS SCREENING OUTCOMES IN A MEDICAL ONCOLOGY SAMPLE D. Pereira1, M.J. Markham2 1 University of Florida, Clinical & Health Psychology, Gainesville, USA 2 University of Florida, Medical Oncology, Gainesville, USA Introduction The American College of Surgeons Commission on Cancer has mandated distress screening on all oncology patients at least once during a pivotal

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medical visit. However, little is known about factors that predict optimal distress screening outcomes, particularly in chronically distressed patients. Objectives To explore patient/provider factors associated with distress screening outcomes among Medical Oncology patients across the first 11 months of distress screening implementation at a large academic health science center. Methods Patients were offered distress screening at every outpatient visit. The Distress Thermometer, problem-area checklist, and Patient Health Questionnaire-2 (PHQ-2) were administered. Positive distress scores prompted referral to Oncology Social Work (OSW). Results 311 OSW referrals were placed on 248 distressed patients (125 referrals/ 100 distressed patients). 81% of distressed patients were referred once (“REF”); 19% were referred more than once (“REF+”). 79% of the REF+ group were referred twice, with an average of 62 days (SD=74) between referrals; 21% were referred 3-5 times, with an average of 45 days (SD=73) between referrals. Patient/provider factors discriminating between the REF and REF+ groups will be explored. Patient factors include patient acceptance of distress screening at office visits, distress screening scores across visits, patient acceptance of OSW referral, sociodemographic factors, mental health/treatment factors, and physical health/treatment factors. Provider factors include patterns of referral to OSW and other supportive services. Conclusions Nearly 1 in 5 distressed patients were referred for supportive services more than once. Understanding the factors that predict this will inform the development/delivery of more effective psychosocial screenings and treatments for this distressed population.

eP176 RAISING THE BAR IN KEEPING OUR PATIENTS SAFE: ADDRESSING NURSE SENSITIVE INDICATORS (NSIS) IN THIS DISEASE MANAGEMENT TEAM N. Ramrup1, S. McEneaney1, K. Wu1, A. Schloms1 1 Memorial Sloan Kettering Cancer Center, Nursing, New York, USA Introduction Meeting or exceeding benchmark for Nurse Sensitive Indicators (NSIs) has been a challenge. Oncology patients have both a higher risk of infection (CAUTI, CLABSI) and falls than the general population. Preventing these complications, which has been a daunting task for the healthcare organizations, contributes to better patient outcomes. Objectives The continuing interest in the contributions of nursing to patient outcomes has inspired the development of new initiatives. Despite these initiatives, meeting NSI benchmarks continue to be a challenge. A different approach was needed on our Disease Management Team (DMT). Methods In our effort to reduce falls a detailed and structured conversation takes place with each patient, which serves to educate them on their risk factors for falling. We discuss risk factors which are unique to their medical condition and hospital visit. To address our CAUTI and CLABSI rates, we implemented a two-person assist for Foley insertions, as well as Mediport assess/re-access and PICC dressings. These interventions assist in maintaining sterile technique and ensure that there is no deviation from our policy and procedure. Results Through our initiatives, we have been able to sustain rates above benchmark for both CAUTI and CLABSI for five out of eight quarters, and six quarters respectively. Our structured conversation initiative to address falls has impacted our rate. We have sustained rates above benchmark five out of eight quarters.

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Conclusions This NCI designated comprehensive cancer center, in collaboration with our patients/caregivers, is committed to improving our NSIs rates and sustaining an organizational culture that is dedicated to improving patient safety. eP177 QUALITY OF LIFE AND EFFICACY OF NEPA AS CINV P R O P H Y L A X I S I N H I G H LY O R M O D E R AT E LY EMETOGENIC CHEMOTHERAPY – INTERIM RESULTS OF A GERMAN NON-INTERVENTIONAL STUDY J. Schilling1, J. Rauh2, D. Guth3, V. Heilmann4, M. Karthaus5 1 BNGO e.V., German Professional Association of Gynaeco-Oncology in Practices, Neuenhagen, Germany 2 Gemeinschaftspraxis Innere Medizin, Praxis, Witten, Germany 3 Gynäkologische Praxis, Praxis, Plauen, Germany 4 Gynäkologische Praxis, Praxis, Günzburg, Germany 5 Städtisches Klinikum München, Hämatologie und Onkologie, München, Germany Introduction NEPA, a fixed dose combination of the NK1-receptor antagonist (RA) netupitant and the 5-HT3-RA palonosetron, has been approved by FDA and EMA for the prevention of acute and delayed chemotherapy-induced nausea and vomiting (CINV) in cancer patients receiving cisplatin-based highly emetogenic (HEC) or moderately emetogenic chemotherapy (MEC). Objectives Primary objective is the evaluation of quality of life (QoL) in adult cancer patients receiving NEPA for CINV prevention in MEC or HEC. Secondary endpoints are efficacy and safety of NEPA. Methods This non-interventional study evaluates CINV prophylaxis with NEPA and QoL in 2,500 cancer patients receiving single day or two day MEC or HEC in German oncology and gynaeco-oncology practices and hospitals. The primary endpoint is quality of life as recorded by FLIE questionnaires. Secondary endpoints are efficacy measured as complete response (CR, no vomiting, no rescue medication), additional medication, and safety. Three consecutive chemotherapy cycles must be documented. Results At cut off date 31.01.2017, 1,615 patients had been included. Of these, 1,247 patients completed cycle 3. 86.7% of patients are female, age 27-89 years. Efficacy, evaluated by physicians’ assessment on a 4 point scale, was rated very good or good for 1,342 (89.9%), 1,241 (90.7%) and 1,142 (91.6%) patients in cycle 1, 2 and 3, respectively. Data on quality of life as recorded in FLIE questionnaires, and updated results on efficacy measured as CR as well as safety data will be presented at the meeting. Conclusions NEPA was very effective in prevention of chemotherapy-induced nausea and vomiting. The study is in ongoing. eP178 RANDOMIZED OPEN-LABEL-PHASE-II TRIAL OF APREPITANT PLUS ONDANSETRON COMPARED TO ONDANSETRON ALONE IN PREVENTION OF CHEMOTHERAPY-INDUCED-NAUSEA-VOMITING (CINV) IN GLIOMA PATIENTS RECEIVING ADJUVANT TEMOZOLOMIDE M. Weant 1 , S. Woodring 2 , D.M. Randazzo 3 , H.S. Friedman 2 , A. Desjardins3, G. Vlahovic2, P. Healy4, J.E. Herndon II4, F. McSherry4, E.S. Lipp2, E. Miller2, C. Cone2, J.Y. Kim2, C. Southerland 2, C. Brown2, M. Carter2, M.P. Johnson2, K.B. Peters2, M.L. Affronti2 1 Duke University Medical Center, Pharmacy, Durham, USA 2 Duke University Medical Center, Neuro-Surgery, Durham, USA

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Duke University Medical Center, Neurology, Durham, USA Duke University Medical Center, Biostatistics and Bioinformatics, Durham, USA 4

Introduction CINV remains a distressing side effect experienced by malignant glioma patients receiving temozolomide therapy in spite of guideline-based antiemetic therapy with selective serotonin receptor antagonists. Antiemetic research for aprepitant has routinely excluded glioma patients. In this study, the use of a non-standard 5-day regimen of aprepitant for glioma patients is investigated. Objectives To assess CINV efficacy (Complete Control (CC): days 1-7) of 5-day aprepitant plus ondansetron vs ondansetron alone in preventing acute and delayed CINV in glioma patients receiving adjuvant 5-day temozolomide, and to assess safety and tolerability of aprepitant with ondansetron. Methods In this phase II study, 136 glioma patients receiving their first cycle of adjuvant temozolomide (150-200mg/m2/d X 5d every 28d) were randomized to Arm A (ondansetron 8 mg Days 1-5 with aprepitant Day1: 125 mg, Days 2-5: 80 mg) or Arm B (ondansetron alone). Randomization was stratified by tumor grade and number of prior chemotherapy regimens. An interim analysis was planned after 68 patients such that accrual was to terminate if the proportion of patients experiencing CC in Arm A was less than that in Arm B. The study was designed to differentiate between a CC rate of 86% and 96% with 90% power (α=0.2; one-tailed). Results After the interim analysis, accrual continued. As of 2/1/2017, 126 patients have completed the study: mean age 53, 60% male, 97% white. 48% with KPS>90%, 61% non-smokers, 93% reported low alcohol use and 43% had CINV history. Conclusions Accrual will be completed in April and final study results will be presented.

eP179 SYMPTOMS AND LIMB CHANGES FOR BREAST CANCER S U R V I V O R S T R E A T E D W I T H N E O A D J U VA N T CHEMOTHERAPY: LYMPHEDEMA RESULTS OF ACOSOG Z1071 (ALLIANCE FOR CLINICAL TRIALS IN ONCOLOGY) J.M. Armer 1 , K. Ballman 2 , L. McCall 3 , V. Suman 4 , Y. Sun 1 , T. Udmuangpia1, K.K. Hunt5, E.A. Mittendorf5, D.R. Byrd6, T.B. Julian7, J.C. Boughey8 1 University of Missouri-Columbia, School of Nursing, Columbia MO, USA 2 Weill Cornell Medicine, Alliance Statistics and Data Center, New York NY, USA 3 Duke University, Alliance Statistics and Data Center, Durham NC, USA 4 Mayo Clinic, Alliance Statistics and Data Center, Rochester MN, USA 5 M D Anderson Cancer Center, Breast Surgical Oncology, Houston TX, USA 6 University of Washington Medical Center, Surgical Oncology, Seattle WA, USA 7 Allegheny Health Network, Breast Surgical Oncology, Pittsburgh PA, USA 8 Mayo Clinic, Breast Surgical Oncology, Rochester MN, USA Introduction Lymphedema is a major complication for breast cancer patients undergoing axillary dissection. This longitudinal substudy prospectively assessed limb volume, circumferences, and symptoms of breast cancer survivors treated with neoadjuvant chemotherapy and axillary dissection on the Alliance Z1071 trial. Objectives We aimed to assess lymphedema occurrence following neoadjuvant chemotherapy and axillary dissection by measuring limb volume, circumferences, and symptoms of breast cancer survivors.

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Methods Z1071-enrolled patients with cT0-T4,N1-2 disease were eligible. Limb volume, circumferences, and related symptoms were assessed at pre-surgery, 12 weeks post-surgery, and followed for 36 months. Lymphedema definitions were volume increase >10% or limb circumference increase >2cm. Symptoms were assessed by the Lymphedema Breast Cancer Questionnaire. Results Lymphedema data were available on 488 patients with median age 49 years (range 23–78). At 36 months post-surgery, lymphedema incidence was 60.3% (95% CI: 55.0%-66.2%) by >10% limb volume increase and 75.4% (95% CI: 70.8%-80.2%) by >2cm circumference increase. Weighted kappa coefficient was 0.27 (95% CI: 0.18-0.36), indicating modest agreement between the two criteria. Arm swelling and arm heaviness had a 3-year 25-31% cumulative incidence, respectively. Lymphedema symptoms were relatively stable after 18 months. There was limited agreement with weighted kappa coefficients (0.05-0.09) comparing volume or >2cm increase to reported heaviness and/or swelling. Conclusions Lymphedema is common after axillary dissection. Lymphedema symptoms decrease from post-op over 18 months after surgery, thereafter remaining stable. Incidence varies by definition (arm measurements/symptoms), indicating both are important to assess. Findings underscore value of prospective clinical surveillance from pre-op to 36 months and importance of both limb and symptom assessment.

eP180 THE AMERICAN LYMPHEDEMA FRAMEWORK PROJECT: AN UNTAPPED RESOURCE FOR ONCOLOGY CLINICIANS AND CANCER SURVIVORS AT RISK OF AND LIVING WITH LYMPHEDEMA J. Armer1, J.L. Feldman2, N.C. Armer1, K.M. Smith1, B.R. Stewart1, G. De Souza3, C.R. Shyu3 1 University of Missouri-Columbia, School of Nursing, Columbia, USA 2 University of Chicago, Pritzker School of Medicine, Chicago IL, USA 3 University of Missouri-Columbia, College of Engineering, Columbia, USA Introduction The American Lymphedema Framework Project (ALFP) was founded in 2008 as the first invited national framework of the International Lymphoedema Framework (ILF). The ALFP's mission is to improve lymphedema management in the US and globally. Objectives ALFP origin; mission; goals; and summaries of: stakeholder meetings, systematic reviews, and other ALFP collaborative exemplars will be shared. Methods Multidisciplinary lymphedema stakeholders established the ALFP mission and goals through 'open-space' stakeholder meetings. In promoting evidence-based best practices, teams comprised of ALFP steering committee members and other lymphedema experts conducted 10 systematic reviews on lymphedema management. Collaboration with engineering/ informatics experts established novel technological tools for lymphedema management and research. Results Based on the ALFP stakeholder meetings, two ALFP goals were identified: (1) Define lymphedema management best practices; and (2) Develop a minimum data set (MDS) to support research to improve lymphedema outcomes. Ten systematic reviews have been completed and published in peerreviewed journals (www.ALFP.org). Look4LE is an ALFP-developed mobile app, a searchable online database with demographic/geo-space information to help find therapists (N=1200) trained to assess and treat lymphedema. The ALFP MDS was created to collect and analyze clinical and selfreported lymphedema data.

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The ALFP team collaborated with engineering experts to develop a 3D mobile imaging platform for remote measurement of limb volume and symptoms transferrable to the MDS for surveillance and clinical management. Conclusions Through continuing multidisciplinary partnerships, ALFP has an established leadership role in lymphedema risk-reduction, treatment, education, and research. ALFP has made a major contribution toward addressing prioritized issues identified by stakeholders to move the field forward.

eP181 THE EFFECT OF LYMPHEDEMA ON THE QUALITY OF LIFE OF BREAST CANCER PATIENTS S. Kwon1, K.S. Seo1, M.W. Park1 1 Seoul national university, rehabilitation, Seoul, Republic of Korea Introduction Lymphedema is a chronic progressive state caused by abnormalities or damage of the lymphatic system. Lymphedema can lead to serious physical and mental illnesses. Objectives The purpose of this study was to evaluate the quality of life of patients with breast cancer according to the presence or absence of lymphedema and the treatment, and to evaluate the subjective evaluation of satisfaction and efficacy for each treatment. Methods One hundred and twenty breast cancer patients were classified as follows: having lymphedema with active treatment, who receiving a diagnosis of lymphedema and getting any intervention at hospital within 6 months; having lymphedema without active treatment; without lymphedema. Questionnaire included Health-related quality of life (EQ-5D), recognition of lymphedema and its treatment. Results Quality of life was different according to lymphedema and its treatment (Table 1). EQ5D index was lower at lymphedema patient without active treatment compared to without lymphedema (P=0.03). Lymphedema patient think satellate ganglion block is most effective among patients with active treatment and manual lymphatic drainage among lymphedema patient without active treatment. Lymphedema patients without active treatment think manual lymphatic drainage is the most uncomfortable treatment (44.4%). Conclusions Lymphedema and its treatments affect quality of life in many aspects. And patients were satisfied with active treatment and it effects the quality of lift among breast cancer patients. Therefore, when breast cancer patients complaint of lymphedema, active treatment must be considered.

eP182 COMPARISON OF EFFECTIVENESS BETWEEN CDT AND SGB IN BREAST CANCER RELATED LYMPHEDEMA PATIENTS M.W. Park1, S. Kwon1, K.S. Seo1 1 Seoul National University Hospital, Department of Rehabilitation Medicine, SEOUL, Republic of Korea Introduction Breast cancer related lymphedema (BCRL) of the upper extremities have largely been following breast cancer treatment. Although complex decongestive therapy (CDT) is currently considered as the standard treatment, stellate ganglion block (SGB) has been reported to be effective in the treatment of BCRL. Objectives To compare the effectiveness between SGB and CDT in patients with breast cancer related lymphedema.

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Methods In total 38 patients with BCRL were recruited. Patients were divided randomly into 2 groups. Patients CDT was tried for 2 weeks in group CDT, and patients in group SGB received 3 consecutive SGBs in every 2 weeks. Changes of circumference, volume, and bioimpedance in upper extremity were measured at baseline and 2 weeks after treatment, and compared between two groups. EQ-5D score for quality of life and subjective improvement were monitored. Results In both groups, changes of circumference, volume, and bioimpedance showed the tendency of improvement. Comparing with both groups, more improvement of circumference in forearm was observed in CDT patients. SGB patients showed more changes in volume reduction and bioimpedance in whole arm. But there were no significant statistical differences. And there were no significant statistical differences in EQ-5D score and subjective symptoms between the two groups.

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difference between pre- and post-operative L-Dex® score in patients who had abnormal score preoperatively (n=4), and improvement of patient’s symptom, and the need of postoperative conservative management (n=29) were assessed. Results The mean age was 59±9.6 years (range: 34-77). The mean stage at operation was 2 (0-3). The mean average of circumference in affected extremity was 25.1±5.7cm (18.9-44.8), decreasing to 23.5±5.1cm (17.7-39.5), 9.4% reduction at post-operative visit (p=0.000). Four patients had abnormal pre-operative L-Dex® score (>10 unit), and L-Dex® decreased in 3 patients (75%). Among these 3 patients, LDex® decreased within normal range in 1 patient. Improvement of clinical symptoms was seen in 68% (15/22) of patients underwent LVA. Conclusions Our data showed objective and clinical benefit of operative treatment for lymphedema patients in a short-term follow-up.

eP184 EFFECTIVENESS OF A TOOTHPASTE WITH SALIVARY ENZYMES AND COLOSTRUM EXTRACT ON ORAL HYGIENE GRADE AND QUALITY OF LIFE IN CHILDREN WITH CHEMOTHERAPY- RELATED ORAL MUCOSITIS E. Bardellini1, F. Amadori1, J. Merlo1, A. Ferri1, A. Majorana1 1 Spedali Civili di Brescia, Dental Clinic, Brescia, Italy

Conclusions The results of the present study show that SGB is an effective treatment in breast cancer-related lymphedema patients. SGB might be an alternative treatment for lymphedema after further studies are followed. eP183 MONITORING THE RESPONSE TO OPERATIVE TREATMENT FOR LYMPHEDEMA K. Tane1,2, C. De LaCruz3, E. Diego1, P. Mc Auliffe1, M. Bonaventura1, G. Ahrendt1, R. Johnson1, A. Soran1 1 MWH, Breast Surgery and Lymphoedema Program, Pittsburgh, USA 2 Hyogo Cancer Center, Breast Surgery, Akashi, Japan 3 MWH, Plastic and Reconstructive Surgery, Pittsburgh, USA Introduction The various surgical procedures for lymphedema (LE) have been reported, but the effectiveness of surgical treatments as well as monitoring LE has been controversial. Objectives The aim of this study was to evaluate the response to operative treatment for LE using tape measurement and bioimpedance spectroscopy (LDex®), and assess patient’s subjective benefit from surgery. Methods We retrospectively reviewed our 34 LE patients (29 with upper limb and 5 with lower limb LE), who had received surgical treatment, such as lymphovenous anastomosis (LVA), lipo-debulking or lymph node transplantation (22, 11, 1 patient, respectively) last 3 years. Patients had a preoperative and post-operative tape measurements and L-Dex® measurements, and patients’ pre- and post-operative symptoms were noted. Average of circumference reduction in affected extremity (n=27),

Introduction During oral mucositis the use of toothpaste can be challenging and often very demanding . Objectives The aim of this study was to assess the impact of the use of a fluoride toothpaste (Bioxtra®, Biopharm, Milan, Italy) with salivary enzymes, essential oils, proteins and colostrum extract versus a fluoride toothpaste without menthol on the oral hygiene grade and on the quality of life (QoL) of children with oral mucositis (OM) grade 1 or 2 receiving chemotherapy for Acute Lymphoblastic Leukemia (ALL). Methods Patients between 6-14 years with OM were randomly assigned to two groups, group A (Bioxtra® toothpaste) and group B (fluoride toothpaste without menthol). The patients were instructed to brush their teeth at least twice a day using a soft toothbrush with a small head. Oral hygiene grade was assessed using the simplified oral hygiene index (OHI-s); quality of life was assessed using the short form of the Oral Health Impact Profile (OHIP-14) questionnaires. The patients were evaluated on day 1(diagnosis of OM-T0) and on day 8 (T1). Statistical analysis was performed. Results A total of 64 patients were enrolled. A significant difference (p<0.001) between the mean of the OHI-s in group A (0.9+1.2) and in group B (1.5+ 1.3) was found; the overall OHIP-14 scores were not associated with the use of one or the other toothpaste (p=0.33). Conclusions Although the use of Bioxtra® toothpaste does not affect the QoL of children undergoing chemotherapy, it may be recommended as clinically effective in improving the oral hygiene grade.

eP185 OZONE THERAPY FOR THE TREATMENT OF PAEDIATRIC C HEMOTHERA PY- IN DU CED OR AL MU CO SITIS: A RANDOMIZED DOUBLE BLIND CONTROLLED STUDY E. Bardellini1, F. Amadori1, J. Merlo1, D. Chiappini1, A. Majorana1 1 Spedali Civili di Brescia, Dental Clinic, Brescia, Italy

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Introduction Ozone therapy can be defined as a versatile bio-oxidative therapy with immunostimulant, analgesic and antimicrobial properties. Objectives The aim of this study was to assess ozone effectiveness in the treatment of paediatric chemotherapy related oral mucositis. Methods A randomized double-blind clinical trial was carried out. Patients from 3 to 14 years of age undergoing cancer therapy and presenting OM grade 2 or more were eligible for this study. Patients were randomly divided into two groups: group A received ozone therapy for four consecutive days from the day of OM diagnosis; group B received sham therapy (placebo) with the same timing. Two blind clinicians performed OM scoring and pain evaluation on day 1 (immediately before the beginning of ozone therapy-T0), on day 4 (after finishing ozone therapy-T1) and on day 7 (T2) as follow up. Results A total of 102 patients were included in the study, divided into group A (n=51) and group B (n=51); in both groups, there was a progressive reduction in the grade of OM, but on day 7 not every mucosal lesion had disappeared. The difference in the decline of OM grading between the two groups resulted not statistically significative. A statistically significative difference in pain reduction between the two groups both at T1 and at T2 (p<0.005) was observed. Conclusions Ozone therapy is effective in reducing pain due to chemotherapy-induced oral mucositis in children.

eP186 PREVALENCE, SEVERITY AND RISK FACTORS OF ORAL MUCOSITIS IN OLDER CANCER PATIENTS RECEIVING C H E M O T H E R A P Y A N D / O R R A D I O T H E R A P Y: A SYSTEMATIC REVIEW AND META-ANALYSIS K. Cheng1, J.H. Lee1, V. Seah1 1 National University of Singapore, Nursing, Singapore, Singapore Introduction Prevalence and risk factors of mucositis in older cancer patients remain unclear. Objectives The purpose of this systematic review was to synthesise existing data on the prevalence, severity, and risk factors of mucositis in older cancer patients receiving chemotherapy and/or radiotherapy. Methods We searched several major databases from their inceptions to November 2015 for articles reporting mucositis in patients aged 60 years or older and treated with chemotherapy and/or radiotherapy. Two authors independently assessed eligible studies for inclusion, and performed quality assessment and extracted relevant data of the included studies. Results Of 1792 articles generated through our searches, 13 of them met our inclusion criteria. The age of patients from 13 studies ranged from 60 to 91 years old. Sample sizes in the studies ranged between 24 and 46692 subjects. The most commonly used measure of mucositis was the NCI CTCAE version 3.0 (n=7 studies). Prevalence of mucositis was dichotomous as presence (grade ≥1) or absence (grade <1), while severity as mild (grade1-2), moderate to severe (grade ≥3). In random effects meta-analysis, the pooled prevalence estimate of mucositis was 32.4% (95% CI 15% - 49.8%), with high heterogeneity. The pooled prevalence of mild and moderate to severe mucositis were 31.6% (95% 18.2% - 45%) and 19.6% (95% CI 14.4% - 24.8%), respectively. ECOG performance status ≥2, aged ≥ 80 years, polypharmacy, depressive symptoms at baseline, combined therapy, higher dosage and frequency of chemotherapy, hyperfractionated radiotherapy increased the risk of mucositis.

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Conclusions Our results suggest that mucositis is a common symptom in older cancer patients.

eP187 CANDIDA AND P. GINGIVALIS: THE EFFECT ON ORAL EPITHELIAL WOUND HEALING IN VITRO T.M. Haverman1, J.J. de Soet2, J. de Lange3, F.R. Rozema1, A.M.G.A. Laheij1 1 Academic Center for Dentistry Amsterdam, Oral Medicine, Amsterdam, The Netherlands 2 Academic Center for Dentistry Amsterdam, Preventive Dentistry, Amsterdam, The Netherlands 3 Academic Medical Center, Oral and maxillofacial surgery, Amsterdam, The Netherlands Introduction Both bacteria and fungi play a role in oral mucositis after chemo- and/or radiotherapy. The exact role of Candida species remains to be elucidated. Objectives We explored the hypothesis that Candida species can cause delayed healing of oral ulcerations due to the inhibition of wound closure. Moreover, we hypothesized that a mixed infection of C. glabrata or C. kefyr and P. gingivalis works synergistic on the inhibition of epithelial cell migration. Methods An in vitro scratch assay model was used to study the influence of viable, heat-killed and conditioned medium of C. glabrata, C. kefyr and C. albicans on cell migration of oral epithelial cells. Also, the effect on wound closure of a mixed infection with P. gingivalis was studied. Results In the presence of 10 viable C. glabrata or C. kefyr versus 1 epithelial cell (multiplicity of infection (MOI) of 10) the relative closure of the scratch was 26% and 17% respectively. At MOI 1 this was 60% for C. glabrata and 78% for C. kefyr. Both species inhibited closure of the scratch significantly stronger than control. No effect was observed for conditioned medium or heat killed Candida species. The inhibition of oral epithelial cell migration challenged with either C. glabrata or C. kefyr together with P. gingivalis was stronger than the inhibition caused by one of both organisms separately. Conclusions Candida species inhibit cell migration in vitro. Candida species together with P. gingivalis inhibit epithelial cell migration significantly stronger than both organisms do separately.

eP188 THE ROLE OF CONTRALATERAL SUBMANDIBULAR SPARING IN HEAD AND NECK INTENSITY MODULATED RADIOTHERAPY (IMRT): A SYSTEMATIC REVIEW AND META-ANALYSIS J.K. Jacinto1, J. Co1, M.B. Mejia1 1 Benavides Cancer Institute- University of Santo Tomas Hospital, Radiation Oncology, Manila, Philippines Introduction Xerostomia is one of the most concerning side effects of radiotherapy affecting mastication, dentition, deglutition, speaking and nutrition. Numerous studies showed improvement in physician-graded xerostomia scores and stimulated salivary flow rates in patients treated with parotidsparing IMRT however, these have poor correlation on patient-reported xerostomia. Submandibular glands are the primary source of unstimulated salivary flow in about 60% and are responsible for mucin production that

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retains water for moisture. Sparing the submandibular gland may improve patient-reported xerostomia. Objectives The aim of this review is to synthesize present available evidences on the effectiveness of contralateral submandibular (cSMG) sparing IMRT in patients with head and neck squamous cell carcinoma. Methods Search of relevant articles was done from 2001 to December 2016. Critical appraisal and meta-analysis of the eligible studies were undertaken to assess effectiveness of cSMG sparing versus non-cSMG sparing IMRT in head and neck cancer treated with parotid sparing IMRT. Results Of the 73 studies screened, 4 were eligible to be included in this review. One prospective study showed cSMG sparing IMRT has higher physician-reported xerostomia scores at 2 and 4 months, and higher unstimulated salivary flow rates at 2, 6, 12 and 18 months after radiotherapy. Retrospective studies showed better patient-reported xerostomia scores and unstimulated salivary flow with equivalent physician-graded xerostomia scores at 12 months (Figure1). Both groups showed equivalent 2-yr Locoregional recurrence rates (Figure2).

Conclusions Current evidences suggest better patient-reported xerostomia without compromising oncologic outcomes with cSMG sparing IMRT. More RCTs are warranted to provide higher level of evidence to verify its benefits.

eP189 TEXT MINING BASED IN SILICO DRUG DISCOVERY IN CANCER THERAPY-INDUCED ORAL MUCOSITIS

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Results We identified 447 genes common between the concepts ‘OM’ and ‘wound healing’ using text mining. Enrichment by gene ontology analysis yielded 89 genes. A final list of 20 genes representing six pathways were found to be targetable by a total of 32 drugs having the potential to be formulated for topical application. Twenty-five of the 32 drugs can directly affect the pathway that has been previously targeted for OM treatment, namely PTGS2 (COX-2) pathway. Among these drugs, two have been previously investigated for OM treatment, both evaluated by systemic administration. Conclusions Drug target discovery based on in silico text mining and molecular pathway analysis can facilitate the identification of existing drugs which can be repurposed for treatment of OM.

eP190 DIET COMPOSITION INFLUENCES INTESTINAL MUCOSITIS IN MICE H. Kissow1, R. Hytting-Andreasen1, B. Hartmann1, J.J. Holst1 1 University of Copenhagen, Department of Biomedical Sciences, Copenhagen, Denmark Introduction Glucagon-like peptide-2 (GLP-2) is secreted from intestinal L-cells in response to nutrients, with protein and sugars as the main stimulators. Endogenous GLP-2 is important for intestinal protection and healing, and treatment with GLP-2 can ameliorate mucositis. Objectives To examine whether mice fed a high fat diet (HFD), which is low in sugar, protein and fiber, would be more susceptible to mucositis due to impaired secretion of GLP-2. Methods Mice were allocated into two control groups (saline+HFD and saline+ chow) and two groups in which mucositis was induced with 5Fluorouracil (5-FU; 400 mg/kg) at day 0 (5-FU+HFD and 5-FU+chow). Body weight (BW) was measured daily. Mice were sacrificed at day 3 and 5. Blood was drawn for GLP-2 analysis, intestinal weight was measured, and tissues collected for myeloperoxidase (MPO) analysis, histology (villus height, crypt depth, mucositis score) and qPCR analysis (Claudin 1). Results When mucositis was induced, the HFD-fed mice showed a greater decrease in BW compared to chow-fed mice. The intestinal weight was significantly lower and levels of tissue MPO were higher on both day 3 and 5 after 5-FU in HFD mice.

J. Kirk1, N. Shah1, B. Noll1, F. Mougeot1, J.L. Mougeot1 1 Carolinas HealthCare System, Cannon Research Center - Oral Medicine Research Laboratory, Charlotte- NC, USA Introduction Oral mucositis (OM) is a major dose-limiting side effect of cancer therapy. The currently available drug-based OM treatments have limited effectiveness. Objectives Our objectives were to utilize publicly available biological data and computational tools to determine genes associated with OM, and to subsequently identify drugs targeting the relevant molecular pathways. Methods OM-associated genes were determined by text mining with the pubmed2ensembl tool. Gene set enrichment and gene ontology analysis were performed using the GeneCodis program for the identification of OM and wound healing-associated pathways. Protein interaction network analysis was carried out using STRING program. Genes belonging to the identified pathways were queried against the Drug-Gene Interaction Database to identify drug candidates based on their potential ability to impede OM development.

Conclusions These preliminary results showed that the composition of the food during chemotherapy may alter the intestine’s susceptibility to

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severe mucositis. Further analysis will show whether the observed difference associates to changes in GLP-2 secretion. If these results can be translated to humans, it could suggest that mucositis risk might be modified by different food regimes, which would be relevant when treating cancer patients.

eP191 INCIDENCE OF RADIATION MUCOSITIS IN NEPALESE PATIENTS AND REVIEW OF ITS MANAGEMENT IN NEPAL A.M. 1, A. Prakash2 1 , Oral Medicine and Radiology, Kathmandu, Nepal 2 , Oral Pathology and Microbiology,, Nepal Introduction Quality of life is reduced significantly following radiotherapy. Radiation mucositis is one of the early side effects of radiotherapy which is one of the means of treatment of head and neck cancer. Objectives To evaluate the number of nepalese radiation oncologists who encounter radiation mucositis and consider worth referring to dentist and to evaluate the attitude of oncologists towards dental consultation to patients planning for/prior to/undergoing/post radiation therapy for head and neck cancer. Methods A questionnaire-based study was carried out following mailing of self-administered questionnaire comprising 11 items to all four radiation oncology centers in Nepal based on convenient sampling. The questionnaire was sent to all the specialists directly involved in the care of such patients. Results Out of the 4 centers, we received responses from all the centers with 50 completely filled questionnaires. 78.7% of the oncologists encountered radiation mucositis and only 30.7% of them considered worth referring it to dentists. Though most oncologists did not consider them worth referring to dentist, there was increase in the more number of onclologists who considered referring compared to similar study conducted amongst radiation oncologists in India few years back. Initial treatment included uses of topical analgesics and anesthetics. Conclusions Though radiation mucositis was frequently encountered oral complaint in patients after/during radiation therapy, most oncologists still did not consider them worth referring to dentist. The study indicated a need for awareness and education among radiation oncologists regarding dental consultation in patients planned/undergoing /post radiation therapy for head and neck cancer.

eP192 PREVALENCE, COSTS, DURATION OF CHEMO-RADIATION MUCOSITIS (CRM) AND A PREVENTION/REVERSAL PROTOCOL USING FDA APPROVED POLYMERIZED CROSS-LINKED SUCRALFATE R. McCullough1 1 Translational Medicine Clinic and Research Center, Translational Medicine, Storrs, USA Introduction Quantifying the prevalence, costs and actual duration of chemoradiation mucositis (CRM) enables assessment of its health economic impact. FDA approved high potency polymerized cross-liked sucralfate (HPPCLS, ProThelial®) may provide a single agent protocol to manage CRM.

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Objectives Calculate expected prevalence and costs of CRM using actuarial data. Present the actual duration of CRM across 3 main cancer treatment regimens. Provide real-world practice outcomes using FDA approved HPPCLS for CRM. Methods Collate published actuarial data and statistics from NCI (SEER) and CIBMTR with published mucositis percentages and associated costs in cancer treatment patients. Review published duration data and published real-world outcomes using HPPCLS. Results 1.6-million US patients are diagnosed annually with cancer. CRM arises from the 382,990, 59,340 & 20,875 treated with chemotherapy, radiation, HSCT resulting in 212,785 with CRM and 41,501 deaths. The 60, 84 and 102 days of CRM from HSCT, RT-(radiotherapy) and CT-(chemotherapy) respectively, can be reduced to 2-3 days or prevented entirely using HPPCLS. Conclusions Of the 212,785 patients with oral and GI CRM and the 20,000 HSCT with CRM, at a cost of $4.7billion USD (2016), a full 19% will die prematurely due to mucositis-associated infections (11% of all HSCT) and mucositis-mediated reduction of dose intensity (via unplanned breaks, dose reductions or treatment cancellations). A single agent protocol involving HPPCLS capable of prevention and rapid reversal of CRM can reduce the health economic impact of this toxicity. Key: SEER (Surveillance Epidemiology End Results); CIBMTR (center for international blood and marrow transplantation research)

eP193 EFFECT OF ORAL CARE FOR ORAL MUCOSITIS AND NUTRITIONAL STATUS IN TONGUE CANCER PATIENTS DURING CHEMO-RADIOTHERAPY S. Mitsunaga1, S. Oguri2, I. Tohnai2 1 Kanagawa Cancer Center, Oral and Maxillofacial Surgery, Yokohamacity, Japan 2 Yokohama City University Graduate School of Medicine, Oral and Maxillofacial Surgery, Yokohama-city, Japan Introduction The purpose of this study was to evaluate the efficacy of oral care for OM and nutritional status in patients of tongue cancer underwent chemoradiotherapy. Objectives This study included 30 patients who had received chemo-radiotherapy between 2011 and 2016. During chemo-radiotherapy, 18 patients were treated by dentists and dental hygienist with systematic dental care and oral hygiene instruction (oral hygiene group) and the remaining 12 patients were treated with routine dental care (standard medication group). Methods A retrospective study was made to assess the oral care outcome based on medical records of the department of head and neck surgery at our hospital and our department. We investigated the severity of oral mucositis (CTCAE ver3.0), inflammatory responses, and nutritional status. Results At the end of chemo-radiotherapy, there was no significant difference of the sevirity of OM between both groups. In oral hygiene group, inflammatory responses were lower and nutritional status was better than standard medication group. Conclusions Systematic dental care with oral hygiene instruction was effective to prevent inflammatory responses and to improve nutritional status during chemo-radiotherapy for tongue cancer.

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eP194 PALIFERMIN FOR ORAL MUCOSITIS PREVENTION IN ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANT PATIENTS (ALLO-HSCT) CONDITIONED WITH TOTAL BODY IRRADIATION (TBI) AND ETOPOSIDE WITH OR WITHOUT METHOTREXATE D. Pon1,2, D. Curi1, S. Shayani2, R. Spielberger3 1 Western University of Health Sciences, College of Pharmacy, Pomona, USA 2 City of Hope National Medical Center, Department of Pharmacy, Duarte, USA 3 City of Hope National Medical Center, Department of Hematology/ HSCT, Duarte, USA Introduction Palifermin prophylaxis is used to reduce duration and severity of oral mucositis (OM) in autologous and allo-HSCT. Use of methotrexate for graft-versus-host-disease (GVHD) prophylaxis increases OM. Objectives The purpose of this study was to determine the difference in duration and severity of OM and hospital length of stay (LOS) in adult allo-HSCT patients conditioned with TBI and etoposide, +/-methotrexate for GVHD prophylaxis, and +/- palifermin prophylaxis. Methods In this Institutional Review Board-approved retrospective review, OM incidence and duration were collected from progress notes, and demographics and length of stay were collected from medical records for patients treated between 1/2003-12/2005 (controls, no palifermin) and 1/2006-12/2009 (palifermin). Results 184 patients were included: controls (n=83), palifermin (n=101). Demographics were similar between groups except for stem cell source and GVHD regimen. Patients were stratified according to methotrexate use for GVHD prophylaxis. In patients treated with methotrexate (n=81), the palifermin group (n=27) experienced lower incidence of severe OM [33% vs. 98%, p<0.0001], median duration OM [14 vs. 27 days, p<0.0001], and median LOS [39 vs. 46 days, p=0.009] compared to controls. In patients treated without methotrexate (n=103), the palifermin group (n=74) experienced lower incidence of severe OM [22% vs. 59%, p=0.0008] and median duration OM [12 vs. 17 days, p=0.0001] compared to controls. Median LOS was not different [38 vs. 39 days, p=0.3]. Conclusions Palifermin prophylaxis in allo-HSCT, +/- methotrexate for GVHD prophylaxis, was associated with decreased duration and severity of OM, but was associated with decreased LOS only in patients who received methotrexate for GVHD prophylaxis. eP195 COST-EFFECTIVENESS ANALYSIS OF PALIFERMIN IN PREVENTION OF SEVERE ORAL MUCOSITIS (OM) AMONG PATIENTS UNDERGOING ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION (ALLO-HSCT) Q. Le1, D. Pon1,2, S. Shayani2, R. Spielberger3 1 Western University of Health Sciences, College of Pharmacy, Pomona, USA 2 City of Hope National Medical Center, Department of Pharmacy, Duarte, USA 3 City of Hope National Medical Center, Department of Hematology/ HSCT, Duarte, USA Introduction Palifermin, a recombinant keratinocyte growth factor, has shown a reduction in duration and severity of OM after fractionated total body irradiation (FTBI) conditioning-based regimens in patients with hematologic malignancies requiring HSCT.

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Objectives The objective of this study was to evaluate the cost-effectiveness of palifermin for preventing severe OM in allo-HSCT patients conditioned with FTBI and etoposide. Methods A decision analysis model was implemented to estimate costeffectiveness of palifermin in preventing severe oral mucositis after allo-HSCT. Clinical outcomes were based on an extended retrospective medical record review examining patients who received palifermin for prevention of oral mucositis after FTBI and etoposide post allo-HSCT, spanning from 01/2005 to 12/2009. Direct medical costs included treatment costs and costs of bacteremia, other infections (fungemia and viremia), OM, and severe OM. All costs were adjusted to 2016 US dollars. Results A total of 184 patients, controls (n=83) and palifermin (n=101), were included. Total costs and lengths of hospital stay in the palifermin vs. control groups were $24,403 vs. $19,505, and 42.6 days vs. 49.8 days, respectively. The resulting incremental cost-effectiveness ratio (ICER) for treatment with palifermin was $1,374 per one hospitalized day avoided. Conclusions In addition to clinical benefits, using palifermin to prevent severe oral mucositis in patients undergoing allo-HSCT appeared to be cost-effective when comparing to the current (2015) average cost per hospital day of $1,878. Further studies are warranted to evaluate quality of life in these patients as well as cost-utility analysis of palifermin.

eP196 TARGETED THERAPY WITH NK-1R ANTAGONIST FOR ORAL MUCOSITIS AND OTHER TISSUE REACTION IN H A M S T E R M O D E L A N D C O M PA R I S O N O F O R A L MUCOSITIS TREATMENT WITH LOW LEVEL LASER S. PS1, A.A. Al Eid2, M. Mohan2 1 Qassim University, Maxillofacial Surgery and Diagnostic Sciences, Buraidah, Saudi Arabia 2 Qassim University, College of Dentistry, Buraidah, Saudi Arabia Introduction Studies noting the NK-1R role in other tissue reactions, pruritis, mucositis is very few, those directed shows affirmative; and a causal association could convey a foundation of targeted therapy for tissue reactions. Objectives 1) To investigate whether the NK-1R antagonist has a therapeutic effect on mucositis, pruritis, and hair loss in the mouse model. 2) Comparison of effectiveness of NK-1R antagonist with low level laser in oral mucositis. Methods The hamsters were divided into four groups, control group with no treatment; Group A, receiving the 5-FU peritoneal injection only; Group B, receiving the 5-FU peritoneal injection and NK-1R antagonist; Group C, receiving the 5-FU peritoneal injection and low level laser. Hamsters were intraperitoneally administered 5-FU at 80 mg/kg on days, 0, 6, and 9. NK1R antagonist, 1 mg/kg, were administered intraperitoneally on Day 1, 2 and 3rd. And low intensity red laser was administered on Day 2, 5 and 7 to the scratched cheek pouches. Results Group A, showed, complete ulceration of the cheek pouch at the end of the 13th day, and very minimal small patches of alopecia (25cm2), and biting, licking of hind paw. Group B, showed, Presence of erythema, and minimal evidence of erosion in the cheek pouch, with no scratching or no biting or licking the hind paw, and very good coat condition. Group C, showed, minimal presence of erythema in the cheek pouch, and very minimal small patches of alopecia and biting, licking or hind paw.

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Conclusions The targeted therapy with NK-1R antagonist in tissue reactions could reduce the symptoms.

eP197 DEVELOPMENT OF THE ONLINE SHARING PLATFORM FOR THE MUCOSITIS STUDY GROUP (MSG) SYSTEMATIC REVIEW ABOUT CLINICAL INTERVENTIONS FOR MUCOSITIS V. Ranna1,2, P. Bossi3, K. Cheng4, S. Elad1 1 Eastman Institute for Oral Health- University of Rochester, Dental Medicine, Rochester, USA 2 University at Buffalo, Dental Medicine, Buffalo, USA 3 Fondazione IRCCS Istituto Nazionale dei Tumori, Dental Medicine, Milano, Italy 4 National University of Singapore, Dental Medicine, Singapore, Singapore Introduction Systematic reviews often involve a large volume of literature, and engage multiple reviewers, possibly from different parts of the world. To organize the data storage and distribution, it is necessary to have a central file exchange system. Objectives To explore the available online platforms for data sharing in systematic reviews with a focus on the potential of Google Drive® for data transfer. Methods Online file sharing systems were evaluated for sharing and access features, security and file tracking as part of the Mucositis Study Group (MSG) systematic review. Results Several online platforms were considered. Multiple Google Drive® architectures were assessed for compatibility. The Google Drive® architecture that was selected for the MSG systematic review had the following features: a backup option to salvage data, a central overview of the materials, reduction in inadvertent duplication/deletion of files/folders, availability for future guidelines update, ability for users to access data without having a personal mail account. Some of the shortcomings of this platform were related to the potential for deletion/duplication of folders, change of password/account details by any of the users, and security settings of Google Drive®. A plan was set to avoid some of these system limitations. Conclusions Developing an online platform for data storage and transfer files is a process that has to be tailored to fit the project’s requirements. The Google Drive® architecture that was selected for the MSG systematic review was the most advantageous, within limitations. This information may be useful for other groups performing systematic reviews.

eP198 EFFECT OF SURFACTANT PROTEIN-D ABLATION ON CH EMO TH ER APY I ND UCE D GAS T ROI NT E ST IN AL TOXICITY IN MICE M. Rathe1, S.L. Von Huth2, G.L. Sorensen2, U. Holmskov2, S. Husby1 1 Odense University Hospital, H.C. Andersen Children's Hospital, Odense, Denmark 2 Institute of Molecular Medicine, Department of Cancer and Inflammation Research, Odense, Denmark Introduction Innate host defense molecules such as Surfactant Protein-D (SP-D) may be involved in the homeostasis and protection of mucosal surfaces after chemotherapy.

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Objectives To investigate the effect of SP-D ablation on chemotherapy induced gastrointestinal toxicity and inflammation in a murine model. Methods SP-D knockout (KO) mice and wildtype (WT) littermates were treated with doxorubicin (20 mg/kg) or saline by i.p. injection and sacrificed at day three or at day seven post-administration. Gastrointestinal toxicity and inflammation was evaluated by weight change, bone marrow cellularity, citrulline levels, intestinal length, histopathological evaluation and quantitative real-time PCR (RT-qPCR) of key genes related to chemotherapy induced mucositis, inflammation, apoptosis and repair of damaged epithelium including Tnf, IL-1β, Casp-1, Casp-3, Bax, Mmp-2, Mmp-12, Serpina3n, Akr1b8, Gsdmc2, Gsdmc3, Gsdmc4. Results Doxorubicin induced toxic complications in terms of wasting, decreased bone marrow cellularity, decreased plasma citrulline, reductions in intestinal lengths, histopathological changes and an increased staining for cleaved caspase 3 (all p<0.05). SP-D KO mice tended to lose more weight than their WT litter mates reaching significance on day 7 postadministration (p<0.05). By RT-qPCR KO mice showed an increased Tnf expression in the colon and an increased Mmp2 expression in the jejunum after doxorubicin treatment (p<0.05). In WT mice doxorubicin resulted in increased SP-D expression. Conclusions SP-D had limited effect on gastrointestinal toxicity after induction of mucositis possibly owing low SP-D expression in the murine intestine. Increased Tnf and Mmp2 expression in the intestine indicates that SP-D may modulate the inflammatory response after chemotherapy with possible implications for the ensuing tissue injury.

eP199 EFFECTS OF GLYCINE IN THE IMMUNOHISTOCHEMICAL EXPRESSION OF EGFR IN ORAL MUCOSITIS IN INDUCED HAMSTERS N. Lopes1, M.T. Alves2, E. Caran3, O. SA3 1 Federal University Sao Paulo, Pediatric Oncology Institute, SAO PAULO, Brazil 2 Federal University of Sao Paulo, Pathology, Sao Paulo, Brazil 3 Federal University of Sao Paulo, Pediatrics, Sao Paulo, Brazil Introduction Mucositis Oral is a debilitating and dose-dependent consequence of antineoplastic therapy. The oral mucositis management remains mainly based on palliative and pain remission, in order to control and minimize the inflamatory process, either modifying the epithelial metabolism. Glycine, an important inhibitory neurotransmitter in the mammalian central nervous system (CNS), has been to modulate inflammatory mediators, that the effect of is due in a glycine-gated Cl– channel in endothelial cells. Objectives to evaluate the use of glicyne on growth factor expression involved in mucosal tissue repair and its effects in reducing the duration of mucositis process, for epidermal (EGFR). Methods The Mucositis has induced in 10 female Golden Syrian hamsters wich will receive intraperitoneal injections of 5-fluorouracil. The induced mucositis done following anesthesia, the right cheek pouch of the animals will be everted and the mucosa irritated by superficial scratching with the tip of an 18-gauge needle. Animals randomly assigned to two groups of 05 animals each: group I - received received systemic glycine supplementation for 7 days; group II - no therapy Glycine (control group). The study used a 2 mg/g of body weight intraperitoneal injection of Glycine diluted in saline at a concentration of 5%. The cheek pouches of animals will be dissected for immunohistochemical expression, EGF (CEP 1916/08).

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Results detected protein levels of epidermal growth factor (EGFR) were measured using Glycine inhibits apoptose signaling of protein levels of vascular epidermal growth factor (EGFR) (Figure1). Conclusions glycine prevents apoptosis of oral mucosa under EGFR deprivation, would be a promising additive to standard and targeted oral mucostis.

eP200 PROGNOSTIC POTENTIAL OF ORAL MUCOSITIS IN TRANSPLANTED ADULT PATIENTS TREATED WITH PREVENTIVE LOW-LEVEL LASER THERAPY W. Miranda e Silva1, F. Paiva Fonseca2, C. Joffily Parahyba1, B. Monteiro Benites1, S. Ribeiro Barros da Cunha3, A.C. Alo Nesrallah1, A. Domingues Pereira4, C. Arrais4, E. Rodrigues Fregnani1 1 Sírio-Libanês Hospital, Oral Medicine Department, São Paulo, Brazil 2 Dental School- Federal University of Minas Gerais, Department of Clinics- Pathology and Surgery, Belo Horizonte, Brazil 3 School of Dentistry of University of São Paulo, Department of Restaurative Dentistry, São Paulo, Brazil 4 Sírio-Libanês Hospital, Hemato-Oncology Department, São Paulo, Brazil Introduction Mucositis is a common oral toxicity in patients treated with allogeneic hematopoietic stem cell transplant (HSCT), usually causing pain, dysphagia, dysgeusia and increased use of opioids, also leading to longer periods of hospitalization. Consequently, a better management of oral mucositis (OM) is desired and preventive low-level laser therapy (LLLT) has emerged as an alternative to improve patients’ quality of life. Objectives To describe the oral clinical features of 78 transplanted patients preventively treated with LLLT and to demonstrate the prognostic potential of OM for these patients. Methods From 2013 to 2016 clinical data of 78 patients submitted to allogeneic HSCT were retrospectively retrieved and investigated for the development of OM. All patients received professional dental care and LLLT before the transplantation. Fisher’s exact test was applied to investigate the association of OM with clinical parameters, while survival curves created with KaplanMeyer method were compared using the Log-rank test. Results OM was observed in 36 patients (46%), with 7 days as median time to develop the toxicity. Severe mucositis was found in 21% of the patients and this toxicity did not influence the time of hospitalization and the mortality rate (p > 0.05). Myeloablative conditioning regimen was the only parameter that significantly increased mucositis incidence (p < 0.0001), but using the univariate analysis, the presence of OM did not determine a lower survival for these individuals (p > 0.05). Conclusions OM in transplanted patients preventively treated with LLLT is not a statistically significant prognostic determinant and usually present as less severe ulcerations.

eP201 MELATONIN ORAL GEL FOR THE PREVENTION OF SEVERE ORAL MUCOSITIS H and N CANCER UNDERGOING CHEMO/ BIO RADIATION (MUCOMEL) C. Tarragó1, L. Alicia2, M. Jordi3, F. Nuria4, M. Rosa5, P. Isabel6, G. Jordi7, L. Manuela8, E. Anne5, G. Luis5, M. Ricard9, R. Jordi10, L.P. Antonio11, B. Neus12, C. Beatriz13, C. Beatriz14, M.T. Javier15, G. Pedro1, V. Vicent16, B. Ramon1

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SPHERIUM BIOMED S.L., Project Management, Esplugues de Llobregat- Barcel, Spain 2 Institut Catala Oncologia ICO L'Hospitalet, Radiation Oncology, L'Hospitalet de Llobregat, Spain 3 Institut Catala Oncologia ICO Girona, Radiation Oncology, Girona, Spain 4 Hospital de la Santa Creu i Sant Pau, Radiation Oncology, Barcelona, Spain 5 Hospital Universitario La Paz, Radiation Oncology, Madrid, Spain 6 Institut Catala Oncologia ICO Badalona, Radiation Oncology, Badalona, Spain 7 Hospital Universitari de la Vall d'Hebron, Radiation Oncology, Barcelona, Spain 8 Hospital Universitario Miguel Servet, Radiation Oncology, Zaragoza, Spain 9 Institut Catala Oncologia ICO L'Hospitalet, Medical Oncology, L'Hospitalet de Llobregat, Spain 10 Institut Catala Oncologia ICO Girona, Medical Oncology, Girona, Spain 11 Hospital de la Santa Creu i Sant Pau, Medical Oncology, Barcelona, Spain 12 Hospital Universitari de la Vall d'Hebron, Medical Oncology, Barcelona, Spain 13 Hospital Universitario La Paz, Medical Oncology, Madrid, Spain 14 Institut Catala Oncologia ICO Badalona, Medical Oncology, Badalona, Spain 15 Hospital Universitario Miguel Servet, Medical Oncology, Zaragoza, Spain 16 Hospital de Sant Pau i Santa Tecla, Medical Oncology, Tarragona, Spain Introduction Oral mucositis (OM) is the most significant adverse event (AE) in patients undergoing concurrent chemo/biotherapy plus radiotherapy for treating head and neck (H&N) cancer. Objectives The objective of the ongoing Phase Ib-II trial is to evaluate the safety of melatonin (MLT) oral gel, its efficacy in the prevention of severe OM in H&N cancer patients (84) and to assess the pharmacokinetic profile of MLT in the subgroup of the first 24 patients. Methods This is a multicenter, prospective, randomized, double blind and placebocontrolled study. Eligible patients are assigned at 1:1 ratio to receive 3% melatonin or matching placebo oral gels (mouthwashes &swallowing). Selected radiotherapy is VMAT-SIB once daily (5d/w), 50.4 Gy (low risk area), 69.96 Gy (high risk area) and 66 Gy (post-operative oral cavity tumour). Radiotherapy plan was previously agreed between all the radiotherapists participating in the study in order to ensure homogeneity between centres. Concurrent systemic treatment is either cisplatin or cetuximab. The primary endpoint is the num. of patients with severe OM (G3-G4/ RTOG), other efficacy, QoL and safety endpoints will be analysed, as well. Results The first patient was enrolled in November 2015 and, up to 14 February 2017, 56 patients were randomized to treatment with either MLT or placebo oral gel. Results are expected by end of 2017. Conclusions This prospective, randomized, double-blind and placebo-controlled study will demonstrate if melatonin oral gel 3% is safe and has been able to prevent severe OM in H&N cancer patients undergoing QRT, and if has shown efficacy in the other evaluated endpoints.

eP202 MICROBIOTA DEPLETION WORSENS GASTROINTESTINAL MUCOSITIS OUTCOME IN RATS S. van der Aa1,2,3, N. Kuiken1,3, R. Havinga3, L. Harthoorn2, A. Hartog4,5, E. Rings6,7, A. Groen3, H. Harmsen8, W. Tissing1

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University Medical Center Groningen, Department of Pediatric Oncology, Groningen, The Netherlands 2 Nutricia Research, Nutricia Advanced Medical Nutrition, Utrecht, The Netherlands 3 UMC Groningen, Department of Pediatric Gastroenterology and hepatology, Groningen, The Netherlands 4 Nutricia Research, Immunology platform, Utrecht, The Netherlands 5 Utrecht Institute of Pharmaceutical Sciences, Department of Pharmacology, Utrecht, The Netherlands 6 Erasmus Medical Center Rotterdam, Department of Pediatrics, Rotterdam, The Netherlands 7 Leiden University Medical Center, Department of Pediatrics, Leiden, The Netherlands 8 University Medical Center Groningen, Department of Medical Microbiology, Groningen, The Netherlands Introduction The gut microbiota plays an important role in intestinal homeostasis. Literature shows that a change in the gut microbiota following chemotherapy coincides with the development of gastrointestinal mucositis. Here, we investigated whether the microbiota influences the severity of mucositis. Objectives This study aims to investigate the effect of depletion of the gut microbiota on the course of mucositis. Methods Rats were treated with a combination of vancomycin, imipenem and metronidazole in the drinking water, designed to deplete the complete gut microbiota, starting one week before single dose of intravenous methotrexate (MTX). The group receiving antibiotics and MTX was compared to a group receiving MTX only; appropriate control groups were included. Blood levels of citrulline were determined as a measure for mucositis over time. Animals were sacrificed on day four or ten to measure the villus length, crypt depth and microbiota. Results Rats treated with antibiotics and methotrexate, having a severely decreased microbial diversity, did clinically worse compared to rats treated with methotrexate only, as indicated by a decreased survival. This worse state was confirmed when the villus length and crypt depth were compared during mucositis and the blood citrulline levels suggested a slower recovery. The microbial composition changed to a predominantly aerobic composition after MTX treatment. Conclusions The results in this study indicate a clinically worse outcome when the gut microbiota was depleted by antibiotics in MTX treated rats. This suggests a potential role of the microbiota in the course of MTX-induced mucositis and a potential target for modulation.

eP203 TOLERABILITY OF AN INNOVATIVE INTRA ORAL COOLING DEVICE IN PATIENTS WITH MYELOMA J. Walladbegi1, M. Jontell1, A. Svanberg2, K. Garming-Legert3 1 Institute of Odontology - The Sahlgrenska Academy - University of Gothenburg, Oral Medicine & Pathology, Gothenburg, Sweden 2 Institute for Medical Sciences, Department of Hematology, Uppsala, Sweden 3 Institute of Odontology - Karolinska Institute, Orofacial Diagnostic & Surgery - Oral Medicine & Pathology, Stockholm, Sweden Introduction Oral mucositis (OM) affects up to 80% of all patients receiving myeloablative therapy prior to stem cell transplantation. The complication manifests as ulcerations and may require high doses of morphine for

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pain alleviation. OM may also interfere with food intake and result in parenteral nutrition, weight loss and impaired quality of life. Current literature indicates no effective profylactic evidence-based interventions for prevention of OM. Objectives The primary objective of the present study was to evaluate the tolerability of an innovative intraoral cooling device in patients scheduled to receive high doses of chemotherapy prior to stem cell transplantation. Methods In total six patients (4 men; 2 women) (mean age: 62 years) diagnosed with multiple myeloma and scheduled to receive Melphalan 200mg/m2 were enrolled in this pilot study. The patients were informed to use the cooling device for 90 minutes before, during and after the chemotherapy infusion. Following each cooling session a questionnaire, specifically developed for the study to assess tolerability, was completed.

Results In four of total six patients the cooling device was perceived as very tolerable. Three of those completed the full cooling time and one endured 70 minutes. The two patients (women) who did not endure the full cooling time experienced the device as too big, a problem that will be solved in the future, as two different sizes will be produced. Conclusions The cooling device is well tolerated. The next step will be to evaluate the cooling device in a randomized clinical setting to establish its efficacy of preventing OM. eP204 EXPLORING THE ROLE OF “GLYCERINE PLUS HONEY” IN D E L AY I N G C H E M O R A D I AT I O N I N D U C E D O R A L MUCOSITIS IN HEAD AND NECK CANCERS B. Yadav1 1 B and C Teaching Hospital, Department of Oncology, Birtamod, Nepal Introduction Oral mucositis is the most common and irritating side effect of chemoradiation. In developing countries like ours, where finances are the major issue, some home-made remedy can help the poor patients to deal with this chemoradiation induced side effect and continue their treatment without breaks. Objectives To assess the efficacy of adding “Glycerine plus Honey” to standard management protocol, in terms of time to delay in oral mucositis ≥ grade 2. Methods Hundred patients of oral cavity and oropharangeal cancers, planned for concurrent chemoradiation (Dose: 60–66Gy/30-33fractions/6 weeks) were randomized 1:1 to receive either home-made remedy made of “Glycerine plus Honey” added to the standard management protocol to prevent mucositis versus standard treatment alone. CTCAE v 4 was used for assessing oral mucositis scores weekly. Chi square test was used to compare mucositis scores, weight loss, opioid use, ryles tube feeding, and unplanned treatment breaks in each cohort. Independent T test was used to compare the delaying in≥ Grade 2 toxicity

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Results Significantly higher number of patients developed grade ≥ 2 mucositis in control arm [n=43 (86%)] compared to study arm [n=30 (60%)] (p=0.003). CTCAE scores favored Glycerine plus honey at week 4, and on last day of radiotherapy. Whereas, time to first occurrence of oral mucositis grade ≥ 2 was 23.17 (± 1.01) days for study arm [radiation dose 31.67Gy (± 1.44)], it was 20.65 (± 0.8) days for control arm [radiation dose 28.14Gy (± 1.16)] (p=0.05). Conclusions Glycerine plus honey demonstrated superiority in delaying oral mucositis, and the combination is safe and well tolerable.

eP205 ORAL ADMINISTRATION OF AMINO ACIDS CYSTINE AND THEANINE ATTENUATES 5-FLUOROURACIL-INDUCED INTESTINAL INFLAMMATION BY SUPPRESSION OF MCP-1 SECRETION AND RECRUITMENT OF INFLAMMATORY MONOCYTE

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Brampton, Canada Odette Cancer Centre, Department of Radiation Oncology, Toronto, Canada 2

Introduction Brain metastases arising from prostate cancer are exceedingly rare and typically occur late in the course of the disease. Most patients have widespread metastatic disease before developing brain metastases from prostate cancer. It is even more uncommon to have the brain as the sole site of metastatic prostate cancer. Objectives To report the case of a 67-year-old male who presented with recurrent prostate cancer with an isolated symptomatic brain metastasis (Figure 1) and to review existing literature on solitary brain metastases.

J. Yoneda1, S. Iwayama1, M. Shiozaki1 1 Frontier Research Labs. - Institute for Innovation - Ajinomoto Co. - Inc., Nutrition and Health Science Group, Kawasaki, Japan Introduction Cystine/theanine (CT) is a supplement containing 700 mg of cystine and 280 mg of theanine. A recent clinical study demonstrated that oral administration of CT reduced adverse events and improved completion rate of an adjuvant chemotherapy. CT attenuated intestinal mucositis and diarrhea, and promoting mucosal recovery in 5-FU-induced mouse mucositis model, however mechanism is unclear. Objectives The objective of this study is to verify mechanisms of the suppressive effects of CT on the intestinal tissue using 5-FU-induced mouse mucositis model. Methods Intestinal mucositis and diarrhea was induced in male BALB/c mice by a single intraperitoneal injection of 5-FU (120 mg/kg). Saline or CT (200 mg/kg of cystine and 80 mg/kg of theanine) were orally administered once daily starting 3 days before 5-FU administration until the end of the experiment. On day 3, the mice were euthanized, and monocytes and macrophages were harvested from mouse intestine for FACS analysis. Results The inflammatory Ly6Chi (CD90/B220/CD49b/CD11c)lo monocyte subset and iNOS positive M1-like macrophage (Ly6C+(CD90/B220/ CD49b/CD11c)hi) subset increased in the small intestinal tissue from 5-FU-treated mice. CT treatment suppressed the accumulation of inflammatory monocyte/macrophage subsets in the 5-FU induced damaged small intestine. We also found increased MCP-1 levels in the plasma in 5-FU treated mice, which were partially decreased by CT administration. Conclusions CT treatment inhibits the 5-FU induced increase[A1] of MCP-1 and decreases the recruitment of inflammatory Ly6Chi monocyte subset and accumulation of iNOS positive M1-like macrophage subset in intestinal tissue, which results in suppression of inflammatory response and promotion of mucosal recovery.

eP206 SOLITARY BRAIN METASTASIS FROM PROSTATE CANCER: A CASE REPORT AND REVIEW OF LITERATURE T. Barakat1, A. Agarwal2, R. McDonald2, V. Ganesh2, S. Vuong2, M. Borean2, E. Chow2, H. Soliman2

Methods A retrospective chart review was conducted, followed by a literature search of published cases on solitary brain metastases. Results The patient received aggressive treatment to the metastatic site that included tumor resection and adjuvant stereotactic radiation treatment (RT) to the surgical bed with a dose of 30 Gy in 5 fractions (Figure 2). ADT was subsequently re-initiated. The patient’s PSA returned to an undetectable level and remained undetectable with no evidence of disease 17 months post-radiotherapy. Follow-up MRI imaging of his head confirmed no residual or recurrent disease (Figure 3). Our review of the literature identified only 16 previouslyreported cases of solitary brain metastasis from prostate cancer over the past 25 years.

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Figure 2. Fractionated stereotactic radiosurgery treatment plan, delivering 30 Gy in 5 fractions.

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of the multidisciplinary team to detect and monitor CIPN is important to fully appreciate its impact on patients’ long-term quality of life. The application of a validated scale to assess neurotoxicity is mandatory to analyze the real prevalence of CIPN.

eP208 REVERSIBLE POSTERIOR LEUKOENCEPHALOPATHY SYNDROME (RPLS) IN ZIV-AFLIBERCEPT TREATMENT IN COLORECTAL CANCER PATIENT. A CASE REPORT AND LITERATURE REVIEW M. Cavanagh1, M. Soria Tristán1, A.M. Sanchez Peña1, J.M. Martin Martínez1, M.T. Diaz Puente1, L. Diaz Paniagua1, B. García García1, M.J. Boya1, S. Enrech Francés1 1 Hospital Universitario Getafe, Oncology, Madrid, Spain

Conclusions Metastatic disease exclusive to the brain in prostate cancer patients remains extremely infrequent. This unique case demonstrates that aggressive treatment with tumor resection and adjuvant stereotactic RT to the surgical bed without whole brain radiation therapy (WBRT) may be optimal in the management of such patients.

eP207 PERIPHERAL NEUROPATHY INDUCED BY CHEMOTHERAPY P. Cavaco1, S. Ponte2, T. Recio2 1 Hospital de São Francisco Xavier - Centro Hospitalar de Lisboa Ocidental, Pharmacy, Lisboa, Portugal 2 Hospital de São Francisco Xavier - Centro Hospitalar de Lisboa Ocidental, Oncology Day Hospital, Lisboa, Portugal Introduction Chemotherapy-induced peripheral neuropathy (CIPN) is a common treatment-related side effect of several cytotoxic drugs. Its side effects and deficits can impair daily function and diminish quality of life, result in dose reductions or early treatment discontinuation. Objectives To analyze the prevalence of CIPN in patients with prescriptions of bortezomib, oxaliplatin and paclitaxel in the oncology sector. Methods Analysis of the prevalence of CIPN through a descriptive, observational study, with retrospective analysis, conducted between January 2016 and June 2016, in the oncology sector of a general central hospital. Data were collected by hospital records review. Results During the study period 146 patients had prescriptions for bortezomib (n=26), oxaliplatin (n=60) and paclitaxel (n=60), the mean age was 64 years (min: 28; max: 86). Most patients had colorectal cancer (n=49), breast cancer (n=40) and multiple myeloma (n=26). Of the total of patients, 27 had symptoms related to neurotoxicity (18%). The majority of them were under oxaliplatin (n=17) and had paresthesia, pain and inability to touch cold objects. In the paclitaxel group, 7 patients had paresthesia and pain. In the bortezomib group (n=3), patients had paresthesia, pain and imbalance in gait. Conclusions Although CIPN is a common side effect of cancer treatment, the low prevalence in this study may be underestimated. Formation and training

Introduction RPLS is a clinicoradiographic entity of encephalopathy, seizures and neurologic symptoms with characteristic neuroimaging demonstrating lesions with posterior and white matter predominance and may be associated with chemotherapy agents. Objectives The purpose of this report is to document a rare case of RPLS during zivaflibercept treatment in colorectal cancer. Methods A 79-year old man with metastatic colon adenocarcinoma under second line treatment with FOLFIRI + ziv-aflibercept since february 2016 presents in November 2016 with acute-subacute onset of language impairment, followed by temporospatial disorientation and visual hallucinations. This picture did not coincide with fever or change in medical treatments. Complementary studies were done ruling out isquemic, progressive metastatic disease or eplileptiform activity. The MRI findings described diffuse and asymmetric cortical and subcortical lesions that support RPLS. The patient experienced resolution of the neurologic symptoms and was discharged 10 days later. Two months later follow up imaging experienced partial resolution. It is planed to rechallenge fluoropirimidines but not ziv-aflibercept. Results In a review of the literature, a meta-analysis of safety data from three large placebo-controlled studies reported no RPLS among 1333 patients treated with ziv-aflibercept in combination with standard chemotherapy (Allegra et al, 2012). High rate of RPLS cases had been observed in combination with cisplatin/pemetrexed treatment in lung cancer patients reason why this combination is not recommended (Chen H, 2014). Conclusions Our patient’s diagnosis of RPLS secondary to ziv-aflibercept treatment in colorectal cancer represents a rare incidence with only a few reported cases in the literature. Physicians should be aware of this adverse event.

eP209 A S E R I E R E P O RT O F F L U O R O U R A C I L I N D U C E D ENCEPHALOPATHY J. Konmun1, N. Likhitsakuochai1, N. Kongsuphon1, P. Tran2, T. Noramon1, S. Teerada1, R. Thanyanan1, S. Ekaphop1, N. Ngamphaiboon1 1 Faculty of Medicine- Ramathibodi hospital- Mahidol University, pharmacy, bangkok, Thailand 2 Walgreens Pharmacy, pharmacy department, Knoxville, USA Introduction Encephalopathy is rarely serious side effect related with 5-Fluorouracil. Pathophysiology is unclear. Manifestation included alteration of consciousness, confusion, and seizure.

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Objectives We reported a 10-case serie of 5-FU induced encephalopathy. Methods This is a retrospective report were reviewed between January 2015 to January 2017 from medical record. Results Patient Characteristic Ten patients developed 5-FU induced encephalopathy in hospital. Seven patients received mFOLFOX6 regimen and 3 patients received cisplatin plus 5-fluorouracil regimen. All patients were naïve for 5-FU treatment. Four patients presented with severe neurological symptoms such as status epilepticus, left hemiparesis or lost of consciousness. All patients developed wide gap acidosis (median anion gap = 20.93 mmol/L) with declining of kidney function. Median time presenting symptoms was 2 days. At the time of presenting symptom, 7 out of 10 patients developed hyperammonemia (median NH3 = 252 mmol/L ) normal thiamine level in 2 patients. All patients completely recovered in 1 day. Eight patients were treated with thiamine injection and 5 patients treated with lactulose. Ammonia level was decreased to normal level at the time of recovery. Rechallenging 5-FU was performed in 5 patients, only one patient had the recurrent symptoms, then the physicians decided to change the chemotherapy regimen afterward. Three patients had the MRI brain scan showed the characteristics of encephalopathy. Conclusions This is a huge serie report of 5-FU induced encephalopathy. Hyperammonemia, wide gap acidosis, and declining of kidney function in every patient which might happen from abnormal drug metabolism. Polymorphisms of drug transporter genes needed to be explored.

eP210 OXI LAPL AT IN A ND CAP ECI TAB IN E PE RIPHE RAL NEUROPATY: MECHANISM OF NEUROTOXICITY AND APPROACH TO PREVENTION S. Kuznecovs1, G. Kuznecova1 1 Institute of Preventive Medicine, Supportive Care, Riga, Latvia Introduction Palliative multiple course with oxilaplatin and capecitabine is an often cause of neurotoxicity. Peripherial neuropaties become chronic in 1520% of cancer patients. The mechanism of this irreversible process and its prevention remains unclear. Objectives The aim of the present study is to investigate the effect of Polyprenol (PP), which provides a dolichol phosphate (DolP) substitute in N-glycosylation of E-cadherin and myelination process control. Methods Oxilaplatin and capecitabine chronic neurotoxicity was reproduced in a rat model. E-cadherin expression was examined in sciatic nerve. PP concentration in the culture medium made up 10-2 -10-6. Immunohistochemical methods were used to detect the changes in the expression levels of Ecadherin. Intermediates of Dolichyl Phosphate Cycle (DPC) fractions were analysed by HPLC method. Results Neurotoxicity process causes DolP and E-cadherin drop in Schwann cells (SC). SC differ from normal one in E-cadherin content lost by 3-4 times. Pathologic process causes abberant N-glycosylation of E-cadherin in DPC. Roentgenostructural analysis displayed the change in the conformation of myeline proteins, the biolayer geometry and its added accessibility for protease action. Treatment of SC with PP in the concentration 10-4 M leads to regulation of E-cadherin N-glycosylation in SC and start of remyelination process Conclusions Oxilaplatin and capecitabine neurotoxicity could cause dysregulation of N-glycosylation of E-cadherin which lead to lost of the initial contact

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between a myelinating SC and axons affecting the stability of tight assembly. The findings indicate that mechanism of chronic oxilaplatin neurotoxicity exhibit demyelinating form of neuropathy, which could be managed by E-cadherin loss prevention with PP.

eP211 SPINAL CORD COMPRESSION ASSOCIATED TO METASTATIC PROSTATE CANCER M. Miguens1, F. Ferreira1, M. Mariana1, J. Santos2, J. Marques1, M. Ana1 1 Hospital de São Francisco Xavier - Centro Hospitalar de Lisboa Ocidental, Medical Oncology, Lisboa, Portugal 2 Hospital de Egas Moniz - Centro Hospitalar de Lisboa Ocidental, Urology, Lisboa, Portugal Introduction In Europe, prostate cancer is the leading cause of cancer among men. 90% of patients with metastatic prostate cancer (MPC) present bone metastasis, responsible for increased morbidity and mortality. Among skeletalrelated events, spinal cord compression (SCC) is the most dramatic for its often irreversible consequences, being therefore desirable to establish an appropriate preventive strategy. Objectives To assess the impact, clinical presentation, diagnostic method and therapeutic approach of MPC patients presented with SCC. Methods A retrospective and observational study, performed in an Oncology Department, identified the cases of SCC in patients with MPC, over a 5-year period. Results Of 106 patients with MPC admitted to an Oncology Department over that period, 5 were diagnosed with SCC. All them had castration-resistant tumors and presented a known vertebral metastasis. The time elapsed between bone metastasis diagnosis and the occurrence of SCC ranged 5-29 months (average 17 ± 10.1 months). The diagnosis was confirmed through magnetic resonance imaging (MRI) in all patients. Thereafter, 3 patients received radiotherapy and 2 undergone laminectomy and radiotherapy. The time interval elapsed since the occurrence of SCC until death ranged 1-15 months (average 5.2 ± 5.7 months). Conclusions SCC was diagnosed in 4.7% of the population surveyed, comparable with published data. In most cases, diagnosis is only made at a late stage, following the establishment of neurological deficits. Beyond the administration of osteoclast-targeted agents, a spine MRI may be considered to all patients with known vertebral metastasis, to allow establishing a preventive therapeutic strategy of this dramatic complication.

eP212 IMPACT OF PERIPHERAL NEUROPATHY ON PATIENTS R E C E I V I N G T A X A N E A N D P L AT I N U M B A S E D C H E M O T H E R A P Y: A L O N G I T U D I N A L S T U D Y O F PREVALENCE, QUALITY OF LIFE, AND METHODS OF ASSESSMENT A. Molassiotis1, H. Cheng1, J. Au2, V. Lopez3, K. Leung2, A. Chan4, K. Wong2, Y. Li2, J. Yorke5, T. Ng4, R. Sundar6 1 The Hong Kong Polytechnic University, School of Nursing, Hong Kong, Hong Kong S.A.R. 2 Queen Elisabeth Hospital, Department of Oncology, Hong Kong, Hong Kong S.A.R. 3 National University of Singapore, Alice Lee Centre for Nursing Studies, Singapore, Singapore 4 National University of Singapore, Department of Pharmacy, Singapore, Singapore

Support Care Cancer (2017) 25 (Suppl 2):S21–S266 5 The University of Manchester, Divison of Nursing- Midwifery & Social Work, Manchester, United Kingdom 6 National University Health System, Department of HaematologyOncology, Singapore, Singapore

Introduction Chemotherapy-induced peripheral neuropathy (CIPN) is a common doselimiting toxicity. Its prevalence and impact on quality-of-life (QOL) has variable documentation in the literature, due to differing assessment modalities utilized. Objectives To systematically determine the incidence, severity and natural history of CIPN with neurotoxic chemotherapy agents, and its impact on QOL. Methods Prospective longitudinal study including patients commencing on taxane or platinum-based therapy, with assessment time-points at baseline, end of each chemotherapy cycle, and 6, 9 and 12-months. Assessments of neuropathy included: sensory assessment using 10gr monofilament and cotton wool, clinician neuropathy grading systems: WHO scale(1-item) and NCI-CTCAE(2-items), and FACT&GOG-Ntx scale. Results In total, 348 patients were recruited to undergo up to 10 assessments over 12 months from three centres in Hong Kong (n=215), Singapore (n=95) and UK (n=38). Participants received taxanes (n=157;46%), platinum (n=111;32%) or a combination of both (n=78;22%). CIPN demonstrated cumulative increase through the chemotherapy cycles and reached a peak at 6 months. Each assessment method showed different CIPN incidence (highest being through WHO scale at month 6 (10.1%)). Taxanes had the highest incidence of CIPN (16% @6-months, 12.1% @12-months), while platinum had the least (2.7% @6-months, 4.5% @12-months). Sensory abnormalities were as common as motor disturbance, with QOL being significantly affected (p=0.48 to <0.001 for different domains at 6-months, 9-months, 12-months assessment). Conclusions CIPN is common with taxane/platinum chemotherapy although less prevalent in this largely Asian population compared to past studies involving predominantly Caucasians. Current assessment methods are suboptimal and often limited only to sensory problems, while motor disturbances receive less attention.

eP213 EFFICACY OF CONTROLLED-RELEASE OXYCODONE FOR OXALIPLATIN-INDUCED PERIPHERAL NEUROPATHY IN ADVANCED COLORECTAL CANCER PATIENTS M. Nagashima1, A. Hiranuma1, T. Oshiro1, T. Nabekura1, K. Kadoya1, K. Kawamitsu1, A. Sato1, T. Kitahara1, T. Urita1, Y. Yoshida1, H. Tanaka1, S. Okazumi1, R. Katoh1 1 Toho University Sakura Medical Center, Department of Surgery, Sakura, Japan Introduction FOLFOX is widely used to treat patients with advanced colorectal cancer (CRC). However, dose-limiting toxicity after continuous oxaliplatin administration can lead to peripheral neuropathy. Several agents, including opioids, that have been employed to treat oxaliplatin-induced peripheral neuropathy (OIPN) have been examined in clinical settings regarding their protective and therapeutic effects. Objectives We investigated the efficacy and tolerability of oxycodone for OIPN and subsequently with FOLFOX therapy in CRC patients. Methods Controlled-release (CR) oxycodone was concomitantly administered to 29 patients (OXY group), whereas the additional 35 patients (non-OXY group) were not given oxycodone during the FOLFOX treatment course.

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The incidence and severity of OIPN and the number of FOLFOX cycles were measured. Neurological toxicities were assessed according to the Common Terminology Criteria for Advanced Events. Results Most patients experienced grade 1 or 2 sensory neuropathy. Grade 3 sensory neuropathy was observed in two patients in the non-OXY group. All patients in the OXY group completed the scheduled FOLFOX therapy, whereas FOLFOX therapy was discontinued in ten patients in the non-OXY group due to severe peripheral neuropathy. The median numbers of FOLFOX cycles in the OXYand non-OXY groups were 13 and 7, respectively (P < 0.05). The median cumulative oxaliplatin doses were 1072.3 mg/m2 in the OXY group and 483.0 mg/m2 in the non-OXY group (P < 0.05). Overall survival was longer among patients in OXY group (49 months vs. 35 months, P=0.14). Conclusions Our findings indicate that CR oxycodone might attenuate the severity of OIPN and extend the use of FOLFOX therapy.

eP214 CANCER RELATED INSOMNIA AND WIRELESS TECHNOLOGY: A FEASIBILITY STUDY B. O'Connor1, P. Ui Dhuibhir1, S. Higgins2, L. Balding2, N. O'Leary2, D. Walsh3,4 1 Our Lady's Hospice & Care Services, Academic Department of Palliative Medicine, Dublin, Ireland 2 Our Lady's Hospice & Care Services, Department of Palliative Medicine, Dublin, Ireland 3 Levine Cancer Institute, Department of Supportive Oncology, Charlotte, USA 4 Carolinas HealthCare System, Professor of Medicine, Charlotte, USA Introduction Cancer related insomnia (CRI): difficulty with sleep onset, maintenance or non-restorative sleep. Prevalence is 19-95%. Consequences include cognitive dysfunction and fatigue. CRI remains under-investigated as objective assessment required specialised laboratories. Mobile technology may provide a solution. Objectives 1. Determine feasibility and acceptability of a wireless bedside sleep monitor to evaluate CRI 2. Correlate objective device results with subjective diary reports Methods A prospective observational study recruited 10 consecutive hospice inpatients (IP) and 20 consecutive community participants (CP) with cancer. Participants used a wireless bedside monitor (SleepMinderTM [ResMed Sensor Technologies Ltd, Dublin]) for 3 consecutive nights. Three insomnia features were examined (sleep onset, maintenance, early awakening). Daily sleep diary was completed and compared to monitor sleep/activity results. Acceptability questionnaires were completed by patient, nurse and family. Results Device successfully recorded sleep patterns in all participants. No technical difficulties experienced. IP: Mean age 63 +/- 9 years. 7/10 had one or more objective insomnia features. Delayed sleep onset was most common (7/10). CP: Mean age 64 +/- 10 years. 15/20 had one or more insomnia features. Poor maintenance was most common (14/20 awake >30 minutes overnight). Diary-monitor comparison: moderate (50-75%) agreement in IP but poor (<50%) in CP as diary often retrospectively completed. All cohorts reported high (100%) device acceptability. Conclusions 1. A wireless bedside monitor effectively measured CRI in inpatient and outpatient settings without a sleep laboratory

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2. High reliability and acceptability supports routine clinical use 3. Subjective reports correlated poorly with objective measurement 4. Concurrent sleep diary and monitor use recommended for comprehensive assessment

eP215 MALIGNANT SPINAL CORD COMPRESSION IN METASTATIC PROSTATE CANCER PATIENTS: REALWORLD DATA FROM A SINGLE CANCER CENTRE N. Tsoukalas1, C. Nikolaou1, I. Binas1, A. Dudek1, A. Pouptsis1, D. Enting1, S. Chowdhury1, S. Rudman1 1 Guy's and St Thomas' NHS Foundation Trust, Oncology, London, United Kingdom Introduction Malignant spinal cord compression (mSCC) in prostate cancer patients is a significant problem. Clinically evident mSCC develops in approximately 10%. Objectives To evaluate the incidence of mSCC in prostate cancer patients deemed to be at high risk due to metastatic bone disease. Methods We have retrospectively reviewed all prostate cancer patients seen during a period of 6 months and have assessed the extent of bone disease based on EOD scoring system, presence of neurological symptoms and MRI spine scans. Statistical analysis used SPSS software. Results In total 375 prostate cancer patients were reviewed, with 59 found to be at high risk of mSCC based on the EOD scoring system (EOD ≥ 2). In particular, 54 patients with EOD=2, 3 with EOD=3 and 2 with EOD=4. 24 out of 59 (40,68%) had neurological symptoms such as weakness, numbness, sensory changes or back pain. Overall, 37 out of 59 (62,71%) underwent an MRI spine scan which was positive in 6 cases (10,17%) and with impending mSCC in 6 (10,17%). MRI scan was positive in 4 patients with EOD=2 (3 with neurological symptoms) and in 2 with EOD=3 (without symptoms). Moreover, in cases of impending mSCC 5 patients had EOD=2 (3 with neurological symptoms) and 1 had EOD=4 and neurological symptoms. Interestingly, MRI scan was negative in 17 (28,81%) patients with neurological symptoms and EOD=2. Conclusions mSCC is associated with significant morbidity and early detection is desirable. MRI spine scans in patients with high EOD may identify clinically important impending cord compression which should be proactively treated.

eP216 THE EFFECT OF CHEMOTHERAPY-INDUCED NEUROPATHY SYMPTOMS ON PHYSICAL FUNCTION AND RISK OF FALLS I N C A N C E R PAT I E N T S R E C E I V E D N E U R O T O X I C CHEMOTHERAPY P. Wang1, G. Abrams2 1 University of California- San Francisco, Department of Epidemiology and Biostatistics, San Francisco, USA 2 University of California- San Francisco, Department of Neurology, San Francisco, USA Introduction Chemotherapy-Induced Neuropathy (CIN) is a common adverse effect due to cancer treatment. Sensory and motor symptoms of CIN caused balance impairments and postural instability, however, the health outcomes of physical function and falls are not well studied.

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Objectives We quantified the effect of CIN symptoms on the occurrence of falls in patients received taxanes, platinum compounds or both, and compared physical function between patients with and without CIN. Methods The occurrence of falls, physical function, and psychological function were compared between patients with and without CIN. Adjusted logistic models were used to determine CIN symptoms that associated with falls. Results Of the total 383 participants, 86.2% of participants developed CIN. For physical function, CIN patients had a lower score (33.1±6.8 vs. 35.2±6.0; p=0.02) assessed by Fullerton Advanced Balance (FAB) Scale, and a longer time (8.0±2.6 vs. 6.8±1.8; p<0.001) measured by the Timed Up and Go (TUG) test. 53.5% of patients reported falls since starting neurotoxic chemotherapy. The increased number (OR=1.74, 95%CI: 1.541.97) and each of CIN symptoms including numbness (OR=6.44, 95%CI: 3.42-12.14), tingling (OR=3.63, 95%CI: 2.04-6.46), sensitivity to cold temperatures (OR=2.19, 95%CI: 1.33-3.60), nerve pain (OR=2.01, 95%CI: 1.25-3.26), muscle/joint aches (OR=2.95, 95%CI: 1.79-4.87), muscle weakness (OR=7.72, 95%CI: 4.52-13.16) are significantly associated with falls. Conclusions Patients received neurotoxic chemotherapy in this cohort had normal physical functions assessed by clinical measurements. But CIN symptoms were significantly associated with higher risks of falls, which addresses the importance of assessing CIN and other cancer-related symptoms early to prevent falls and ensure patients' safety.

eP217 COMPARISON OF THE SIDE EFFECTS OF SPLIT-COURSE AND STANDARD RADIOTHERAPY ON PATIENTS WITH STAGE IIIA-IIIB LUNG CANCER A. Aksu1, Y. Pak2, F. Goksel3, M. Akmansu2 1 ada radiotherapy center, Radiation Oncology, Ordu, Turkey 2 Gazi University, Radiation Oncology, ANKARA, Turkey 3 Abdurrahman Yurtaslan Ankara Oncology Hospital, Radiation Oncology, Ankara, Turkey Introduction Considering the rapid proliferation of the lung cancer, delivery of a high dose of radiotherapy within a relatively short period increases the tumor control. At the same time, for years, a method within RT courses is being investigated, that would also decrease radiotherapy toxicity. Objectives The aim of this study is to compare the results of treatment response, survival results and side-effects between split-course radiotherapy (SCRT) and standard radiotherapy (STRT) in patients with stage IIIA IIIB lung tumor. Methods Between January 2004 and March 2005, 59 patients who had radiotherapy with a diagnosis of stage IIIA and IIIB lung cancer were retrospectively reviewed. Twenty-nine patients had SCRT, whereas 30 patients was studied after STRT. Mean follow-up period was 22.6 months. Results There was no difference between two groups in overall survival(15.0 months vs 12.8 months, p:0.97) and disease-free survival(7.7 months vs 6.6 months, p:0.83). Response to treatment (complete response) was observed in 27.5%(n=6) of the patients in SCRT arm, whereas it was observed in 56.5%(n=13) of the patients in STRT group, p:0.046.Patient performance status was worse in the SCRT arm (p:0.01). Grade 2-3 leucopenia was more frequent in the STRT group, p:0.046.The rate of dysphagia was found to be similar in both groups (p:0.94)

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Conclusions The effects of SCRT and STRT on the survival were similar at stage IIIAIIIB lung cancer. STRT was observed to be more potent when tumor response to treatment is considered but side effects such as leukopenia are seen more frequently in the STRT arm. The rate of disphagia is similar in both groups.

eP218 COMPARATIVE COST-EFFICIENCY OF FILGRASTIM, BIOSIMILAR FILGRASTIM-SNDZ, AND PEGFILGRASTIM FOR THE PROPHYLAXIS OF CHEMOTHERAPY-INDUCED (FEBRILE) NEUTROPENIA (CIN/FN) IN THE US S. Balu1, A. McBride2, K. Campbell3, M. Bikkina4, K. MacDonald5, I. Abraham5 1 Sandoz Inc., US Medical Affairs, 08540, USA 2 University of Arizona Cancer Center, Supportive Oncology, Tucson, USA 3 Sandoz Inc., US Medical Affairs, Tucson, USA 4 Sandoz Inc., US Medical Affairs, Princeton, USA 5 Matrix45- LLC, Health Economics, Tucson, USA Introduction Guidelines recommend CIN/FN prophylaxis with granulocyte colonystimulating factor (G-CSF) based on chemotherapy myelotoxicity and patient-related risk factors. Objectives To conduct a cost-efficiency analysis of the direct acquisition and administration costs of reference filgrastim (Neupogen®), biosimilar filgrastimsndz (Zarxio® EP2006), pegfilgrastim (Neulasta®), and pegfilgrastim injection device (Neulasta/Onpro®) for CIN/FN prophylaxis. Methods Cost-efficiency analysis of prophylacting one patient during one chemotherapy cycle under 1–14 days time horizon using the unit dose average selling price (ASP) and wholesale acquisition cost (WAC) and Current Procedural Terminology (CPT) codes for subcutaneous prophylactic injection. Results Using ASP+CPT, cost savings achieved with Zarxio® relative to Neupogen® ranged from $38.79 (1d) to $543.03 (14d); relative to Neulasta ® from $3,516.14 (1d) to $67.46 (13d); and relative to Neulasta/Onpro® $3,499.27 (1d) to $50.59 (13d). At no point over a 14-day prophylaxis period did daily Neupogen® yield a savings advantage over Zarxio®. Using WAC+CPT, cost savings of Zarxio® were greater: from $48.64 (1d) to $680.96 (14d) vs Neupogen®; $4,879.99 (1d) to $746.38 (14d) vs Neulasta®; and $4,863.12 (1d) to $729.51 (14d) vs Neulasta/Onpro®. Conclusions CIN/FN prophylaxis with Zarxio® is cost-efficient under all analyzed scenarios relative to Neupogen® and through day 13 (per ASP+CPT) and day 14 (per WAC+CPT) versus Neulasta® and Neulasta/Onpro®. In the absence of convincing evidence that pegfilgrastim is superior in efficacy to reference filgrastim, there is no cost-efficiency rationale to prophylactically use Neulasta® or Neulasta/ Onpro® over Zarxio®. Considering that routine clinical practice with filgrastim is <14d, Zarxio® offers a more cost-efficient GCSF support strategy.

eP219 SUPPORTIVE THERAPY IN MALIGNANT LYMPHOMA (ML) AND MULTIPLE MYELOMA (MM) A. Dimitrovska1, S. Crvenkova1, L. Milanova1 1 Institute of Radiotherapy and Oncology, Lymphoma and Sarcoma, Skopje, FYR Macedonia

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Introduction The management of disease and therapy-related complications in ML and MM became more important in recent decades due to improvement in treatment and prolonged survival. Objectives To examine the impact of supportive therapy on the performance status and treatment outcome of patients (pts) suffering from ML and MM. Methods Histories of 286 pts with ML and 124 pts with symptomatic MM were retrospectively reviewed. Clinical signs, radiological and laboratory findings and the kind of supportive therapy were analyzed. Results Anemia was the most common finding in ML followed by abnormal liver function (7%) and renal impairment (5%). Nausea, vomiting and myelotoxicity were the most common therapy associated side effects. Emesis was successfully managed with 5-HT3 receptor antagonists plus dexamethasone in 86% of pts. Colony-stimulating factors could effectively reduce neutropenia. Anemia due to anti-tumor therapy appeared in 38% (109/286) of pts with ML and in 65% (81/124) pts with MM. Hemoglobin level was less than 8g/dl in 2% (ML) and 7% (MM). After erythropoietin treatment a response rate of 72% (78/109 ML) and 77% (62/81 MM) was recorded. Osteolytic bone destructions in MM were treated with bisphosphonates, radiotherapy or surgery and 78% responded well. RT and/or surgery ensured good palliation and relieved the pain in 85% of pts. Renal impairment, seen in 37% of pts with MM was reversible in 75% (34/46) after administration of i.v. fluids and CT. Conclusions Our results confirmed that efficient management of disease and therapyinduced complications in ML and MM improve patients’ well being and probably prolong the survival rate.

eP220 ENSURING THE RIGHT NEUTROPENIC SEPSIS CULTURE – A RETROSPECTIVE REVIEW OF A CANCER CENTRE’S MICROBIOLOGICAL CULTURE PRACTICE AND RESULTS FOR SOLID TUMOUR PATIENTS C. Forde1, C. Curry1, C. Forde2, P. Scullin1, V. Coyle1 1 Belfast City Hospital, Cancer Centre, Belfast, United Kingdom 2 Belfast Health and Social Care Trust, General medicine, Belfast, United Kingdom Introduction Accurate identification of a causative agent and source of infection remains a priority in initial neutropenic sepsis (NS) management to deliver optimal targeted antibiotic therapy. Agreement exists on the importance of taking blood cultures (both peripherally and from indwelling lines) as well as obtaining samples from sites of suspected infection. Objectives Assess rates of obtaining microbiological samples in solid tumour NS patients, determining the frequency of positive culture results. Methods Retrospective review of consecutive solid tumour patients treated for NS in the Northern Ireland cancer centre from January 2015 – November 2016. Results 185 episodes of NS in 171 patients were reviewed (69% female, mean age 54 years). Common tumour sites were breast (47%) and lung (11%) with 56% receiving radical or adjuvant treatments. In 177 episodes (96%) blood cultures were taken. In 24 episodes (14%) blood cultures were positive. 16 (9%) were felt to be clinically significant with nine gram positive and seven gram negative isolates. In 94% of episodes at least one or more other microbiological sample was also sent.

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There was a limited yield of organisms for which our empirical antibiotic regimens would not have been adequate treatment for. In seven episodes intensive care support was required and four patients died of NS. Conclusions High rates of microbiological samples were cultured in NS patients, with limited identification of causative organisms. Continuing to promote early blood culture sampling remains a priority, with opportunity to reduce contamination rates and rationalise other microbiological sampling and investigations to where there is clinical suspicion of a suspected source.

eP221 CHOOSING WISELY: REVIEW OF PROPHYLACTIC WHITE BLOOD CELL GROWTH FACTOR USE IN A REGIONAL UK CANCER CENTRE C. Forde1, C. Forde2, P. Scullin1, V. Coyle1 1 Belfast City Hospital, Cancer Centre, Belfast, United Kingdom 2 Belfast Health and Social Care Trust, General Medicine, Belfast, United Kingdom Introduction Multiple factors are contributing to a reduction in neutropenic sepsis (NS) incidence, including increased use of prophylactic antibiotics and white blood cell (WBC) growth factors. WBC growth factors reduce duration and severity of neutropenia, risk of hospitalisation and infection, facilitating delivery of more intensive chemotherapy when required for patient management. There is however an associated cost, an unclear effect on all cause or infection related mortality and significant rates of complicating bone pain sometimes requiring opioid analgesia. Objectives Review prophylactic WBC growth factor administration against regional guidelines, based on international guidance, to ensure appropriate use. Methods Retrospective review of WBC growth factor use, over a four month period in 2016, in a regional UK cancer centre. Results 153 patients received pegfilgrastim prophylaxis, with 78% administered in accordance with regional guidelines. The most commonly represented tumour sites were gynaecology (35%), breast (33%) and gastrointestinal (13%). 45(29%) documented bone pain toxicity secondary to growth factor use (93% Grade I/II). 29/45 receiving taxane containing regimes, with chemotherapy also however likely contributing.

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Conclusions Majority of growth factor use was appropriate and compliant with regional guidance although variability in clinician practice was noted. Instances detected of weak rationale for commencing primary prophylaxis and use of secondary prophylaxis with palliative patients where a dose reduction may have been more appropriate. Associated bone pain appears not an insignificant problem but generally manageable. Review of WBC growth factor administration helps prevents overuse and ensures evidence based practice. Optimising tools to better individualise patients’ NS risk should continue to be prioritised.

eP222 EFFECTIVENESS AND SAFETY MANAGEMENT OF DOSEDENSE ANTHRACYCLINE AND CYCLOPHOSPHAMIDE (DDAC) WITH PEGFILGRASTIM FOR JAPANESE BREAST CANCER PATIENTS Y. Kikuchi1, T. Wakeda1, T. Niwa1, K. Nishioka1, K. Tada1 1 Tokyo Univesity, Breast and Endocrine Surgery, Tokyo, Japan Introduction Chemotherapy induced febrile neutropenia (FN) causes not only increase of infection risk, but also reduction of relative dose intensity (RDI) in chemotherapy effects. Objectives From November, 2014, the use of pegfilgrastim in dose dense chemotherapy for breast cancer patients has approved in Japan. Our institute started to use pegfilgrastim from January, 2015. We examined effectiveness and safety management of ddAC with pegfilgrastim. Methods From January 30th, 2015 to January 30th, 2017, 26 breast cancer patient’s ddAC with pegfilgrastim. We examined their cancer subtypes, age, RDI, tumor reduction effect, side effects, WBC counts during the chemotherapy. Results Eighteen patients received ddAC as neo adjuvant chemotherapy (NAC), and eight patients received as adjuvant therapy. Median age was 48.9 years old, 19 patients had ER positive, 15 patients had PgR positive, and 5 patients had triple negative type. 21 patients had lymph node metastasis. In neo adjuvant chemotherapy patients, 14 patients showed tumor reduction. Three patients extended in NAC, although RDI was good at 0.85. There were 4 patients of nausea, 4 of fever, 5 of back pain or arthralgia. No patients had FN, on the other hand, 9 patients had leucocytosis. Conclusions Dose dense AC with pegfilgrastim was thought to be well tolerated regimen without serious adverse events. Among NAC patients, 14 showed tumor shrinkage effects. During the course of treatment, no patients had FN, but some patients had symptoms of arthralgia who had leukocytosis. It was suggested that the administration timing of pegfilgsrastim was affected.

eP223 UPFRONT USE OF SUCROSOMIAL IRON PREVENTS TRANSFUSIONS IN CANCER PATIENTS ON CHEMOTHERAPY S. Barni1, V. Lonati1, M. Ghilardi1, K.F. Borgonovo1, M. Cabiddu1, A. Astori1, G. Tarantino2, F. Petrelli1 1 ASST Bergamo Ovest, Oncology, Treviglio, Italy 2 Pharmanutra S.p.A., Scientific Direction, Pisa, Italy Introduction Anemia is a cancer-related condition and associated with antineoplastic treatments. It’s management is based on iron prescription plus or minus

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erythropoiesis stimulating agents (ESAs) according to Hb value, with red blood cell transfusions (RBCT) deserved only for severe anemia due to potential detrimental effect in cancer patients. Sucrose and phospholipidsbased iron capsules (Sideral forte ®) appears significantly more bioavailable than other oral formulations with better tolerability. Objectives We started a prospective study to evaluate the effects of administration of sucrosomial iron 30 mg/day on Hb levels (preventing fall to <10 g/dL and use of ESAs or transfusions) in cancer patients starting chemotherapy with Hb values 10-12 g/dL. Methods Patients with solid tumors starting chemotherapy with mild baseline anemia (Hb level 10-12 g/dL and transferrin saturation (TSAT) 15-50%), were included. Treatment continued for 3 months. Iron parameters were checked at 6 and 12 weeks. Results Up to January 2017 16 patients were enrolled in our division. In n=3 cases, treatment lasted < 12 weeks. At baseline, medium Hb level was 11.18 g/dL. After 6 and 12 weeks (in n=12 pts with both data evaluable), medium Hb levels were 10.9 g/dL. TSAT increased from 13.45 to 20.1 and 20.6% at 6 and 12 weeks. No patient was transfused or received ESAs. Conclusions In a series of 16 patients with baseline mild anemia, intake of sucrosomial iron for 3 months maintained Hb level and avoided ESAs or RBCTs. Its use could be considered as a supportive measure in cancer patients treated with chemotherapy.

eP224 HEMOTRANSFUSIONS IN OUR OUTPATIENT SUPPORTIVE CARE SERVICE (OSCS): CLINICAL AND ECONOMICAL IMPACTS A. Sbrana1, G. Musettini1, A. Farnesi1, E. Biasco1, F. Paolieri1, L. Galli1, I.M. Brunetti1, E. Vasile1, S. Ricci1, A. Falcone1, A. Antonuzzo1 1 Azienda Ospedaliero-Universitaria Pisana, Oncologia Medica, Pisa, Italy Introduction Anemia is a frequent event in oncological patients, both on active treatment and in best supportive care. These patients often require hemotransfusions. Several settings are available for such therapy and an outpatient supportive care service (OSCS) can offer different advantages. Objectives We wanted to highlight the economical and clinical advantages in performing hemotransfusions in an OSCS rather than in emergency rooms (ERs) or inpatient medical wards. Methods We retrospectively collected data of patients treated with hemotrasfusions in our OSCS (Hospital S. Chiara, Pisa, Italy) from January until December 2016, analysed the related costs and compared them to an hypothetical scenario where these patients are treated in ERs and hospital medical wards. Results 125 patients accessed our OSCS to receive hemotrasfusions and 215 red cell concentrates (RCCs) were administered the same day the patients access our OSCS. The cost per administered RCC in our OSCS was 373€, leading to a total cost of 80,195 €. A single RCC administered in an ER setting costs 900€, so the total cost would have been of 193.500€. If we consider an inpatient medical ward, the total cost would have been 129,000€ (that is, 600€ per unit). Finally, the same activity in an Emergency Medicine Unit would have brought to a total cost of 258,000€ (namely, 1,200€ per unit). Conclusions Not only does the administration of RCCs in an OSCS offer the patients a better quality of life, avoiding useless waiting times in ERs and days of unplanned hospitalisations, but it is also cost-effective.

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eP225 IMPACT OF A NURSE-DRIVEN SEPSIS SCREENING PROTOCOL ON INCIDENCE OF SEVERE SEPSIS IN PATIENTS MANA GED WITHIN A HEMATOLOGY-ONCOLOGY AMBULATORY CLINIC B. Shelton1, S. Rutkowski2, J. Kane1 1 Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Oncology, Baltimore, USA 2 The Johns Hopkins University School of Nursing, Nursing, Baltimore, USA Introduction Severe sepsis occurs in 14-45% of patients with cancer admitted for possible infection. International sepsis best practices are established, but little evidence validates the impact of implementing these recommendations in cancer patients. Objectives A nurse-driven protocol for sepsis screening and initial diagnostic interventions was instituted in 2014 for patients managed in a hematologiconcology specialty clinic. This IRB-approved quality improvement project aimed to evaluate fidelity to protocol interventions and incidence of severe sepsis following protocol implementation. Methods Data were analyzed from randomly selected infection-related admissions from clinic at baseline and following protocol implementation. Variables included host characteristics, oncologic treatment, infectious risks and symptoms, organ dysfunction, intervention completeness, and outcomes. Descriptive statistics were used to compare groups. Incidence of severe sepsis was the outcome variable of interest. Results All patients were undergoing active treatment, and admitted to the hospital for possible infection. Group tests for equality showed more neutropenia (p= .000) in the baseline group and more concomitant steroids (p= .013) in the post-protocol group. Severe sepsis incidence was not statistically different; however, initial blood lactate was obtained once (2.6%) in the baseline population, and in 90% of the post-protocol group. After removing lactate from the severe sepsis definition, the incidence of severe sepsis reduced from 50% to 30% but was not statistically significant (p = 0.071). The incidence of sepsis-related hypotension was reduced from 38.5% to 12.5% (p = 0.023). Conclusions This protocol demonstrated that consistent screening and initial diagnostic testing for possible sepsis in patients with hematologic malignancy can lead to reduced infection-related hypotension.

eP226 NUTRITIONAL RISK IN ALLOGENEIC STEM CELL TRANSPLANTATION: RATIONALE FOR A TAILORED NUTRITIONAL PATHWAY T. Aoyama1, O. Imataki2, H. Arai3, K. Mori4, K. Omae4, K. Yoshitsugu5, M. Fukaya5, H. Shiozaki1, N. Katsumata1, M. Mori1, T. Kume6, K. Ishide7, T. Enami5, I. Shiki5, R. Tatara5, T. Ikeda5 1 Shizuoka Cancer Center, Nutrition, Shizuoka, Japan 2 Kagawa University Hospital, Hematology & Stem Cell Transplantation, Ikenobe, Japan 3 University of Shizuoka, Laboratory of Clinical Nutrition and Management Graduate School of Integrated Pharmaceutical and Nutritional Sciences, Suruga-ku, Japan 4 Shizuoka Cancer Center, Biostatistical Chief- Clinical Research Promotion Unit- Clinical Research Center, Shizuoka, Japan 5 Shizuoka Cancer Center, Hematology & Stem Cell Transplantation, Shizuoka, Japan 6 Shizuoka Cancer Center, Pharmacy, Shizuoka, Japan 7 Shizuoka Cancer Center, Nursing, Shizuoka, Japan

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Introduction Hematopoietic stem cell transplantation carries nutritional-related risks. Therefore, nutritional therapy needs to be initiated before transplantation even takes place. Objectives We assessed nutritional risk among patients who underwent allogeneic stem cell transplantation. Methods We assessed nutrient supply (calorie supply and protein supply) by chart review. Assessments were made from the pretreatment phase of transplantation to after the end of parenteral nutrition in 51 patients who underwent allogeneic stem cell transplantation at Shizuoka Cancer Center between 2007 and 2012. We compared nutrition-related adverse events and parameters between 2 groups: those in whom % loss of body weight was ≥ 7.5 and those in whom % loss of body weight was < 7.5. Results A correlation was observed between changes in weight and skeletal muscle mass (r = 0.89; P < 0.0001). A weak correlation was observed between % loss of body weight and nutrient supply of calories (r = 0.517; P = 0.0001). There were significant differences between the % loss of body weight ≥ 7.5 group and the % loss of body weight < 7.5 group in the following variables: % loss of body weight, nutrient supply from calories and protein; orally ingested nutrient supply from calories and protein; start day of oral intake; and acute graft-versus-host disease. Orally ingested calories were negatively correlated with nutrition-related adverse events in both groups. Conclusions Early and customized nutritional intervention may be optimal for all patients who undergo allogeneic stem cell transplantation to ameliorate body weight loss associated with nutrition-related adverse events.

eP227 THE EFFECT OF GINGER (ZINGIBER OFFICINALE ROSCOE) ON GASTRIC ACTIVITY, INFLAMMATORY MARKERS AND GHRELIN LEVELS IN PATIENTS WITH THE ANOREXIA CACHEXIA SYNDROME (ACS) R. Bhargava1, M. Chasen2, N. Mac Donald3 1 william Osler Health System, Corporate Research- Palliative Care, Brampton, Canada 2 william Osler Health System, Palliative Care, Brampton, Canada 3 McGill University, Oncology, Montreal, Canada Introduction Anorexia-cachexia syndrome (ACS) is defined by loss of weight, skeletal muscle mass and appetite. Ginger can affect gastric myoelectrical activity (GMA). Electrogastrography (EGG) records GMA. There is no data on pattern of GMA in response to Ginger in ACS. Objectives To determine: (1) effect of oral Ginger administration on GMA in patients with ACS (2) evaluate symptoms measured by Edmonton symptom assessment scale (ESAS), patient generated subjective global assessment form (PGSGA) and dyspepsia symptom severity index (DSSI) (3) correlate ginger administration with inflammatory markers and Ghrelin. Methods Patients with ACS were recruited to document a baseline and post water load EGG after oral ingestion of Ginger capsule (1650mg) once daily, for 14 days. DSSI, ESAS and PG-SGA were completed and blood test to measure Ghrelin and inflammatory markers was done pre and post intervention. Results Fifteen patients (8M;7F) with varying cancer diagnoses were enrolled. EGG diagnosis suggests that 9 out of 15 patients had direct improvement in their GMA. All showed statistically significant improvement in nausea (p<0.02), dysmotility-like symptoms (p<0.01) and reflux-like symptoms

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(p<0.01). Statistical significance was also noted on the total PGSGA score [10.5 vs. 8.17 (p<0.01)]. Ghrelin level 679.2 pg/ml vs. 752.2 pg/ ml (p=0.29); Albumin 43.3 g/L vs. 42.1 g/L (p=0.06) and CRP were 5.44 vs 6.3 mg/L (p=0.29). Conclusions Ginger may regulate GMA as measured by EGG. By regulating gastric motility, ginger may improve a range of GI symptoms in ACS that can significantly affect oral intake and quality of life.

eP228 A SYSTEMATIC REVIEW OF STUDIES OF BIOMARKERS IN CANCER ANOREXIA-CACHEXIA SYNDROME S. Cherkaoui1, S. Thirlwell2, D. Portman2, K.A. Donovan2 1 University of South Florida, Environmental and Occupational Health, Tampa, USA 2 H. Lee Moffitt Cancer Center, Supportive Care Medicine, Tampa, USA Introduction Cancer Anorexia Cachexia Syndrome (CACS) is a syndrome manifested by a group of symptoms including anorexia, weight loss, and muscle wasting. CACS is generally diagnosed based on anthropometric criteria, but biomarkers are increasingly being used. In the clinical setting, the measurement of blood-based biomarkers of CACS may facilitate diagnosis and development of effective interventions that can mitigate the impacts of this syndrome on cancer patients. Objectives To systematically review the empirical evidence for blood-based biomarkers that can detect CACS. Methods Forty-three articles from 1993 to October 2016 identified from MEDLINE were analyzed for potential blood-based biomarkers for CACS. Results Generally, the articles identified biomarkers related to the pathogenesis of CACS: inflammation (22 studies), fat metabolism (15 studies), and muscle metabolism (6 studies). Studies varied widely with respect to study purpose, design, and the nature and size of the samples included. Few studies used standard definitions of cachexia, anorexia or CACS, and few studies used adequate control groups. Conclusions Our systematic review suggests that specific biomarkers are useful and important indicators of CACS. Screening for biomarkers including CRP, IL-6, IL-1 beta, TNF-α, Leptin, ghrelin, Angiotensin II and neutrophilderived proteases, may help clinicians to help detect the presence of CACS and along with the other diagnostic criteria of the whole syndrome, may suggest CACS severity. Our findings also reveal opportunities to standardize research methodology for improved CACS biomarker characterization.

eP229 NUTRITIONAL STATUS EVALUATION IN OUR CLINICAL PRACTICE A. Farnesi1, G. Musettini1, A. Sbrana1, E. Biasco1, F. Paolieri1, N. Virgili1, I.M. Brunetti1, L. Galli1, E. Vasile1, S. Ricci1, A. Falcone1, M. Lacorte2, K. Nardi3, A. Antonuzzo1 1 Azienda Ospedaliero-Universitaria Pisana, Oncologia Medica, Pisa, Italy 2 Azienda Ospedaliero-Universitaria Pisana, Geriatria, Pisa, Italy 3 Azienda Ospedaliero-Universitaria Pisana, Servizio Dietetico, Pisa, Italy Introduction Malnutrition is one of the most frequent complication in patients (pts) with cancer, especially in head and neck and gastrointestinal ones.

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Objectives The aim of this retrospective study is to assess which kind of pts would benefit of an early nutritional assessment and therapy, based on our daily clinical practice. Methods We retrospectively collected data from September 2015 to October 2016 of 82 pts that come to our supportive care service for nutritionrelated problems. Pathological characteristics are summarized in Figure 1.

Each pt underwent physical evaluation and nutritional assessment, in particular BMI (body mass index), MUAC (middle upper arm circumference), weight reduction in the last 3-6 months, the capacity of oral intake, MUST score (malnutrition universal screening tool) and PEM (proteinenergy malnutrition) (Figure 2). After that pts were referred to a clinical nutritionist for appropriate supportive care.

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Introduction Cancer patients often suffer from Malnutrition which raises the risk of infections. Being immunocompromised, there is a marked reduction on quality of life (QoL) and health outcome. Malnutrition also enhances the incidence of postoperative complications such as delayed wound healing, wound dehiscence, morbidities and mortalities Objectives To investigate malnutrition among cancer patients and to assess the nutritional status of patients receiving chemotherapy. Methods The study was conducted in Sir Ganga Ram Hospital, Lahore. Simple screening tool (Short screening sheet) for malnutrition was used. Nutritional assessment of 80 patients receiving chemotherapy was done by assessing BMI, mid upper arm circumference MUAC, triceps skinfold thickness TST, serum albumin, Total lymphocytes count. Nitrogen Balance and intake of macronutrients were also analysed. Results According to full nutritional assessment, 42 patients (52.5%) out of 80 were found malnourished. Short screening sheet identified 51 patients as malnourished who were receiving chemotherapy. The SSM had a specificity of 0.88 and sensitivity of 0.72. 62% of the patients exhibited negative nitrogen balance. Conclusions Nutrition is the most neglected area of clinical care. Early nutritional support and counselling is essential in order to improve patients Quality of Life (QoL). Mass media should be involved so that adequate attention can be given to nutritional issues arising in diagnostic and therapeutic procedures.

eP231 IMPACT OF CANCER CACHEXIA ON SURVIVAL DURING C H E M O T H E R A P Y I N PAT I E N T S W I T H U P P E R GASTROINTESTINAL CANCER H. Goto1 1 Edogawa Hospital, Oncology & Hematology, Higashikoiwa- Edogawaku, Japan

Results In our series we found that pts affected by H&N and non colorectal GI (NCGI) cancer had more frequently MUST score ≥2, respectively 19.4% and 23.3 %. The same type of pts had a higher incidence of moderatesevere grade of MPE, respectively 23.2% and 24.4%. According to weight loss, we found that in the NCGI cancer group the largest part of pts had a weight loss ≥ 10% (19.6%) at baseline. Conclusions Considering our data, we observed that H&N and NCGI cancer pts have frequent occasional findings of moderate to severe nutritional deficiencies. We then strongly suggest a nutritional evaluation at baseline and periodically in this categories of pts.

eP230 INVESTIGATING MALNUTRITION AMONG CANCER PATIENTS RECEIVING CHEMOTHERAPY IN A TERTIARY CARE HOSPITAL OF PAKISTAN A. Fatima1, S. Zaidi2 1 , Lahore, Pakistan 2 WeCare, Research, Lahore, Pakistan

Introduction When cancer cachexia develops before chemotherapy, adverse events increase and treatment efficacy decreases. However, it is unknown if a similar correlation exists with the development of cachexia during treatment. Objectives To clarify the relationship between survival and nutritional deterioration and reduction in weight and/or skeletal muscle during chemotherapy. Methods We focused on upper gastrointestinal cancer among deceased patients who had received chemotherapy in our hospital in 2012– 2016. All data were obtained retrospectively from electronic medical records. Data regarding blood test results, patient background, and psoas major muscle area obtained from computed tomography images at the time of primary and secondary treatment were used for statistical analyses. Results We enrolled 66 cases. The rate of shift to secondary treatment was 39.4%. The group with secondary treatment significantly prolonged survival (P<0.001). The prognostic factors for secondary treatment were serum albumin (Alb) (hazard ratio, 0.32; 95% confidence interval [CI], 0.11–0.90, P=0.03) and body weight change during primary treatment (hazard ratio, 0.85; 95% CI, 0.75–0.96, P=0.007). The group with serum Alb level < 3 g/dL or body weight change < −5% had significantly worse outcomes (P<0.001). In addition, a strong correlation was found among body weight, serum Alb value, and psoas major muscle area.

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Conclusions Nutritional deterioration and weight loss during chemotherapy were correlated with poor outcomes. These results suggest a need for active nutritional support during treatment, before occurrence of refractory cachexia.

eP232 FACTORS EFFECTING HOSPITAL LENGTH OF STAY AND S U RV I VA L F O L L O W I N G P E LV I C E X E N T E R AT I O N SURGERY IN CANCER PATIENTS Y. Guo1, E. Chang2 1 University of Texas MD Anderson Cancer Center, PalliativeRehabilitation and Integrative Medicine, Houston, USA 2 Toronto Rehabilitation Institute 550 University Ave. 7-131-1, Physical Medicine and Rehabilitation, Toronto, Canada Introduction Total pelvic exenteration is performed in selected patients with locally advanced or recurrent pelvic malignances. Objectives To identify risk factors that prolonges hospital LOS and shortened 5-year survival in patients received pelvic exenteration. Methods Between 2002 and 2012, 100 patients undergoing pelvic exenteration for pelvic malignances were identified from a retrospective database. Clinical variables were collected as risk factors for prolonged hospital LOS and 5year survival. The risk factor were analyzed using univariate and multivariate regression. Results Among all the patients, 50% had gastrointestinal cancer, 14% genitourinary cancer, 31% gynecological malignance. Of 100 patients, 46 percent had previous radiotherapy. At the time of pelvic exenteration, 15 percent of patients received intraoperative radiation. Perioperative complications included infection (44 percent), pelvic abscess (6 percent), wound or flap dehiscence (11 percent), and ileus or bowel obstruction (30 percent). Mean hospital length of stay (LOS) for all patients was 18±11 (range, 3.2-105.6) days. On multivariate regression analysis, obese and underweight, sarcoma and genitourinary cancer, infection, anastomotic leak, rehabilitation consult and admission, 2 or more consultation were independent risk factors of prolonging hospital LOS (P < 0.05). Five-year survival was unfavorably associated with myocutaneous flap and postoperative wound dehiscence (P < 0.05). Conclusions Hospital LOS after total pelvic exenteration can be prolonged by many risk factors. Minimize some of the risk factors, such as underweight may improve hospital LOS. Future study is needed to understanding why myocutaneous flap and wound dehiscence affect long-term survival.

eP233 PRELIMINARY RESULTS OF A PILOT STUDY USING VA L I D AT E D N U T R I T I O N S C R E E N I N G T O O L S T O INVESTIGATE THE NUTRITION EVOLUTION OF PATIENTS WITH ACUTE MYELOID LEUKEMIA J. Heimgartner 1 , W. Hogan 2 , J. Vruwink 1 , M. McMahon 1 , A. Butterbrodt3, C. Diedrich3, M. Kunde3, K. Spencer3, F. Ottery4, H. Jager-Wittenaar4 1 Mayo Clinic, Endocrinology- Diabetes and Nutrition, Rochester, USA 2 Mayo Clinic, Hematology, Rochester, USA 3 Mayo Clinic, School of Health Sciences, Rochester, USA 4 Hanze University of Applied Sciences, Research Group Healthy AgeingAllied Health Care and Nursing-, Groningen, The Netherlands

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Introduction At Mayo Clinic, adult patients with Acute Myeloid Leukemia (AML) are treated in hospitalized inpatient, hospital-based outpatient, and traditional ambulatory outpatient settings. Access to a registered dietitian (RD) varies in these settings and we hypothesize that this contributes to late identification of patients with potential increased nutrition risk. Because research on the nutrition evolution of patients with AML throughout the full continuum of treatment (induction through transplant) does not exist, specific nutrition intervention guidelines have not been established. Objectives This descriptive pilot study will determine what nutrition risk patterns exist among patients being treated for AML, from diagnosis through transplant. The study will compare the Malnutrition Screening Tool (MST), Patient-Generated Subjective Global Assessment© (PG-SGA) and current hospital admission malnutrition screening tool for specificity and sensitivity in this population. Methods At two to four week intervals subjects answered eight questions about their nutrition status. Three questions constitute the MST, the fourth is part of our hospital’s nutrition screening. The final four questions are the patient-generated portion of the PG-SGA©, or “short form” PG-SGASF©. Subjects completed the PG-SGASF© questions using a touchscreen application (Pt-Global v. 2.6, pt-global.org). Researchers conducted nutrition focused physical exam and chart review to complete the full PGSGA©. Results will be compared for specificity and sensitivity in determining nutrition risk. Results We have preliminary results from five subjects as of 2/14/17 and will have results from at least ten patients by June of 2017. Conclusions Results of this pilot study may contribute to evidence-based nutrition care guidelines for this population.

eP234 BROWN ADIPOSE TISSUE SCORE AND BMI IN NON-SMALL CELL LUNG CANCER (NSCLC) L. Kuo-Bonde1, J. Silvestre2, R. Hall3 1 University of Virginia Health System, Radiology, Charlottesville, USA 2 University of Virginia Health System, Medicine: Geriatrics and Palliative Care, Charlottesville, USA 3 University of Virginia Health System, Medicine: Hematology/Oncology, Charlottesville, USA Introduction Lung cancer is the second most commonly diagnosed malignancy annually in the United States but is the most lethal. Patients with stage IV NSCLC frequently exhibit cancer related cachexia, which is poorly understood. We hypothesize that upregulation of brown adipose tissue (BAT), measured radiographically on CT scans is associated with cachexia in stage IV NSCLC. Objectives Measure BAT on CT or PET/CT scans of patients with stage IV NSCLC and correlate with patient outcomes including BMI during the course of treatment, overall survival, and patient reported outcomes measured through the MyCourse questionnaire. Methods HU of BAT on CT and PET/CTs were calculated by linear interpolation of water density (HU=0) and air density (HU=-1000) and manually placing a circular region of interest (ROI) measuring 5mm corresponding to a 28mm2 area over the supraclavicular brown fat and second ROI over the anterior chest wall subcutaneous fat as an internal control. BAT density was correlated with BMI from the same day.

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Results Preliminary data from 10 patients demonstrates that higher amounts of supraclavicular brown fat demonstrated by higher BAT score correlates with reduced BMI. Changes in BAT scores also appear to correlate with weight loss through the course of treatment and as disease progresses.

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Results Twelve studies were included for review with eight reporting improvement in measures of fatigue, while four reported no benefit. However, many studies were non-randomized, open-label and/or used inappropriate dose or comparators. Only three studies were reported to have a positive rating for methodological quality and low risk of bias, all reporting no significant improvement in fatigue. A meta-analysis was performed in 3 studies with sufficient data. LCarnitine did not significantly reduce cancer-related fatigue with a standardised mean difference (SMD) of 0.06 points [95% CI -0.09, 0.21]; p=0.45. Conclusions Results from studies with lower risk of bias do not support the use of carnitine supplementation for cancer-related fatigue. Future studies should include rigorous study design methods to reduce bias and focus on population subsets (e.g. carnitine deficient) who are most likely to be susceptible to carnitine-sensitive fatigue.

eP236 EARLY DETECTION OF CANCER CACHEXIA BY BREATH ANALYSIS W. Muircroft1, R. Yazbek2, S. Stranks3, D. Currow4 1 Repatriation General Hospital, Southern Adelaide Palliative Services, Adelaide, Australia 2 Flinders University, Non-invasive Bioengineering Centre, Adelaide, Australia 3 Repatriation General Hospital, Southern Adelaide Diabetes and Endocrine Services, Adelaide, Australia 4 Flinders University, Department of Supportive and Palliative Services, Adelaide, Australia Conclusions The BAT density correlates with BMI and serves as a novel imaging biomarker. The implication of BAT in cancer metabolism makes it a potential target for new therapies aimed at mitigating cancer related cachexia. Further analysis of our patient cohort will examine the BAT score with clinical outcomes and patient reported symptoms.

eP235 EFFICACY AND EFFECTIVENESS OF L-CARNITINE SUPPLEMENTATION FOR CANCER-RELATED FATIGUE: A SYSTEMATIC LITERATURE REVIEW AND META-ANALYSIS W. Marx1, L. Teleni2, R. Opie1, J. Kelly2, L. Isenring2 1 La Trobe University, Department of Human Nutrition and Dietetics, Melbourne, Australia 2 Bond University, Faculty of Health Sciences and Nutrition, Gold Coast, Australia Introduction Carnitine deficiency has been implicated as a potential reason for cancerrelated fatigue which might be treated with L-carnitine supplementation. Objectives The aim of this systematic literature review was to evaluate the literature regarding the use of supplemental L-carnitine as a treatment for cancerrelated fatigue. Methods Using the PRISMA guidelines, an electronic search of the Cochrane Library, MEDLINE, Embase, CINAHL and reference lists was conducted to identify peer-reviewed articles published from database inception to December, 2016 in English. Eligible study designs included intervention trials with pre- and post-intervention data. Data were extracted and independently assessed for quality using the Academy of Nutrition and Dietetics evidence analysis by two reviewers.

Introduction Cancer cachexia is characterised by systemic inflammation, negative protein and energy balance, and involuntary loss of lean body mass, with or without loss of adipose tissue. It causes a reduction in patient quality of life, and is associated with poor response to treatment and survival. Objectives This is a proof of concept pilot study to develop a novel breath analysis tool for the early detection of cancer cachexia. The main aims are to quantify the 13:12C ratio and volatile organic compounds (VOCs) in the breath of patients with early and established cancer cachexia and to compare breath biomarkers with existing diagnostic tests. Methods 20 participants will provide breath samples for 13CO2 analysis at 2 weekly intervals over 6 months and the samples will be analysed by mass spectrometry for quantification of exhaled breath compounds. These results will be compared with appendicular lean body mass measured by DEXA scanning, physical activity and inflammatory markers of cachexia. Carers will also be recruited to the breath testing arm of the study to gain further information on the background release of 13CO2 and VOCs as control subjects. Results The preliminary results in animal models indicate that breath analysis of 13:12C ratio shows promise as a non-invasive biomarker in cachexia. The utility amongst human models is not yet proven. Conclusions If this preliminary study indicates a positive signal for the early detection of cancer cachexia, a large scale prospective study will be planned. eP237 NINETY-DAY SUPPLEMENTAL TUBE-FEEDING NUTRITION A F T E R H O S P I TA L D I S C H A R G E F O R PAT I E N T S UNDERGOING ESOPHAGECTOMY

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M. Niihara1, Y. Tsubosa1, A. Tanuma2, K. Mori3, A. Yamashita4, S. Mayanagi1, H. Tsumaki4, T. Okayama2, T. Ishii2, H. Ishikawa4, N. Nagata4, Y. Onozawa4, H. Fukuda4 1 Shizuoka Cancer Center, Division of Esophageal Surgery, Sunto-gun, Japan 2 Shizuoka Cancer Center, Division of Rehabilitation Medicine, Suntogun, Japan 3 Shizuoka Cancer Center, Clinical Trial Coordination Office, Sunto-gun, Japan 4 Shizuoka Cancer Center, Nutrition Support Team, Sunto-gun, Japan Introduction In patients who have undergone gastrointestinal surgery, appetite and diet intake decline during the catabolic period could continue. Enteral nutrition might have a positive impact on clinical outcomes in some short-term studies. Objectives The aim of this study is to evaluate the feasibility of the 90-day supplemental tube-feeding nutrition (STN) at home in patients undergoing esophagectomy. Methods This prospective feasibility study (FAST-ERAS Trial) will provide preliminary information on the routine use of 90-day STN after hospital discharge. Between February 2015 and September 2016, 24 patients following esophagectomy were enrolled in this study. The primary outcome was the ratio of patients who completed the intervention. The completion was defined as administering 70 % or more of planned nutrient. Participants were taught to independently manage the enteral nutrition. For the first 90 days after hospital discharge, the participant would administer intermittent jejunostomy (trans-gastric) tube-feeding of total 250 ml enteric nutrient (ENEVO TM) a day using catheter tip by patient himself/herself in addition of oral intakes. Results Age (median, range): 62.5, 37-74. Sex (Male/Female): 18/16. Clinical Stage (I/II/III): 7/4/13. Histology (Squamous cell carcinoma / Adenocarcinoma): 20/4. Preoperative body weight (median, range): 56.6, 35.4-88.5 kg. The ratio of patients who completed the intervention: 20/24 (83.3%). The ratio of patients who administered 100 % of planned nutrient: 14/24 (58.3%). Conclusions Our results show that routine use of 90-day home STN after hospital discharge for patients undergoing esophagectomy is feasible and acceptable. Our next step is to assess the association STN with improvement in nutritional status and physical activity.

eP238 CANCER MALNUTRITION: BIOELECTRICAL IMPEDANCE IN ROUTINE CLINICAL ASSESSMENT B. O'Connor1, C. Lorton1,2, B. Brady1,3, P. Ui Dhuibhir1, S. Higgins4, L. Balding4, N. O'Leary4, D. Walsh5,6 1 Our Lady's Hospice & Care Services, Academic Department of Palliative Medicine, Dublin, Ireland 2 Trinity College Dublin, School of Medicine, Dublin, Ireland 3 University College Dublin, School of Medicine and Medical Science, Dublin, Ireland 4 Our Lady's Hospice & Care Services, Department of Palliative Medicine, Dublin, Ireland 5 Levine Cancer Institute, Department of Supportive Oncology, Charlotte, USA 6 Carolinas HealthCare System, Professor of Medicine, Charlotte, USA Introduction At cancer diagnosis, approximately 50% present with nutritional deficit. Cancer cachexia plays a significant role. Malnutrition remains poorly

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evaluated, as the frequently measured weight and body mass index give no indication of body composition. Bioelectrical impedance analysis (BIA) presents a potential solution. It is a rapid, non-invasive, bedside body composition assessment tool. BIA measures phase angle (PhA). Low PhA represents poor cell membrane integrity, an indicator of malnutrition. Feasibility of routine use in palliative care inpatients remains unclear. Objectives Evaluate the feasibility and acceptability of BIA to assess body composition in a specialist palliative care inpatient unit (SPCU). Methods A prospective observational study recruited 50 consecutive cancer admissions. BIA recorded body composition on 2 consecutive mornings under real-world conditions. Ideal test conditions were identified (bladder voided, fasting, right-side electrode placement, supine). Participant acceptability was evaluated by questionnaire. Significance threshold: p<0.05. Results Mean age was 67 ±12 years. BIA was successfully completed in all participants. High (100%) device acceptability was reported. Low PhA was recorded in 40% (20/50). Daily PhA variation was observed in 30% (14/47) [p=0.67]. Technical issues occurred in 8% (4/50). Ideal test conditions were not always achieved: 88% right-sided electrode placement; 76% supine position; 66% bladder voided; 34% fasting. Conclusions 1. BIA was feasible for routine bedside assessment of body composition in SPCU 2. High acceptability supports clinical use 3. Frail cancer participants experienced difficulty in compliance with ideal test conditions 4. PhA result may vary daily 5. Further studies should evaluate significance of alternative test conditions

eP239 WEIGHT CHANGES AT DIAGNOSIS IN SOLID TUMOURS N. O'Donoghue1,2, S. Shrotriya3, A. Aktas3,4, B. Hullihen3,4, S. Ayvaz3,5, D. Walsh1,2,3,4 1 Trinity College Dublin, School of Medicine, Dublin, Ireland 2 Our Lady’s Hospice & Care Services, Academic Department of Palliative Medicine, Dublin 6W, Ireland 3 The Cleveland Clinic Taussig Cancer Institute, Department of Solid Tumor Oncology, Cleveland, USA 4 The Cleveland Clinic Taussig Cancer Institute, The Harry R. Horvitz Center for Palliative Medicine, Cleveland, USA 5 The Cleveland Clinic Foundation, Department of ITD Analytics eResearch, Cleveland, USA Introduction Unintentional weight loss (WL) is common in cancer and associated with increased morbidity and mortality. Most research has examined WL in advanced disease. Clinical significance of any weight change (WC) before/at cancer diagnosis remains unclear. Objectives To determine prevalence and clinical significance of WC at solid tumour diagnosis. Methods Retrospective study of the electronic medical record (EMR) was conducted (n=6477). Those with a pre-diagnosis weight, T0, (≤6 months before diagnosis) and 2 subsequent weights (diagnosis, T1; final visit, T2) were identified (n=4258). Logistic regression and survival analysis identified WC predictors and overall survival respectively. Significance threshold: p<0.05. Results Mean age: 61±12.5 years. 54% (n=2315): male.

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T1 Demographics: Common tumours included breast (17%; n=725), prostate (16%; n=664), lung (14%; n=599), upper GI (11%; n=470). Metastatic disease=15% (n=652). 68% (n=2908) overweight/obese (WHO BMI Classification). 98% (n=4159) had WC (T0-T1); loss: 58% (n=2454). Tumours significantly associated with WL included colon, head & neck, kidney, lung, upper GI. 8% (n=320) cachectic (>5% WL in previous 6 months), 50% (n=2134) pre-cachectic (≤ 5% WL), 3% (n=128) “Abnormal Weight Loss” (ICD 9 Code). Primary tumour site (lung, upper GI), normal/underweight BMI at T1 predicted poor prognosis. Worst survival: WL >5%, weight gain (WG) ≥10%, WL 2.5-5% from T0-T1 (p<0.05). WG of 0.1-2.4% was protective. Conclusions WC highly prevalent; WL typically undiagnosed. Most were overweight/ obese at T1; nevertheless 58% (n=2454) met current cachexia/pre-cachexia criteria. Those with WL > 5%, WG ≥ 10% or WL 2.5-5% at T1 had worst survival. Most had significant, yet frequently undiagnosed, WC at T1.

eP240 COMPLETE ORAL NUTRITIONAL SUPPLEMENTS: DIETITIAN PREFERENCES AND CLINICAL PRACTICE P. Ui Dhuibhir1, N. Collura2, D. Walsh3 1 Our Lady's Hospice & Care Services, Academic Department of Palliative Medicine- Education and Research Centre, Dublin, Ireland 2 Nualtra Ltd, Tierney Building- University of limerick, Limerick, Ireland 3 Trinity College Dublin, School of Medicine, Dublin, Ireland Introduction Oral Nutritional Supplements (ONS) complement food intake in malnutrition. ONS selection is typically dietitian-led. Dietitian ONS preferences and their influence on prescribing is a neglected area. The degree to which individual perceptions influence dietetic practice is unclear. Objectives 1. Explore factors that influence ONS prescribing; 2. Examine dietitians hedonic ratings and Overall Impression of three ONS; 3. Study phenylthiocarbamide (PTC) sensitivity in relation to ONS hedonic ratings. Methods Dietitians in six hospitals completed: 10-Item Clinical Practice Questionnaire Five Taste Tests of 3 ONS -Compact Milkshake: 125ml/300kcal/12g protein (2 samples) -Protein-rich Milkshake: 200ml/300kcal/20g protein (1 sample) -Dessert: 125g/225kcal/12.5g protein (2 samples) 7-point hedonic Likert scale recorded five hedonic characteristics and Overall Impression PTC taste strip test Results Thirty-one dietitians (30 female), all < 50 years recruited. Seven prescribed ONS. In rank order the top five factors that influenced clinical practice were Nutritional Value, Patient Palatability, Patient Acceptability, Tolerance and Pharmacy Contracts. Taste was the highest rated hedonic characteristic, followed by Consistency. Appearance, Smell and Aftertaste were the least favoured, but Overall Impression was consistently high for all three products (Figure 1).

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27% had a positive PTC test. No statistically significant relationship between ONS Overall Impression and PTC sensitivity was found. Conclusions 1. Key drivers of dietitian’s ONS prescribing were nutritional value, patient palatability, acceptability, and tolerance. 2. ONS hedonic characteristics and Overall Impression were highly rated. 3. Taste and Consistency were rated better than Appearance, Smell and Aftertaste. 4. No statistically significant relationship between PTC sensitivity and ONS Overall Impression.

eP241 TASTE AND SMELL ABNORMALITIES IN TREATMENTNAIVE CANCER PATIENTS: OBJECTIVE AND SUBJECTIVE ASSESSMENT P. Ui Dhuibhir1, M. Barrett2, N. O'Donoghue3, C. Gillham4, N. El Betagi4, D. Walsh3 1 Our Lady's Hospice & Care Services, Academic Department of Palliative Medicine- Education and Research Centre, Dublin, Ireland 2 Our Lady's Hospice & Care Services, Academic Department of Palliative Medicine- Education & Research Centre, Dublin, Ireland 3 Trinity College Dublin, School of Medicine, Dublin, Ireland 4 St James' Hospital, St Luke's Radiation Oncology Centre, Dublin, Ireland Introduction Taste and Smell Abnormalities (TSA) in cancer occur as a result of treatments or the disease itself. No gold standard for assessment exists. Previous work suggests a high prevalence of subjective TSA in treatment naive patients. Objective taste and smell assessment may enhance our understanding of these abnormalities. Objectives 1. Assess prevalence, severity and characteristics of TSA in treatmentnaïve, newly diagnosed non-head and neck cancer patients; 2. Examine the relationship between objective and subjective measurements; 3. Determine nutritional status and symptoms in TSA. Methods Radiation-Oncology outpatients recruited in a tertiary hospital. The Taste & Smell Survey evaluated chemosensory change subjectively; Burghart Taste Strips® and ‘Sniffen’ Sticks Olfactory Test® assessed taste and smell objectively. Nutritional status and symptoms measured using the Abridged Patient-Generated Subjective Global Assessment. Results Thirty patients (27 females) were recruited. Subjective TSA prevalence was 53% compared to objective prevalence at 33%. When objective and subjective results were combined 70% had TSA (figure 1).

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Figure 1 54% were at risk of malnutrition, 75% of these had TSA. There was no statistically significant different in risk of malnutrition between those with and without TSA. Median number of nutritional symptoms was 1 (range 0-8). The most frequent symptoms were loss of appetite (10), fatigue (9), pain (8). Conclusions 1. The majority of treatment-naïve patients had TSA. 2. TSA characteristics showed considerable variation. 3. Subjective and objective results were not consistent across all participants suggesting a need to further scrutinise assessment methods. 4. The majority were at risk of malnutrition prior to treatment.

eP242 EVALUATION OF QUALITY OF LIFE IN NEPALESE PATIENTS U S I N G O B T U R AT O R P R O S T H E S E S A F T E R H E M I MAXILLECTOMY B. Acharya1 1 Nepal Medical College, Department of Prosthodontics, Kathmandu, Nepal Introduction Hemi-maxillectomy is often performed as a treatment of oral cancer affecting palate and maxillary sinus. The prosthodontists play an important role in rehabilitation and improving quality of life of cancer survivors in terms of reconstruction of the defect and restoration of oro-nasal functions while maintaining the facial contours. Objectives To assess the quality of life in oral cancer survivors rehabilitated with obturator prostheses. Methods Questionnaire study was conducted among 40 Nepalese patients using obturators following maxillectomy, response was obtained from 35 patients. The questionnaire included Obturator Functioning Scale (OFS) and quality of life questions related to the patient’s physical health, psychological status, social relation and environmental conditions. Functioning of the obturator prosthesis, impairment of ingestion, speech and appearance, the extent of therapy, and the existence of pain in patients with obturators were also evaluated. The data were processed with statistical package version 21. Results Most of the patients (85%) reported on improvement in quality of life after rehabilitation with obturator prosthesis. A significant impact on the quality of life (p<0.005) was seen in relation to functioning of the obturator prosthesis, impairment of ingestion, speech and appearance, the extent of therapy, and the existence of pain .had significant impact on the quality of life. Conclusions Prosthodontists play a signature role in improving wellbeing of oral cancer patients. Obturator prosthesis is a highly positive and non-invasive approach to improve the quality of life of patients with maxillectomy defects.

eP243 DENTAL DISEASE PRIOR TO RADIATION THERAPY FOR HEAD AND NECK CANCER M. Brennan1, T. Sollecito2, N. Treister3, B. Schmidt4, L. Patton5, K. Mohammadi6, L. Long-Simpson7, H. Voelker6, J. Hodges7, R. Lalla8 1 Carolinas Healthcare System, Oral Medicine, Charlotte, USA 2 University of Pennsylvania School of Dental Medicine, Oral Medicine, Philadelphia, USA 3 Brigham and Women's Hospital, Oral Medicine and Dentistry, Boston, USA

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New York University College of Dentistry, Oral and Maxillofacial Surgery Research, New York, USA 5 University of North Carolina, Dental Ecology, Chapel Hill, USA 6 University of Minnesota, Divison of Biostatistics, Minneapolis, USA 7 University of Minnesota, Division of Biostatistics, Minneapolis, USA 8 University of Connecticut, Oral Medicine, Farmington, USA Introduction No evidence-based guidelines exist for preventive dental care before radiation therapy (RT) in head and neck cancer (HNC) patients. An ongoing multi-center, prospective cohort study, Clinical Registry of Dental Outcomes in HNC patients (OraRad) (1U01DE022939-01), is addressing this knowledge gap. Objectives Evaluate dental disease and associated factors pre-RT. Methods OraRad enrolls patients at six U.S. clinical centers pre-RT; follows them every 6 months for 2 years post-RT with primary outcome of tooth loss. Calibrated examiners assess caries and periodontal disease using validated scales and standardized procedures. Results Baseline measures were reported for 356 participants with mean (SD) age 59.9 (11.0) years; 77% male. Pre-RT dental disease parameters (means) include: number of teeth 22.9; decayed, missing, filled surfaces (DMFS) 33.3 with 1.6 decayed surfaces; clinical attachment level 1.8mm; and probing depth 2.4 mm with 13.5% of tooth sites ≥4mm. Participants with at least a high school diploma had more teeth and fewer tooth sites with PD ≥4mm compared to those with less education. Patients who received routine dental care had more total teeth pre-RT vs. those without (24.0 vs. 19.8, respectively). We found 37.2% of patients had at least 1 decayed surface and 47.4% had a least one tooth with a probing depth >4mm. Conclusions A high proportion of patients have dental disease at the start of RT for HNC. Observing dental outcomes post-RT, OraRad has the potential to determine the risk of dental disease at the start of RT and determine the best treatment recommendations for HNC patients pre- and post-RT.

eP244 PRE-RADIATION DENTAL TREATMENT IN THE HEAD AND NECK CANCER PATIENT A. Iturbide1, V. Dhaliwal1, J. Noll1, J. Hodges2, I. von Bültzingslöwen3, M. Brennan1 1 Carolinas HealthCare System, Oral Medicine, Charlotte, USA 2 University of Minnesota, Division of Biostatistics, Minneapolis, USA 3 University of Gothenburg, Department of Oral Microbiology and Immunology, Göteborg, Sweden Introduction Removal of at-risk teeth is frequently recommended to decrease negative dental outcomes pre-RT for head and neck cancer (HNC), but no current standard of care exists for pre-RT dental treatment. Objectives Assess factors associated with recommended full-mouth extraction (FME) for HNC pre-RT. Methods We compared 60 patients with a FME recommendation (cases) to 60 patients with a recommendation to save teeth before RT (controls). Control patients were all enrolled in the study, “Clinical Registry of Dental Outcomes in H&N Cancer Patients (OraRad; 1UO1DE022939).” Results Cases were mean age (SE)=61(1.3) years, 68% male, and 95% diagnosed with squamous cell carcinoma (SCC); controls were 57(1.3) years, 75% male, and 87% SCC. Approximately 90% of cases did not have dental insurance vs. 53% controls (p<0.0001). More cases had not seen a dentist

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for routine care in over 10 years vs. controls (41% versus 10%, respectively; p<0.0001). Cases brushed less frequently (<4x/week) than controls (64% vs. 3%, respectively; p< 0.0001) and flossed less frequently (<1x/week; 95% vs. 20%, respectively; p<0.0001). Cases had more dental disease than controls: number of teeth with periapical lesions (1.3(0.2) vs. 0.42(0.2), p=0.0007), caries extending to dentin or pulp (4.2(2.5) vs. 2.5(0.4), p=0.006), pulpal exposure (1.8(0.3) vs. 0.5(0.3), p=0.0005), and percent of radiographic bone loss (46%(1.5) vs 22%(1.4), p<0.0001), all respectively. Conclusions In the present study, cases and controls differed on many measures. Decision-making surrounding a pre-RT FME recommendation appears to be related to oral hygiene history, accessibility to care, and level of dental disease.

eP245 THROAT SYMPTOMS IN HEMATOPOIETIC STEM CELL TRANSPLANT PATIENTS (HCST): ORASTEM STUDY R. Koppelmans1, I. von Bültzingslöwen2, A. Hovan3, J. Raber4, N. Blijlevens5, B. Hasseus6, K. Garming Legert7, M.C. Huysmans8, N. Rozario9, J.E. Johansson10, C.G. Patterson9, M. Brennan11 1 ACTA, Department of Oral Medicine, Amsterdam, The Netherlands 2 Sahlgrenska Academy, Department of Oral Microbiology and Immunology, Göteborg, Sweden 3 BC Cancer Agency, Oral Oncology and Dentistry, Vancouver- British Columbia, Canada 4 ACTA, Section Preventive Dentistry, Amsterdam, The Netherlands 5 Radboud University Medical Center, Department of Hematopoietic Diseases, Nijimegen, The Netherlands 6 Sahlgrenska Academy, Institute of Odontology, Göteborg, Sweden 7 Karolinska Institute, Department of Dental Medicine, Huddinge, Sweden 8 Radboud University Medical Center, Cariology and Endodontology, Nijimegen, The Netherlands 9 Carolinas Healthcare System, Center for Outcomes Research and Evaluation, Charlotte, USA 10 Sahlgrenska Academy, Section of Hematology, Göteborg, Sweden 11 Carolinas Healthcare System, Oral Medicine, Charlotte, USA Introduction Throat symptoms can be major dose-limiting side effect of cancer therapy. Objectives We evaluated the prevalence of throat symptoms during hospitalization of HSCT patients and determined their relationship with functional limitations and quality of life. Methods HSCT patients were 3 days/week during hospitalization for HSCT as part of OraStem study. Prevalence for specific throat symptoms was determine. Dysphagia was measured by the CTCAE3.0 scare (0-4). Mucositis was measured by the World Health Organization (WHO) scale (0-4). Functional limitations and impact on quality of life was assessed by the Oral Mucositis Daily Questionnaire (OMDQ). Descriptive statistics and correlations were assessed. Results This interim analysis included 141 patients, age 52.5 years (SD=13.5), 55% male. Common medical diagnoses were multiple myeloma (n=54), acute myelogenous leukemia (n=25), lymphoma (n=17), and other leukemias (n=21). Any throat symptoms in the last 24 hours included: none (37%), dryness (17%), swallowing problems (14%), pain (10%), sensitivity (9%), hoarseness (7%) and burning (3%) and the worst throat symptom in the last 24 hours included none (53%), dryness (17%), swallowing problems (13%), pain (6%), sensitivity (5%) and hoarseness (3%). The mean dysphagia grade was positively correlated with more

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limitations in sleeping (r=0.51,p<0.0001), drinking (r=0.76,p<0.0001), eating (r=0.72,p<0.0001), talking (r=0.63,p<0.0001) and swallowing (r=0.81,p<0.0001). The mean WHO mucositis score was positively correlated with more limitations in sleeping, drinking, eating, talking and swallowing (range: r=0.32-0.48,p<0.0001). Conclusions Numerous throat symptoms occur in HSCT with dryness and swallowing problems the most common throat symptoms. The mean dysphagia score was strongly correlated with functional limitations.

eP246 SALIVARY DYSFUNCTION IN HEMOTOPOIETIC STEM CELL TRANSPLANT PATIENTS (HCST): ORASTEM STUDY N. Blijlevens1, I. von Bültzingslöwen2, A. Hovan3, J. Raber4, B. Hasseus5, K. Garming Legert6, S. van Leeuwen7, N. Rozario8, J.E. Johansson9, C. Patterson8, M.C. Huysmans10, M. Brennan11 1 Radboud University Medical Center, Department of Hematopoietic Diseases, Nijimegen, The Netherlands 2 University of Gothenburg, Department of Oral Microbiology and Immunology, Göteborg, Sweden 3 BC Cancer Agency, Oral Oncology and Dentistry, Vancouver- British Columbia, Canada 4 ACTA, Section Preventive Dentistry, Amsterdam, The Netherlands 5 Sahlgrenska Academy, Institute of Odontology, Goteborg, Sweden 6 Karolinska Institute, Department of Dental Medicine, Huddinge, Sweden 7 Radboud University Medical Center, Department of Dentistry, Nijimegen, The Netherlands 8 Carolinas Healthcare System, Center for Outcomes Research and Evaluation, Charlotte, USA 9 Sahlgrenska Academy, Section of Hematology, Goteborg, Sweden 10 Radboud University Medical Center, Cariology and Endodontology, Nijimegen, The Netherlands 11 Carolinas Healthcare System, Oral Medicine, Charlotte, USA Introduction Dry mouth can be major side effect of cancer therapy. Objectives We evaluated the relationship of salivary dysfunction and xerostomia with mucositis, dysphagia, pain and QoL after HSCT. Methods Patients were seen 3 days/week for the OraStem study. Stimulated salivary flow was measured at baseline and was dichotomized: low (<0.7 ml/min) and normal (≥0.7ml/min). During hospitalization, xerostomia was measured by CTCAE3.0 scale(0-3). Mucositis was measured by WHO scale(0-4), and by modified Oral Mucositis Assessment Scale (OMAS), documenting ulceration(0-3) and erythema(0-2). Dysphagia was measured by CTCAE3.0(0-4). Pain was documented by WHO pain grade (0-4), and CTC pain scale. A study-specific question regarding distress level from oral dryness(0-10 scale) was also assessed. Descriptive statistics, correlations and non-parametric comparisons between the low and high salivary groups were assessed. Results This interim analysis included 141 patients, age 52.5 years(SD=13.5), 55% male. Common medical diagnoses were multiple myeloma (n=54), acute myelogenous leukemia (n=25), lymphoma (n=16), and other leukemias (n=21). The worst xerostomia grade had a positive correlation with worst mucositis (r=0.24,p=0.01) and OMAS ulceration (r=0.23,p=0.02). Additionally, the worst distress level from oral dryness and worst xerostomia grade during hospitalization were positively correlated with dysphagia, WHO pain, CTC pain and xerostomia CTC (range r=0.23-0.64,p=0.02-<0.0001). There were no significant differences with mucositis scores, WHO pain grade, CTC pain

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scale and xerostomia measures between patients with normal (n=54,(64%)) and low (n=31(36%)) salivary flow. Conclusions Patients with xerostomia have worse mucositis, pain, dysphagia and QoL. This study will continue to enroll patients for more robust analyses.

eP247 ORAL SALIVARY RINSE ACCURATELY PREDICTS HEAD AND NECK SQUAMOUS CELL CARCINOMA (HNSCC); POTENTIAL FOR UTILITY IN EARLY DETECTION M. Donovan1, E. Franzmann2 1 Icahn School of Medicine at Mt. Sinai, Pathology, New York City, USA 2 University of Miami, Otolaryngology, Miami, USA Introduction Background Head and neck squamous cell carcinoma (HNSCC) is the 6th most common cause of cancer mortality throughout the world affecting some 50,000 people in the US and 600,000 worldwide each year. The ability to detect the disease in a potentially malignant phase and earlier stage could have significant impact on overall outcome. Objectives We sought to better understand performance of salivary markers in oral cancer detection. Methods Two oral rinse cohorts: A. 310 patients (107 HNSCC cases; 203 controls) and B. 134 (38 HNSCC; 96 controls) were obtained from bio-repositories. Both a quantitative lab (A) and and point-of-care (POC, B) lateral flow test assay assessed CD44 and total protein (TP), +/- clinical variables (i.e. lab test) were evaluated using the AUC, sensitivity, specificity, and NPV. Results Cohort A: 95% HNSCC patients (cases) were >/=40 years, 72% male, 97% white and 65% smokers vs. 23%, 36%, 60% and 44% for controls; Cohort B. mean age: 60 years, 97% white, 74% smokers for cases vs. mean age 43 years, 28%, 96% and 0%, for controls. Lab assay: AUC of 0.72; logistic regression model combined with sex, and race = AUC 0.83, sensitivity of 87%, specificity of 94%. The POC test, sensitivity of 84-71%, and specificity of 30-50%: TP levels. Both lab and POC had NPV>90%. Conclusions Elevated levels of either CD44 or TP continue to perform well for discriminating HNSCC. The POC and lab assays represent novel tools for discrimination of risk. Additional studies are underway to further confirm these results.

eP248 ECONOMIC AND PRACTICAL CONSIDERATIONS IN THE TREATMENT OF ORAL MUCOSAL CHRONIC GRAFTVERSUS-HOST DISEASE S. Elad1, K. Zinchuk2, N. Treister3 1 Eastman Institute for Oral Health- University of Rochester Medical Center, Division of Oral Medicine, Rochestrer NY, USA 2 Brigham and Women’s Hospital, Investigational Drug Service, Boston MA, USA 3 Harvard School of Dental Medicine- Dana-Farber/Brigham and Women’s Cancer Center, Division of Oral Medicine and Dentistry, Boston MA, USA Introduction Chronic graft-versus-host disease (cGVHD) frequently affects the oral mucosa. Clinicians may benefit from guidance in choosing the appropriate topical therapy with respect to practicality and cost.

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Objectives To assess the economic considerations related to topical immunomodulatory treatments for management of oral mucosal cGVHD and their practical implications. Methods Topical treatments used for management of oral cGVHD were obtained from the NIH Consensus document for ancillary and supportive care. Cost data for a standard one month prescription was obtained from national databases for commercially available formulations and from compounding pharmacies for formulations requiring compounding. Results There are numerous topical preparations used for the management of oral cGVHD, some require compounding. The average whole price of the commercially available agents ranges from $5-277/month, and the cost of the compounded preparations ranges from $43-499/month and can be influenced by drug, patient, and pharmacy-related factors. Conclusions The costs associated with topical treatment of oral cGVHD are substantial, particularly since the disease is chronic and the expenses accumulate over time. Rational prescribing according to a proposed algorithm, including de-escalation of therapy when indicated, can help to minimize associated costs. This has practical implications for patients, physicians, pharmacies and health insurance companies.

eP249 DEVELOPMENT OF MODELS TO PREDICT RADIATION DOSIMETRIC DISTRIBUTION IN DIFFERENT REGIONS OF THE JAWS IN PATIENTS RECEIVING RADIOTHERAPY FOR TONSILLAR CANCER C. Estilo1, A. Owosho1, P. Hilden2, S. Yom1, N. Lee3, J. Huryn1, C.J. Tsai3 1 Memorial Sloan Kettering Cancer Center, Surgery, New York, USA 2 Memorial Sloan Kettering Cancer Center, Biostatistics, New York, USA 3 Memorial Sloan Kettering Cancer Center, Radiation Oncology, New York, USA Introduction High radiation dose (RTd) to the jaws is associated with increased complications such as osteoradionecrosis. Detailed RT plan is not always available to guide clinicians. Objectives We developed a model to predict delivered RTd to different regions of the jaws in 174 patients treated with intensity-modulated RT. Methods For each patient, we calculated the actual delivered RTd to regions of the jaws based on the treatment plan. Two predictive models were built, one for four molar regions and another for six non-molar regions. RTd was transformed in both models to reduce skewness. A marginal generalized estimating equation model was used with an exchangeable correlation to account for within patient correlation. Candidate predictors for both models included tumor side, overall-, T- and N-stages, with all models adjusted for region. Results Most patients had T1/2 primary (70%), with 30% having N0/1, 55% with N2a/b, and 15% with N2c/3. The molar model indicated that T3/4 tended to receive higher RTd vs. T1/2; as well as N2a/b and N2c/3 vs. N0/1, and decreased RTd for recent treatment years. For non-molars, T3/4 tended to receive higher RTd vs. T1/2; as well as stage IV vs. I-III. The median (SD) absolute difference between the observed dose and predicted dose for each model was 5.7 (6.5) and 6.9 (7.5) for molars and non-molars, respectively. Conclusions The model offers reasonable estimation of RTd to the jaws, particularly the ipsilateral molars. Future work will focus on independent validation of these models and development of an online user interface.

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eP250 IMPROVING THE FOLLOW-UP OF CANCER PATIENTS AT HOME: HOW TO DESIGN A CANCER CARE COORDINATION PROGRAM? M. ferrua1, F. Yatim1, A. Fourcade1, M. Lacaze2, B. Lalloue1, M. Di Palma2, E. Minvielle1 1 gustave roussy, projet CAPRI -IGH- 1er étage bur 657, villejuif, France 2 gustave roussy, Département ambulatoire, villejuif, France Introduction There is significant interest in Cancer Care Coordination Program (CCCP) to improve transitions of care by improving communication between stakeholders and providing patients' assistance. Use of health information technologies (HIT) can be combined with Nurse Coordinators (NC) to improve remote patient follow-up. Objectives Describing how to design a CCCP based on HIT (through a web portal) and NC. Methods The research was conducted within the CAPRI project which included design, implementation and evaluation of a CCCP. Three studies were conducted: 1.A patient survey to understand HIT use and intention to use for their health. 2.A qualitative analysis to understand the existing care processes and define how the CCCP could prevent difficulties and facilitate coordination. 3.An analysis of home care coordination activities to identify the necessary skills and tasks to perform home care coordination activities. Results 1. 1371 questionnaires were returned. Patient attitudes toward e-health activities were mainly positive, particularly to have an access to ER, filling out a self-test, communicating, and scheduling appointment. 2. 43 interviews were conducted. The qualitative analysis enabled to refine the features the CCCP could offer and highlighted the need to develop decision support tools for NC. 3. 543 calls received at the coordination platform were analyzed. The majority of patients' and professionnals' needs were related to managerial and organizational issues. Conclusions These studies identified patient’s needs and the main features expected by HIT. NC should have a role as a case manager in order to prevent risky situations. Operational since June 2016, they have helped to implement the CCCP for patient treated by oral therapy.

eP251 MODIFIED PENTOCLO MAY PROMOTE ADEQUATE MANAGEMENT OF STAGE III OSTEORADIONECROSIS L. Gueiros1, G. Soares1, T. Melo1, J. Leão1 1 Federal University of Pernambuco, Clinic and Preventive Dentistry, Recife, Brazil Introduction Osteoradionecrosis (ORN) is a severe long-term complication associated with fibro-atrophic and destructive vascular effects of head and neck radiation therapy. PENTOCLO protocol has been described as a promising option by inducing mucosal and bone healing. Nevertheless, some countries do not have all drugs of the protocol offered by the public health system. Objectives The aim of the present study was to report a small case series of severe ORN adequately managed with modified PENTOCLO. Methods Four ambulatory patients clinically and radiographically diagnosed with grade III ORN were included in the study. All individuals have received

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head and neck radiation therapy for malignant tumors and were given pentoxifylline (400mg twice a day), tocopherol (1000UI once a day) and alendronate (5mg/week). In addition, patients were put on amoxicillin 875mg plus clavulanate 125mg twice a day for 30 days. The endpoints included symptom control, trismus and mucosal healing. Results All patients were male with age ranging from 47 to 65 years and were referred by primary care dentists after unsuccessful management. All patients presented with significant pain and acute trismus and symptoms were controlled after 25-42 days. Partial or complete mucosal healing was achieved by all patients. Flare ups were observed in 1 patient after 6 months of treatment, with rapid response to a new cycle of the same antibiotics. One patient reported mild gastrointestinal adverse effects secondary to pentoxifylline use, which ceased after reducing the dose. Conclusions Adapting the PENTOCLO protocol to distinctive clinical realities is feasible and may promote significant control of advanced ORN cases.

eP252 ANALGESIC EFFECTS OF INDOMETHACIN SPRAY ON ORAL MUCOSITIS IN PATIENTS UNDERGOING CHEMOTHERAPY H. Hata1, S. Takada Shinya2, K. Yoshikawa3, K. Imamachi3, M. Edo1, S. Tamaki2, T. Sagawa4, M. Ueda5, S. Rin5, Y. Kitagawa3 1 Hokkaido Cancer Center, Division of Dentistry and Oral surgery, Sapporo, Japan 2 Hokkaido Cancer Center, Department of Pharmacy, Sapporo, Japan 3 Hokkaido University, Oral diagnosis and medicine- Graduate School of Dental Medicine, Sapporo, Japan 4 Hokkaido Cancer Center, Department of Gastroenterology, Sapporo, Japan 5 Hokkaido Cancer Center, Department of Clinical Oral oncology, Sapporo, Japan Introduction Severe, chemotherapeutically induced mucositis frequently reduces the patient’s quality of life. Objectives We studied the analgesic effects of 0.25% indomethacin spray (IMS) as an in-hospital preparation on chemotherapeutically induced mucositis. Methods Eighteen patients with oral mucositis Grade 2 and over, undergoing chemotherapy in our hospital were selected. Pain was recorded using a visual analog scale (VAS), before administration of IMS and 30 min after. Categories allocated for pain relief were as follows: none=0, slight=1, moderate=2, good or significant=3, and complete=4. Scores were recorded at 15 min (PR15), 30 min (PR30), and 60 min (PR60), and total pain relief at 60 min (TOTPR60) was calculated. Results Before administration, mean VAS (±SD) was 6.28±2.13, which then fell markedly to 3.44±2.40 at 30 min (P=0.001 by Wilcoxon signed-rank test). TOTPR60 was 5.0±2.60. Conclusions The application of IMS will contribute in the improvement of the patient’s quality of life. The risk of systemic adverse effects is considered low based on the low dosage of IM applied to the oral mucosa. In conclusion, it is suggested that IMS is effective for the relief of chemotherapeutically induced pain associated with oral mucositis, and is a useful preparation for immediate self-medication.

eP253 REPLACING ZOLEDRONIC ACID WITH DENOSUMAB INCREASE THE RISK OF ONJ

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T. HIguchi1, Y. Soga1, M. Kajizono2, M. Muro1, A. Sasaki3 1 Okayama University, hospitaldentistry, Okayama, Japan 2 Okayama University, Department of Pharmacy, Okayama, Japan 3 Okayama University, Department of Oral and Maxillofacial Surgery and Biopathology, Okayama, Japan Introduction Zoledronic acid (ZA) administration is often replaced with denosumab administration for patients with bone metastatic cancer because of their clinical load. ZA is a bisphosphonate with a strong ability to inhibit osteoclast action over a long time period. Denosumab is an antiRANKL antibody that inhibits osteoclast maturation by binding to and inhibiting RANKL. Their pharmacological mechanisms are completely different; thus, replacing ZA with denosumab may affect osteonecrosis of the jaw (ONJ) development. Objectives Considering the known risk factors, this study aimed to evaluate the risk of developing ONJ when replacing ZA with denosumab. Methods In total, 149 consecutive Japanese patients who were administered ZA for bone metastatic cancer during 2012–2015 were enrolled. All patients underwent a dental examination before ZA administration and were followed up. The risk of developing ONJ was evaluated by logistic regression analysis using the following factors: age, sex, cancer type, angiogenesis inhibitors, steroids, and replacement of ZA with denosumab. Results Twenty-one patients (14.0%) developed ONJ. A single regression analysis revealed significant differences in age, cancer type, angiogenesis inhibitors, and replacement of ZA with denosumab. A multiple regression analysis revealed significant differences in angiogenesis inhibitors (OR=3.6, 95%CI: 1.3-10.0, P=0.014) and replacement of ZA with denosumab (OR=3.5, 95%CI: 1.3-10.2, P=0.017). Conclusions Replacing ZA with denosumab is a risk factor for developing ONJ. Bisphosphonate binding to the bone and RANKL inhibition could increase the risk of developing ONJ. Additionally, our result showing high frequency of ONJ development suggests racial differences and/or prevalence of unknown ONJ patients who are not receiving dental examinations.

eP254 RELATIONSHIP BETWEEN ORAL COMPLICATIONS AND DENTAL CONDITIONS IN THE PATIENTS RECEIVING CANCER THERAPY: A RETROSPECTIVE STUDY T. Kataoka1 1 Kobe Minimally Invasive Cancer Center, Dental Oncology, Kobe, Japan Introduction Oral supportive care including oral and dental care and management of oral complications is important for cancer patients. Objectives This retrospective study evaluated the relationship between oral complications and dental conditions in patients receiving cancer therapy. Methods Clinical records for 1,079 cases from April 2013 to December 2016 were analyzed. Patients’ dental conditions were checked before the start of cancer therapy. Oral supportive care was continued to maintain good oral hygiene, and to detect and manage oral complications early. Results Primary site was lung in 235, esophagus in 185, breast in 117, liver, gallbladder, and pancreas in 115, head and neck in 111, colon in 235, hematological cancer in 85, others in 126. Treatment was chemotherapy in 727, chemoradiotherapy in 352. NCI CTC-AE Grade 3-4 oral complications occurred in 373, including oral mucositis in 189, oral candidiasis

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in 75, tooth infection in 70, and osteonecrosis in 39. The median duration from latest dental visit was 6 months in both groups with and without G34 oral complications. There was a significant difference in the incidence of oral complications between more and less than 3 months from the latest dental visit (p<0.02). Conclusions Oral supportive care for cancer patients receiving anticancer therapy should begin before the start of treatment and continue until the successful completion of treatment, especially for the patients who don’t receive dental checkup and cleaning more than 3 months.

eP255 RETROSPECTIVE STUDY OF PATIENTS WITH MEDICATIONRELATED OSTEONECROSIS OF THE JAW TREATED CONSERVATIVELY T. konishi1 1 national cancer center hospital east, dental, chiba prefecture, Japan Introduction Treatment methods for medication-related osteonecrosis of the jaw (MRONJ) have yet to be established, and the number of patients with this condition is on the rise. Objectives In Japan, though several reports have described successful surgical treatments, there are few reports describing outcomes of patients receiving mainly conservative management because surgical treatment was considered to be difficult. We report a retrospective study of patients with MRONJ who received conservative treatment. Methods In total, 79 of the MRONJ patients who visited our department during the period from 2010 through 2016 were conservatively treated. These patients were retrospectively investigated. Results The patients were 38 men and 41 women, and their median age was 68 years. The most common primary disease was breast cancer, followed by prostate cancer. The median time to onset of MRONJ was 22 months (3– 112 months). Factors considered to have caused osteonecrosis were tooth extraction, 23 patients; apical and/or marginal periodontitis, 29; ill-fitting dentures, 13; unknown, 13; and implant, 1. The disease stage at first presentation was 0 in 21 patients, 1 in 3, and 2 in 55. All of these patients were treated conservatively (oral care, oral cleaning, and antibacterial administration). Conclusions When surgical treatment for MRONJ is regarded as being difficult, rather than choosing a surgical approach to expedite healing as the first line therapy, the possibility of conservative management should be considered. Long-term administration of appropriate antibacterial agents is a potential alternative that may compare favorably with surgical treatment.

eP256 ORAL COMPLICATIONS AFTER RADIATION THERAPY FOR HEAD AND NECK CANCER R. Lalla1, N. Treister2, T. Sollecito3, B. Schmidt4, L. Patton5, K. Mohammadi6, J. Hodges6, M. Brennan7 1 University of Connecticut Health, Oral Medicine, Farmington, USA 2 Brigham and Women's Hospital, Oral Medicine and Dentistry, Boston, USA 3 University of Pennsylvania, Oral Medicine, Philadephia, USA 4 New York University, Oral & Maxillofacial Surgery, New York, USA 5 University of North Carolina, Dental Ecology, Chapel Hill, USA 6 University of Minnesota, Biostatistics, Minneapolis, USA 7 Carolinas Medical Center, Oral Medicine, Charlotte, USA

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Introduction Radiation Therapy (RT) for Head and Neck Cancer (HNC) can cause significant oral complications. However, modern techniques such as Intensity Modulated RT (IMRT) may reduce their incidence/severity. Objectives To assess severity of oral complications 6 months after modern RT for HNC. Methods OraRad is an ongoing 6-center prospective cohort study. Oral outcomes are evaluated before start of RT (baseline), and 6, 12, 18, 24 months after RT. For this analysis, we compared baseline vs. 6 month data using mixed linear models for continuous measures and generalized estimating equations for categorical measures. Data are presented as outcome mean (SD, number of subjects), unless otherwise stated. Results Stimulated whole salivary flow declined from 1.09 ml/min (0.67, 354) at baseline to 0.47 (0.47, 216) at 6 months (p < 0.0001). Maximal mouth opening reduced from 45.58 mm (10.40, 371) to 42.53 (9.52, 208) (p < 0.0001). 17 of 203 subjects (8.4%) had persistent oral mucositis at 6 months. Overall oral health-related quality of life score (1-4 scale) worsened from 1.48 (0.42, 371) to 1.86 (0.47, 211) (p < 0.0001). Contributing to this decline were subject-reported negative changes related to swallowing solid food, choking when swallowing, opening the mouth wide, dry mouth, sticky saliva, smell, and taste (p < 0.0001). At 6 months, there was greater frequency of using dental floss, and greater proportion using supplemental fluoride (p < 0.0001). Conclusions Despite use of IMRT, HNC patients continue to suffer significant oral complications of cancer therapy, with negative impact on oral health, function, and quality of life.

eP257 EFFECTS ON SALIVATION OF THE MUCO-ADHESIVE DIETARY SUPPLEMENT AQUALIEF IN XEROSTOMIC PATIENTS: A RANDOMIZED MULTICENTER DOUBLEBLIND PLACEBO CONTROLLED PILOT STUDY F. Macchi1, L. Prof. Levrini2, C. Rumio3, G. Aldini4 1 Helsinn Healthcare SA, Head of Scientific and Clinical Portfolio Development-Helsinn Integrative Care, Lugano, Switzerland 2 University of Insubria, Department of Surgery and Medicine- Dental Hygiene School- Research Centre Cranio Facial Disease and Medicine, Varese, Italy 3 University of Milan, Dep. of Pharmacologial and Biomolecular Science, Milan, Italy 4 University of Milan, Department of Pharmaceutical Sciences, Milan, Italy Introduction Xerostomia (XE) is defined as dry mouth resulting from reduced or absent saliva flow. It may or may not be associated with decreased salivary gland function. Objectives Aim of this study was to investigate the effects of Aqualief®, a patented dietary supplement based on carnosine and Hibiscus extract, on salivation in patients suffering from Xerostomia from different etiologies. Methods Eleven adult consecutive patients presenting XE grade 1-2 RTOG/EORTC were enrolled. Patients were randomly assigned to Aqualief® or placebo (P) and instructed to stick on the cheek (oral mucosa surface) the mucoadhesive tablet three times per day for 7 days. Effects on saliva production were evaluated through the measurements of the volume of saliva at T-0 and T=7dd, with and without mechanical stimulation. Impact on QoL of XE was evaluated according to the Thomson’s modified questionnaire.

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Results On the eleven patients enrolled, both treatments resulted as safe. Al the subject of the Aqualief® group showed a significant increase (+28%) of the unstimulated saliva production (P<0.002), while, no significative differences have been observed in the P group; mechanical stimulation did not affect saliva production in both groups. Aqualief® had a positive effect on XE starting from T=1dd (Thomson’s Questionnaire). Also QoL parameters improved over 7 days of treatment. Conclusions Aqualief® is a safe, well tolerated and effective product that can improve saliva production and QoL in Xerostomic patients.

eP258 ORAL POTENTIALLY MALIGNANT DISORDERS AND ORAL CANCER IN NEPALESE DENTAL PATIENTS A. Acharya Mainali1, B. Acharya2 1 Nepal Medical College, Department of Oral Medicine and Radiology, kathmandu, Nepal 2 Nepal Medical College, Department of Prosthodontics, Kathmandu, Nepal Introduction Oral cancer is the sixth most common cause of cancer related deaths and is a worldwide problem. Oral potentially malignant disorders (OPMDs) describe oral lesions and conditions associated with a risk of malignant transformation. Early detection, treatment and identification of patients at risk remains the most important approach for reducing the risk of malignant transformation associated with OPMDs. Objectives To determine the prevalence, types, and risk factors of OPMDs and oral cancer among a group of Nepalese dental patients, and to evaluate their awareness and attitudes towards early diagnosis and treatment. Methods A total of 2500 patients attending a Dental Hospital were examined for the presence of OPMDs. Few clinically diagnosed cases were sent for histopathological examination and patients were interviewed to evaluate their knowledge attitudes towards early detection and treatment of oral cancer. Results The prevalence of OPMDs was 6% and oral cancer was 2%. Lichen planus was the most common lesion (54.1%) followed by leukoplakia (14.1%), Oral submucous fibrosis (31.6%). Smoking, Smokeless tobacco age (>36 years) were the main identifiable risk factors. Most patients with OPMDs had fear for cancer (56.6%), however there was general lack of awareness, negative attitude (58.3%) towards early diagnosis and supportive treatment. Conclusions OPMDs among dental patients are relatively common and awareness about oral cancer among Nepalese dental patients is low. Necessary steps need to be taken to improve public knowledge about oral cancer and attitudes toward early diagnosis, supportive care and treatment.

eP259 ORAL CANCER AND SUPPORTIVE CARE KNOWLEDGE AMONGST UNDERGRADUATE DENTAL STUDENTS A. Acharya Mainali1, P. Gupta2 1 , Oral Medicine and Radiology, Kathmandu, Nepal 2 , Department of Oral Medicine and Radiology, Kathmandu, Nepal Introduction Oral cancer is one of the most debilitating of all malignancies. Though the oral cavity is amenable to routine screening and clinical examination for malignant changes, oral cancer remains a highly lethal disease. Deficiencies in training, which hinder the recognition and supportive care

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of lesions may also contribute to the delayed diagnosis and discomfort of patients along with other factors. Objectives To assess the knowledge and awareness about oral cancer and supportive care among undergraduate dental students. Methods A questionnaire-based study comprising 12 questions was carried out in clinically posted dental students of third year and final year students of college of dental sciences and hospital, Nepal Medical College. The total number of participants were 100. Results The majority of students were aware of oral cancer (94.0%) and recognized signs and symptoms of oral cancer. A satisfactory knowledge was observed on risk factors(98%) and on supportive care (92%); unsatisfactory knowledge was observed about treatment cost (89%), (68%) were unsure about where to refer the patients with oral cancer. 96% of students preferred to have more training in oral cancer diagnosis methods and treatment options available. Conclusions Early identification of oral cancerous lesions reduces rates of morbidity and mortality, increases the quality of life and lowers treatment costs. Education of future dentists starts from dental school and recent updates needs to be reinforced among students along with advanced training in detection and palliative care of cancer.

eP260 PATIENT COMPLIANCE FOLLOWING USE OF ARTIFICIAL SALIVA IN PATIENTS WITH XEROSTOMIA FOLLOWING RADIOTHERAPY A.M. 1 Oral Medicine and Radiology, Kathmandu, Nepal

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Introduction Xerostomia is subjective feeling of dryness in mouth. Xerostomia is often seen following irradiation of salivary glands during radiotherapy of patients with oral cancer. Use of artificial saliva product usually provides symptomatic relief for the patients. Objectives To see the efficacy of salivary substitute in irradiated patients with xerostomia and to know its effect in quality of life. Methods 30 xerostomic patients were distributed artificial saliva and were reviewed after a month. The patients were further asked about comfort, and their opinion towards cost and improvement in quality of life following usage of artificial saliva. Results 83% of patients reported comfort following usage of artificial saliva. 85% of the patients felt there was improvement in quality of life. However 25% of the patients felt the cost of artificial saliva quite unaffordable if they were to use regularly. Conclusions Artificial saliva increases quality of life in xerostomic patients. Provisions for distributing supportive medicines for irradiated patients should be made free if possible in developing countries like Nepal.

eP261 A RANDOMIZED PHASE 2 PLACEBO CONTROLLED TRIAL OF CLOBETASOL RINSE FOR TREATMENT OF ORAL CHRONIC GRAFT-VERSUS-HOST DISEASE J. Mays1, L. Curtis2, C. Bassim1, S. Steinberg3, J. Rose2, M. Cho2, J. Dodge1, C. Kanakry2, F. Yazdanie1, D. Avila2, K. Baird4, G. Grimes5, D. Fowler2, R. Gress2, F. Hakim2, S. Pavletic2

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National Institutes of Health- NIDCR, Division of Intramural Research, Bethesda, USA 2 National Institutes of Health- National Cancer Institute, Experimental Transplant Immunology Branch, Bethesda, USA 3 National Institutes of Health- National Cancer Institute, Office of Biostatistics and Data Management Section-, Bethesda, USA 4 FDA, Center For Biologics Evaluation and Research, Silver Spring, USA 5 National Institutes of Health, Clinical Center, Bethesda, USA Introduction Oral cavity involvement by chronic graft-versus-host disease (cGVHD) has a major impact on morbidity and health-related quality of life, but evidence-based topical treatments for oral chronic GVHD (oGVHD) are scarce. Objectives Here, through a phase 2 clinical trial (NCT01557517), we tested the safety and efficacy of oGVHD therapy using clobetasol 0.05% solution formulated under an FDA-monitored IND as an oral rinse in aqueous base to facilitate dispersion and adherence in the oral cavity. Methods This was a phase-2 open-label trial with an initial 2-week randomized double blind placebo-controlled period. The primary endpoint is the day 28 oGVHD response on the Oral Mucositis Rating Scale (OMRS). Patient-reported data, baseline and day 28 oral biopsies, salivary gland functional assessments, pharmacokinetic testing, endocrine and immunologic outcomes were collected. Results Thirty-two of 36 randomized pts completed the primary endpoint. Clobetasol rinse reduced oGVHD: median baseline OMRS score 48(24-85) vs. 14(5-60) on day 28(69% reduction, p<0.0001); 19% pts met criteria for complete response of oral cGVHD, 72% for partial response, and 9% had stable disease. Histopathologic severity was significantly reduced (p=0.0001), as was patient-reported oral pain* (p<0.05), oral sensitivity (p<0.01), OHIP-14 oral health related quality of life* (p<0.001), on a 5-point interval change scale (p<0.0001) and subjective oral dryness (p=0.01). However, no change was observed in saliva production. During the blinded period, the placebo group had a smaller mean improvement in OMRS score, 7%, than did the clobetasol group, 41%, p=0.003.

Conclusions Data suggest that 0.05% clobetasol oral rinse is effective and safe for the supervised treatment of oGVHD.

eP262 THE EFFECT OF PERIOPERATIVE ORAL HEALTH CARE ON THE IMPROVEMENT OF THE ATTITUDE TOWARDS ORAL HEALTH IN PATIENTS UNDERGOING CANCER SURGERY H. Nakata1, K. Matsuo2, H. Suzuki1, R. Watanabe1, M. Okamoto2, H. Taniguchi2, K. Nakagawa2 1 Fujita Health University Hospital, Dentistry/ Oral and Maxillofacial Surgery, Toyoake- Aichi, Japan 2 Fujita Health University, Dentistry, Toyoake- Aichi, Japan

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Introduction Perioperative oral health care can prevent postoperative complications, but it is also important to maintain patients’ oral health after surgery to prevent the other adverse events by postoperative chemotherapies. Objectives The aim of this study was to examine (1) the relationships between the attitude towards oral health (ATOH) and oral health status (OHS) in patients undergoing cancer surgery and (2) the changes in the ATOH by perioperative oral health care. Methods Patients who underwent a cancer surgery and visited hospital dental clinic before the surgery were prospectively recruited. A questionnaire assessed the ATOH before and after the surgery. Their answers were classified into positive and negative ATOH groups. The OHS including the number of tooth and periodontal status was assessed before the surgery. The relationships between ATOH and OHS, and the perioperative changes in ATOH were statistically tested. Results A total of 507 patients answered the baseline questionnaire before surgery. Of those, 324 patients answered the same questionnaire after surgery as well. The OHS was significantly poor in negative ATOH than positive ATOH group. Positive answers for the ATOH significantly increased from 68.6% to 82.2% through the perioperative period. Conclusions We found that patients who had poor ATOH had poor OHS, but the ATOH could be improved by perioperative oral health care. These suggest that perioperative oral health care is important not only to prevent postoperative complications but to improve the oral health care knowledge and attitudes to maintain oral health status.

eP263 TOXICITY PROFILE AND SYMPTOM MANAGEMENT IN TWO DIFFERENT HEAD AND NECK CANCER TREATMENT REGIMENS: A COMPARATIVE STUDY S. Pandit1, S. Sapkota2 1 Kathmandu Cancer Center, Radiotherapy & Oncology, Bhaktapur, Nepal 2 Kathmandu Cancer Center, Radiotherapy & Oncology, Kathmandu, Nepal Introduction Toxicities of combined-modality treatment of head and neck cancers usually associated with significant morbidity and decreased quality of life. Different treatment modalities different toxicity profile and need adequate supportive care measures to decrease suffering while maintaining the ability to deliver full treatment. Objectives To evaluate the radiation therapy toxicities & role of supportive care and treatment compliance of patients in head & neck squamous cell carcinoma(HNSCC) treated with two different treatment modalities. Methods A total of 66 patients were studied. 40 patients underwent chemoradiation (Group A) while 26 patients received post-operative radiotherapy (Group B). Results Hospital admission required in 25%(10) patients in Group A and 20%(5) in group B. Feeding tube placement was needed in 3/40(7%) patients in chemo-radiation arm and 5/26 (19%) patients in postoperative radiotherapy arm. Overall 23% patients required hospital admission during radiotherapy for supportive management in which 10( 25%) patients were hospitalized during treatment in chemo-radiation arm and 5(20%) in postoperative radiotherapy arm. Acute toxicity encountered was mucositis, Group A : gr I:54.5%,gr II:18.18% and Group B: gr I 50% and gr II:29.2% at 1 month post RT.

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At 3 month follow up there was improvement in both arms with Gr I mucositis in 60.3% in Group A and 56.5% in Group B with no Grade II mucositis. Mucositis was managed with prophylactic baking soda gargle, local anesthesia solution. Pain was managed with NSAIDS and morphineConclusions Majority of head & neck cancer patient had significant problem during radiotherapy. Supportive management remains an important aspect in the management of radiation toxicities.

eP264 CHRONIC ORAL GRAFT-VERSUS-HOST DISEASE: CLINICIANAND PATIENT RATED OUTCOMES AND IMPACT ON QUALITY OF LIFE R. Slief1, A.M.G.A. Laheij1, F.R. Rozema1, J. de Lange2, J.E. RaberDurlacher2 1 Academic Centre for Dentistry Amsterdam ACTA, Oral Medicine, Amsterdam, The Netherlands 2 Academic Medical Center Amsterdam AMC, Oral and Maxillofacial Surgery, Amsterdam, The Netherlands Introduction Chronic Graft versus Host Disease (cGVHD) is a complication of allogeneic hematopoietic stem cell transplantation. The oral cavity is often affected, presenting with mucosal changes, dryness and taste change, or sclerodermatous changes. Objectives To study associations between objective (clinician-rated) and subjective (patient-rated) oral cGVHD assessments and to examine the influence of oral cGvHD on patients’ quality of life (QoL). Methods Sixteen patients diagnosed with oral cGVHD filled out questionnaires on oral symptoms (PRO-oral cGVHD and OHIP-14) and QoL (EORTC QLQC30/OH-17). Mucosal changes were scored (NIH-score), salivary flow rates (stimulated and unstimulated), and mouth opening were measured. Results A strong correlation was found between objective and subjective oral dryness (r = -0.92, p<0.01). However, objective and subjective assessments of oral mucosal cGVHD did not correlate. A negative correlation was found between QoL ratings and experiencing pain and discomfort in the oral cavity and having trouble eating (r = -0.599 p = 0.014 and r = 0.614 p = 0.011). No significant correlation was found between oral dryness, mucosal cGVHD, and fibrosis/sclerosis. Conclusions Objective and subjective oral dryness assessments were strongly associated. In contrast, objective and subjective assessments of oral mucosal cGVHD did not correlate. No associations could be identified between oral dryness, mucosal cGVHD and sclerodermatous changes suggesting that these features may occur in isolation. Having trouble eating and experiencing oral pain and discomfort were associated with diminished QoL. Our results point to the importance of including patient-reported outcomes in clinical evaluation of oral cGVHD.

eP265 THE RELATIONSHIPS BETWEEN ORAL INTAKE AND DAYS TO DISCHARGE AFTER TREATMENT IN PATIENTS WITH HEAD AND NECK CANCER UNDERGOING CHEMORADIOTHERAPY H. Sakamoto1, K. Matsuo2, M. Fujita1, M. Okamoto2, H. Taniguchi2, K. Nakagawa2 1 Fujita Health University Hospital, Dentistry/ Oral Maxillofacial Surgery, Toyoake, Japan 2 Fujita Health University, Dentistry/ Oral Maxillofacial Surgery, Toyoake, Japan

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Introduction Nutrition and food oral intake are important factors in mortality and quality of life of patients with head and neck cancer receiving chemoradiotherapy. Objectives The aim of this study was to examine the relationships total and oral intake calories during chemoradiotherapy (CRT) and days to discharge after completing the CRT. Methods We collected retrospectively the nutritional data of 35 patients with head and neck cancer who underwent CRT and visited hospital dental clinic before the treatment. The data of the amount of total intake calories including tube feeding and parenteral nutrition, oral intake calories and body mass index (BMI) at before CRT and one week before the completion of CRT (late CRT) were extracted from the medical chart. Days to discharge from the day of completion of the CRT were also calculated. We tested the correlations between days to discharge and the nutritional status measures using simple correlation and multiple regression analysis. Results Total intake calories before or at late CRT were not significantly associated with days to discharge after CRT, but oral intake calories at late CRT had significant correlation with days to discharge after CRT (r = -0.54, p = 0.002). BMI had no significant correlation with days to discharge either. Conclusions Our findings suggest that the ability of oral intake during chemotherapy is associated with a hospital stay after CRT. The influencing factors to oral intake during CRT such as oral mucositis, dysphagia, pain and nausea should be concerned when patients receive the CRT.

eP266 FINANCIAL AND SOCIO-ECONOMIC FACTORS INFLUENCING POST CANCER THERAPY ORAL CARE D. Smith1, E. Castellanos2, B. Murphy2 1 Vanderbilt University Medical Center, Biostatistics & Oral Maxillofacial Surgery, Nashville, USA 2 Vanderbilt University Medical Center, Oncology, Nashville, USA Introduction Cancer therapy can result in lifelong detrimental changes to oral function. These changes often result in negative effects on patients' quality of life. Objectives The primary objective of this study is to evaluate attendance at dental visits among patients receiving a cancer diagnosis, and how attendance may change through survivorship. Methods The Health and Retirement Study is a publically available dataset containing longitudinal survey data detailing financial and health information on 4195 patients, over 51 years old who received a new cancer diagnosis during the study. The odds of reporting a dental visit were examined as patients proceed through various phases of cancer therapy using a mixedeffects logistic regression model. Results The odds of attending a dental visit were substantially lower in the diagnosis wave OR = 0.784 (0.700, 0.876) and the post-diagnosis waves OR = 0.734 (0.655, 0.823) compared to pre-diagnosis waves. This effect persisted in patients who survived for at least two years indicating that the decline in oral health visits was not due to extremely low expected survival. The decrease in oral health visits was not affected by age, race, gender, income, insurance coverage or education. Patients who attended a dental visit at diagnosis demonstrated a reduced hazard of all-cause mortality HR = 0.825 (0.681, 0.979) compared with those with no attendance. Conclusions Dental attendance decreases by a statistically and clinically significant amount both during and after cancer therapy. Decreases in care were

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not modified by socioeconomic factors suggesting that it is not strictly financially motivated.

eP267 MUCOSAL AND DENTAL LATE EFFECTS IN LONG-TERM SURVIVORS AFTER ALLOGENEIC STEM CELL TRANSPLANTATION WITH NORWEGIAN CONDITION REGIMEN PERFORMED DURING CHILDHOOD, ADOLESCENCE OR YOUNG ADULTHOOD. K.E. Tanem1, P. Wilberg1, P.P. Diep2, E. Ruud2, L. Brinch3, A.B. Skaare1, B.B. Herlofoson1 1 University of Oslo / Institute of Clinical Dentistry, Department of oral surgery and oral medicine, Oslo, Norway 2 Oslo University hospital- Rikshospitalet, Department of Pediatric Medicine- Women and Children’s Division-, Oslo, Norway 3 Oslo University hospital- Rikshospitalet, Department of Hematology, Oslo, Norway Introduction Long-term survivors (LTSs) of allogeneic hematopoietic stem cell transplantation (HSCT) may experience oral late effects like lichen planus-like changes, a diagnostic criterion for chronic oral graft versus host disease (GvHD) (NIH criteria), and dental developmental disturbances. The conditioning regimen used in Norway is mainly busulphan-based chemotherapy without total body irradiation (TBI). Objectives The primary aim of the study was to investigate oral late effects in LTSs after allogeneic HSCT. Methods At Oslo University Hospital 157 LTSs treated with allogeneic HSCT before the age of 30, were invited to participate in this multidisciplinary study. Data were collected through i) a validated questionnaire survey with self-reported oral health ii) an oral examination including registration of mucosal changes and dental developmental disturbances and iii) panoramic x-ray. Results The oral examination was undertaken in 100 participants, 64% of the invited. Seventy-four (74%) were treated with allogeneic HCST for malignant diseases. Lichen planus-like changes were identified in 23 (23%). In addition to these, 21 (21%) LTSs had one or more distinctive signs and symptoms of GvHD. In these xerostomia was reported in 17, mucoceles registered in three, mucosal atrophy in three and oral ulcers in one of the participants. Dental developmental disturbances were registered in 14 out of 18 participants treated ≤5 years. Among these, microdontia was registered in 11, agenesis in 10 and hypoplasia in eight. Conclusions The results indicate that although treated with mainly busulphanbased chemotherapy without TBI, many LTSs experience oral side effects after allogeneic HCST which may affect their oral health negatively.

eP268 PROSPECTIVE COHORT STUDY OF ORAL HEALTH PROMOTION PROGRAM FOR HEAD AND NECK CANCER PATIENTS RECEIVING RADIOTHERAPY H.G. WU1, E. Kim1, D.H. Han2, H.J. Lee2, J.H. Kim1 1 Seoul National University College of Medicine, Department of Radiation Oncology, Seoul, Republic of Korea 2 Seoul National University College of Dentistry, Department of Preventive and Social Dentistry, Seoul, Republic of Korea

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Introduction Many patients who receiving radiotherapy (RT) for head and neck cancer (HNC) suffer from oral complications. But there is no standard program to prevent to RT-induced oral complications. Objectives To develop oral health promotion program and evaluate its effectiveness in HNC patients receiving RT. Methods This was an open-label, non-randomized, prospective study in 84 HNC patients treated with RT. Dental health promotion program consisted of oral exam, oral health education, fluoride varnish and mouthwash. Fortyseven patients were assigned to an experimental group with the dental health care program and 37 to a control group. Clinical benefit was measured by EORTC QLQ-H&N35 and the oral examination before and up to 6 months after RT. Results Compared with the control group, the experimental group showed significant improvement in sexuality, use of pain killers, and worried about future (p = 0.045, p = 0.049, and p < 0.001, respectively). Oral health promotion program did not affect the development of xerostomia. Subgroups of patients with old age (≥ 60 years), stage IV HNC, and radical RT reported significant improvement in quality of life by oral health promotion protocol. Although caries experience significantly increased in a control group (p = 0.002), there was no significant change in an experimental group. The experimental group showed significantly decreased plaque score and bleeding on probe (p < 0.001 and p = 0.004). Conclusions Administration of our oral health promotion program decreased dental problems and slightly improved patients’ quality of life. We recommend the dental care program for HNC patients receiving RT.

eP269 EXPERIENCES OF LESBIAN, GAY, BISEXUAL, AND T R A N S G E N D E R ( L G B T ) C A N C E R S U RV I V O R S , A QUALITATIVE STUDY A. Alpert1, L. Margolies2, L. Darbes3, J. Griggs4, C. Kamen5 1 Cambridge Health Alliance, Internal Medicine, Cambridge, USA 2 LGBT Cancer Network, Founder and Executive Director, New York, USA 3 University of Michigan, School of Nursing- Department of Health Behavior and Biological Sciences, Ann Arbor, USA 4 University of Michigan, Internal Medicine- Hematology & Oncology Division, Ann Arbor, USA 5 University of Rochester, Surgery- Cancer Control Unit, Rochester, USA Introduction LGBT patients with cancer are often invisible in cancer studies because data regarding sexual orientation and gender identity are rarely collected. Similarly, the experiences of LGBT patients with cancer have not been explored. Objectives This qualitative study investigated the experiences of LGBT cancer survivors. Methods 307 LGBT cancer patients with various cancers completed an online survey that included the prompt: “If you were to give a class to healthcare workers, focused on cancer care, what would you tell them about being LGBT and being diagnosed with cancer?” Participants were recruited through LGBTspecific websites, and the survey was posted January to April 2012. Two researchers conducted open coding, a code book was generated collaboratively, themes were clustered and refined, and the data were re-coded. Results Five themes emerged: LGBT cancer patients (1) are confronted with gaps in provider knowledge and skills, assumptions about sexual orientation and gender identity, and mistreatment that lead to suboptimal care; (2)

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receive more effective care when their support networks are included; (3) want safe clinical encounters in which to disclose their identities; (4) have differing experiences based on multiple intersecting identities; and (5) are resilient in the face of morbidity and marginalization. Conclusions LGBT cancer survivors report ongoing challenges accessing competent cancer treatment. To address this, providers could use inclusive language, inquire about patients’ identities, and include chosen support people. Learning about diverse LGBT communities may minimize assumptions. Acknowledging the resilience of LGBT cancer survivors may improve relationships between patients and providers.

eP270 A PROSPECTIVE STUDY ON ANAEMIA IN CANCER PATIENTS UNDERGOING RADIOTHERAPY AND CHEMOTHERAPY IN NATIONAL HOSPITAL ABUJA, NIGERIA S.C. Aruah1 1 National Hospital Abuja, Radiation Oncology, Abuja, Nigeria Introduction Many cancer patients present with anaemia prior to radiotherapy and chemotherapy or may experience anaemia /worsening of anaemia at some point during treatment. Objectives Pattern of anaemia in cancer patients undergoing Radiotherapy and Chemotherapy using serial haemoglobin measurement. Methods 201 cancer patients of both sexes with histopathologically confirmed malignancies (solid cancers) were recruited over a period of 8 months. Pre-treatment Hb was taken on first day of consultation. Patients were distributed into Radiotherapy, Chemotherapy and Chemoradiation. Their Hb were measured once every 2 weeks. The whole process was terminated after 3 consecutive Hb reading. Anaemia was classified into: Less than 10g/dl - Severe anaemia10 - 10.9g/dl - moderate anaemia 11-11.9 g/dl - mild anaemia12 g/dl and above - no anaemia. Results Out of 201 cancer patients, 86.1% were female and 13.9% were male. Age range, 25 - 75 years, 100 patients were on Chemotherapy, 63 patients on Radiotherapy and 38 patients on Chemoradiation. The prevalence of anaemia in the study was 63%. At the end of therapy, 62% (100) patients on Chemotherapy and 55.6% (63) patients on Radiotherapy had their Hb level between 11-12g/dl, 39.5% (38) cancer patients on Chemoradiation had Hb value of 10-10.9 g/dl. At P- value > 0.05, there was no statistical significance on distribution of mean Hb, standard deviation based on sex and treatment type. Conclusions Prevalence of anaemia in the study group was found to be 63%. At 95% confidence interval, Chemotherapy had greatest impact on Hb level during therapy. Thus Chemotherapy; 9.60-10.62g/dl, Radiotherapy; 11.5212.1 3g/dl, Chemoradiation therapy; 10.98-11.3 6gIdl.

eP271 UNDERSTANDING OF BIOSPECIMEN STORAGE/SHARING: RACIAL/ETHNIC DIFFERENCES AMONG 710 CANCER PATIENTS AND HEALTHY SUBJECTS IN UNIVERSITY OF ROCHESTER NCI COMMUNITY ONCOLOGY RESEARCH (URCC-NCORP) NATIONWIDE STUDY M. Asare1, C. Kamen1, L. Peppone1, C. Heckler1, D. Wendler2, L. Minasian3, M. Feige4, A. Onitilo.5, C. Weil3, J. Long6, S. Cole7, G. Morrow1, M. Janelsins1 1 University of Rochester Medical Center, Surgery, Rochester, USA 2 NIH/CC/BEP, Clinical Center, Bethesda, USA

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NIH/NCI, NCI, Bethesda, USA Association for the Accreditation of Human Research Protection Programs- Inc, AAHRPP, Washington D.C, USA 5 Wisconsin NCORP, NCORP, Weston, USA 6 Cancer Research Consortium of West Michigan, Cancer Research Consortium of West Michigan, Rapids, USA 7 Dayton Clinical Oncology Program, Dayton Clinical Oncology Program, Dayton, USA 4

Introduction Difficulties in understanding informed consent documents containing language about biospecimen storage/sharing (BSS) may be a barrier to minority participation in cancer research. However, these difficulties are understudied. Objectives We examined whether white and non-white subjects who consented to a cognitive function study differed in their understanding of the ways their BSS could be used by researchers. Methods We analyzed data from female breast cancer patients scheduled to receive chemotherapy at NCORP sites and healthy controls. After consenting to a study about cognitive function, participants’ understanding of BSS was evaluated using four items for biospecimen sharing (score 0-4); three items for relevance to care (score 0-3); nine items for biospecimen use (score 0-9); and six for research purpose (score 0-6); a higher score indicates better understanding. Linear models were used to compare the mean scores between groups. Results 461 breast cancer patients and 249 healthy controls completed the survey. The white participants scored higher than the non-whites (mean scores 14.43 vs. 13.43) on the survey questions overall (p< 0.05). Whites were more likely than non-whites to correctly answer all the questions for the biospecimen use (42.1% vs. 34.4%, p<0.22), biospecimen sharing (31.3% vs. 28.1%, p<0.74), relevance to care (35.1% vs. 17.2%, p<0.01), and research purpose (4.1% vs. 1.4%, p<0.97). Conclusions Informed consent comprehension related to BSS is low overall across all racial/ethnic backgrounds, but non-whites’ scores remained lower than whites. Efforts should be made by researchers to make it easier for all study subjects, especially racial minorities, to understand informed consent form and BSS.

eP272 BIOMARKERS FOR CHEMOPREVENTATIVE CAPACITY OF NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS): A REVIEW OF THE LITERATURE A. Bobrowski1, A. Agarwal1, A. Furfari1, R. McDonald1, L. Rowbottom1, S. Chan1, P. Zaki1, B.A. Wan1, H. Lam1, A. Azad2,3,4, R. Chow1, G. Charames3,4,5, E. Chow1, C. DeAngelis1 1 Sunnybrook Health Sciences Centre- University of Toronto, Odette Cancer Centre, Toronto, Canada 2 Mount Sinai Services Inc., N/A, Toronto, Canada 3 University of Toronto, Laboratory Medicine and Pathobiology, Toronto, Canada 4 Mount Sinai Hospital, Pathology and Laboratory Medicine, Toronto, Canada 5 Sinai Health System, 5Lunenfeld-Tanenbaum Research Institute, Toronto, Canada Introduction Inflammation is an important part of the carcinogenic process. As such, there may be a role for non-steroidal anti-inflammatory drugs (NSAIDs) to lower inflammation and the associated risk of carcinogenesis. Genetic variations and short nucleotide variants (SNVs)

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may contribute to differences in effectiveness of NSAIDs for cancer prevention across patients. Objectives To examine the peer-reviewed evidence addressing biomarkers significantly associated with the chemopreventative capacity of regular NSAID use. Methods A literature search was conducted in OVID MEDLINE and Embase with the following keywords: “cancer”, “inflammation” and “biomarkers”. Studies reporting on genetic or protein biomarkers associated with cancer prevention, cancer recurrence, and/or the clinical efficacy and toxicity of NSAIDs in conjunction with mainline cancer treatment were considered eligible. Results Eight articles were included in this review, with 33 associated genetic predictors of NSAID chemopreventative capacity identified. Most commonly-reported associated genetic predictors were SNVs of the PTGS2 gene coding for the COX-2 enzyme (including rs5277, rs4638310, rs2383529, and rs5275) and SNVs of IL6 (including rs1800796 and rs1800795). While a negative association was identified by several studies between breast cancer and the use of COX-2 inhibitors, no such associations were identified for colorectal, lung and prostate cancers. Conclusions While there is evidence to support the preliminary identification of genetic predictors of NSAID chemopreventative capacity and NSAID response to certain cancers, more robust studies are needed to explore these associations and their therapeutic value.

eP273 CANCER, SEXUALITY AND HEATH CARE OFFER: WHAT ARE THE EXPECTATIONS AND NEEDS IN FRANCE? P. Bondil1, D. Habold2, D. Carnicelli2, F. Farsi3, E. Bauvin4 1 general hospital metropole-Savoie, urology-andrology, chambery, France 2 general hospital Metropole Savoie, urology-andrology, Chambery, France 3 Reseau espace sant Cancer, reseau regional de cancerologie, Lyon, France 4 Oncomip, reseau regional de cancerologie, Toulouse, France Introduction Sexual difficulties are usual reported unmet needs due to problems of specific health care offer. Objectives To identify the perceived needs of information, training and organization in the domain of cancer and sexuality in France. Methods To successively analyse the needs / demands / actions in three concerned populations from 2007 to 2015: a) cancer survivors: 101 counties committees of the national League (LCC) by using a questionnaire and phone interview, b) scientist associations: supportive cancer care association (AFSOS) and cancer regional networks association (ACORESCA) by using 3 annual surveys about the realized / planned specific actions, c) health care professionals (HCPs) (n = 41O): by using of validated questionnaire for training needs. Results For all: this problem appears as really important but its appropriation is still not realized and to know where to direct patients remains a challenge. Cancer survivors: if the motivation is strong for informing and helping patients, the only organized response relies on useful information documents / tools. Scientist associations: a progressive and partial response exists but mainly for fertility. HCPs: their usual confrontation explains a strong demand for both

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specific guidelines and better heath care offer visibility, and training for the most concerned/motivated. Conclusions all these successive surveys confirm that the national response remains insufficient. Only a minority of patients really benefit from specific care. There is a real expectation and a strong demand for a better visibility, access and organization of specific supportive care offer explaining the successive plan actions setting up in France.

eP274 SETTING UP OF ONCOSEXUALITY IN FRANCE: LESSONS FROM THE SUPPORTIVE CANCER CARE PILOT PLAN P. Bondil1, D. Habold2, D. Carnicelli3, F. Farsi4, E. Huyghe5, E. Bauvin6 1 general hospital metropole-Savoie, urology-andrology, chambery, France 2 General hospital metropole-Savoie, Supportive care, Chambery, France 3 genral hospital Metropole-Savoie, urology-andrology, Chambery, France 4 Reseau Espace Sante Cancer, reseau regional de cancerologie, Lyon, France 5 Centre Hospitalier Universitaire, urology-andrology, Toulouse, France 6 Oncomip, reseau regional de cancerologie, Toulouse, France Introduction 2/3 of French survivors report sexual problems but the majority does not receive the optimal information, care and cure they need. Objectives to analyze the main key-points and action levels noted during the setting up of oncosexuality in France. Methods 3 successive phases have been analyzed during the 11 years original process. Results 1) inventory phase (2005-2008): Major brakes. invisibility of offer; semantic difficulties; gaps of knowledge's/skills; shared communication difficulties; Positive points: real awareness to oncosexual dimension; Negative points. "sexual" morbidity is still not “serious”; engagement of too few motivated persons; multifactorial resistances; health care professionals (HCPs) are mainly reactive. To obtain both support and approval of HCPs & health institutions is a mandatory but not sufficient parameter. 2) operative phase (2009-2012): to optimize the oncosexual health care offer requires: a) to organize/coordinate the oncosexual cancer care continuum, b) to identify and promote an oncosexual trajectory by defining HCPs expected place/role and patient/couple needs, c) to inform/ sensitize/train all concerned actors, d) to have a skills/resources directory and clinical practice guidelines (CPGs) is a mandatory but not sufficient step. 3) expansion phase (2013-2016): 3 additional key-issues: a) to reinforce the politics of information and training thanks to helpful daily practice tools, b) to elaborate/diffuse/implement the CPGs, c) strong impact of attitude/exemplarity of physicians for legitimating oncosexual demand and organizing the specific supportive care response. Conclusions Optimal oncosexuality setting up is an individual/collective challenge requiring a multidisciplinary and multi-target process. This French experience may help other countries in spite of sociocultural and health systems particularities.

eP275 A RISK-SCORING MODEL FOR THE PREDICTION OF ENDOMETRIAL CANCER AMONG IRANIAN POSTMENOPAUSAL WOMEN Z. Bouzari1 1 Babol University of Medical Sciences, Obstetrics & Gynecology, Babol, Iran

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Introduction Abnormal uterine bleeding, very common among postmenopausal women, the chance of endometrial cancer is about 10% in women with postmenopausal bleeding. Objectives The aim of this study was to evaluate the accuracy measures of the newly developed predictive models, called MAD30, used to estimate the risk of endometrial cancer in postmenopausal women presenting with vaginal bleeding. Methods The present cross-sectional, descriptive and analytical study enrolled 112 postmenopausal women with abnormal bleeding presenting to Ayatollah Rouhani Hospital, Babol, Iran. These patients underwent transvaginal ultrasound and hysteroscopy and the samples sent for pathological examination. The logistic regression model and the receiver operating characteristic (ROC) curve were used. Furthermore, models among of bleeding, age, diabetes, BMI cut-off value (MAD30) were defined to predict endometrial cancer in this study. Results The present study found body mass index (BMI), menopause age, and a history of having diabetes diseases to be statistically significant in postmenopausal women with abnormal bleeding and endometrial cancer and also higher compared to those without the cancer (P=0.002, P=0.011, P=0.001 and P=0.015 respectively). According to the receiver operating characteristic (ROC) curve evaluation results, the best performance of MAD30 was 0.824 and 95% CI for ROC Area (0.71- 0.93) and best the cut-off ≥ 6, with a sensitivity of 71.43%, a specificity of 75.51% in postmenopausal women with vaginal bleeding which could predict endometrial cancer. Conclusions The present study recommends MAD30 predictive models as alternatives for predicting endometrial cancer in postmenopausal women with vaginal bleeding

eP276 SELF-REPORTED HEALTH (SRH) AND ACCESS TO CARE (AC) AMONG CANCER CAREGIVERS (CCS): ANALYSIS OF THE 2015 BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS) E. Castellanos1, S. Nikpay2 1 Vanderbilt University Medical Center, Hematology/Oncology, Nashville, USA 2 Vanderbilt University School of Medicine, Health Policy, Nashville, USA Introduction Caregivers are vital to the support of cancer patients. Caregiver wellbeing can impact patient-perceived quality of care. Objectives To compare SRH and AC in CCs and non-caregivers (NCs). To determine the relationship of caregiver burden to SRH and AC. Methods We used the Caregiver and Core Modules of the 2015 BRFSS, a federal health-related survey. Caregiver burden was graded according to time and task. SRH and AC between CCs and NCs were compared using t-test or Chi-Square testing. Associations of caregiver burden with SRH and AC were assessed with linear and logistic regressions. Results 1,910 CCs and 84,412 NCs were included. CCs were more likely than NCs to have cost barriers to seeing a physician (15% vs 9%; p < 0.001), depression (25.0% vs 17.9%; p<0.001), and poor mental health (mean days/month 5.7 vs 3.1; p<0.001). Increased task burden was associated with increased poor mental health days (low vs moderate/high: ß=1.8, 95% CI 0.5–3.1, p=0.008; ß=2.0, 95% CI 0.6–3.3, p=0.004) and likelihood of cost barriers (low vs moderate/high: OR 1.6, 95% CI 1.03–2.5, p=.035; OR 1.8, 95% CI 1.2–2.9, p=.008). Increased time burden was

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associated with more poor mental health days (low vs moderate/high: ß=1.5, 95% CI 0.2–2.7, p=.02; ß=4.4, 95% CI 3.3–5.6, p<.001). No differences between CCs and NCs in insurance, personal physician, check-ups, or physical health were identified. Conclusions CCs are more likely than NCs to report poor mental health, depression, and cost barriers to care. Risk of poor mental health and cost barriers to care increases with higher caregiver burden.

eP277 INTER-RATER RELIABILITY IN PERFORMANCE STATUS ASSESSMENT AMONG HEALTH CARE PROFESSIONALS: A SYSTEMATIC REVIEW R. Chow1, N. Chiu1, E. Bruera2, M. Krishnan3, L. Chiu1, H. Lam1, C. DeAngelis1, N. Pulenzas1, S. Vuong1, E. Chow1 1 Odette Cancer Centre - Sunnybrook Health Sciences Centre - University of Toronto, Institute of Evaluative Clinical Sciences, Toronto, Canada 2 The University of Texas MD Anderson Cancer Center, Department of Palliative Care and Rehabilitation Medicine, Houston, USA 3 Dana-Faber Cancer Institute - Harvard Medical School, Department of Radiation Oncology, Boston, USA Introduction Studies have reported that performance status (PS) is a good prognostic indicator in patients with advanced cancer. However, different health care professionals (HCPs) could grade PS differently. Objectives The purpose of this review is to investigate the PS scores evaluated by different HCPs as reported in the literature. Methods A literature search was conducted in Ovid MEDLINE and OLDMEDLINE from 1946 to Present (July 5, 2015), Embase Classic and Embase from 1947 to 2015 Week 26, and Cochrane Central Register of Controlled Trials up to May 2015. Information of interest was whether there was a difference of PS assessment between HCPs. Other statistical information provided to assess the agreement in ratings, such as Cohen’s kappa coefficient, Krippendorff’s alpha coefficient, Spearman Rank Coefficient, and Kendall’s correlation, was noted. Results Of the fifteen articles, eleven compared PS assessments between HCPs of different disciplines, one between the attending and resident physician, two between similarly-specialized physicians, and one between two unspecified-specialty physicians. Three studies reported a lack of agreement (kappa =0.19–0.26; Krippendorff’s alpha =0.61–0.63), four reported moderate inter-rater reliability (kappa =0.31–0.72), two reported mixed reliability, and six reported strong reliability (kappa =0.91–0.92; Spearman rank correlation=0.6–1.0; Kendall’s correlation =0.75–0.82). Four studies reported that Karnofsky performance status (KPS) had better interrater reliability than both the Eastern Cooperative Oncology Group Performance Status (ECOG PS) and the palliative performance scale (PPS). Conclusions The existing literature cites both good and bad inter-rater reliability of PS scores. It is difficult to conclude which HCPs’ PS assessments are more accurate.

eP278 REVIEW OF A PHARMACIST-LED TELEPHONE FOLLOWU P P R O G R A M F O R A M B U L AT O R Y PAT I E N T S RECEIVING CHEMOTHERAPY AT A TERTIARY CANCER CENTRE

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R. Chow1, C. Sun1, P. Sousa1, C. DeAngelis1, F. Charbonneau1, S. Chan1, M. Pasetka1 1 Odette Cancer Centre - Sunnybrook Health Sciences Centre - University of Toronto, Department of Pharmacy, Toronto, Canada Introduction The Odette Cancer Centre (OCC) Pharmacy’s clinical call-back program provides teaching and advice for patients new to receiving chemotherapy. Trained pharmacists and pharmacy students initiate and facilitate calls to follow-up with patients at home one to three days after their first treatment. During these calls the pharmacist/student assesses and manages patients with respect to presence and severity of treatment-related toxicities. Objectives The aim of this study was to examine a pharmacist-led telephone followup program in patients receiving parenteral anticancer therapy at the OCC through a retrospective chart review. Methods This was a retrospective study, whereby chart review was conducted to determine the number of patients called by the Odette Cancer Centre Pharmacy from June 5, 2013 to June 30, 2016. Patients were identified using the centre’s computerized physician order entry system, OPIS (Oncology Patient Information System), and chemotherapy scheduling system, CHARM (Chemotherapy Appointment Reservation Manager). This retrospective review was approved by Sunnybrook Health Sciences Centre’s research ethics board. Results From June 2013 to June 2016, 6,984 calls were made, of which 5,511 (78.9%) successfully reached patients. 3,184 unique patients were called, and the percentage of patients requiring more calls in the latter years declined. Conclusions While the total proportion of successful calls fell year-after-year, the number of patients who were never reached declined, highlighting the positive reception of this program. Future studies should investigate patient satisfaction, information learned, actions taken as a result of the follow-ups, and clinical outcomes.

eP279 DIABETES MELLITUS POST-CHEMOTHERAPY IN WOMEN WITH BREAST CANCER L.A.P.D. Cruz1, T.D.O. Gozzo1, A.J.F. Cassenote2, A.M.D. Almeida1 1 University of São Paulo at Ribeirão Preto College of Nursing, MaternalInfant and Public Health Nursing, Ribeirão Preto, Brazil 2 Faculdade de Medicina- University of São Paulo, Post-graduate Program in Infectious and Parasitic Diseases-, São Paulo, Brazil Introduction Cancer treatments may influence glycemic levels, especially after chemotherapy, and such changes have a negative impact in women overall survival. Objectives To identify the association between the development of diabetes mellitus (DM) and chemotherapy in women with breast cancer. Methods Descriptive study. Were enrolled 50 women with breast cancer who underwent chemotherapy at a university hospital in São Paulo stateBrazil. The variables used was age, occurrence of type 1 or 2 DM, duration of disease, fasting glycemia before and after chemotherapy and in the follow-up. Analyses of repeated means used to evaluate the different measures of fasting glycemia over time and among individuals with and without DM. Results 18% of the participants were diabetic and of these, 66.6% were diagnosed after the end of chemotherapy. The mean blood glucose for patients with DM presented a high variability when compared to individuals without the

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disease (1: 156.1 mg / dl vs 96.7 mg / dl, 2: 169.1 mg / dl vs 94.3 mg / dl and 176.0 mg / dl Mg / dl vs. 96.6 mg / dl - p-value <0.001 - between subjects). Conclusions The occurrence of DM and the attention to treatments should be part of the evaluation of health professionals, who should consider the physical conditions of women and the possible adverse effects that chemotherapy may cause. In addition, is necessary further studies about the consequences of breast cancer treatment on the metabolism and development of DM.

eP280 MEANING OF THE WORK ACTIVITIES TO YOUNG WOMEN WITH BREAST CANCER P.A.P.D. Magalhães1, M.S. Panobianco2, E.A.C.D. Loyola1, M.L. Borges2, T. de Oliveira Gozzo2 1 University of São Paulo at Ribeirão Preto College of Nursing, MaternalInfant and Public Health Nursing- PhD candidate, Ribeirão Preto, Brazil 2 University of São Paulo at Ribeirão Preto College of Nursing, MaternalInfant and Public Health Nursing, Ribeirão Preto, Brazil Introduction Breast cancer causes negative effects on work activities of women, specially the younger ones. Objectives To comprise the meanings of the breast cancer experience to young women related to work activities. Methods It’s a qualitative study developed in a Mastology Outpatient Clinic and a Mastectomized Rehabilitation Nucleus in Brazil. Discourse of the Collective Subject (DCS) was the methodological approach, and, Symbolic Interacionism was the theoretical approach used. The data collection occurred between February, 2014, to January, 2015. Inclusion criteria: medical records of women between 18 to 40 years old, and, with up to one year of the breast cancer diagnosis. Exclusion criteria: those women who could not express themselves, and had metastasis. Twelve women were interviewed using the guiding question: “Tell me about being a young woman with breast cancer in relation to work”. Thematic Content Analysis was applied to the DCS. Results Three theoretical categories were established: “To be young and to stop working: Sometimes, I feel invalid”; “The importance of the work for being woman and young: the work is the building up of the soul”, and “The removal of a young woman from her work activities and social relations”. The fact of a young woman has to be away from her work despite the illness meant powerless, inability and invalidity. Go back to work after the illness meant satisfaction, financial Independence, and freedom. Conclusions Despite the difficulties to go back to work, the support of family members, friends and coworkers was pivotal in coping this process.

eP281 S U F F E R I N G , L O V E , A N D S P I R I T U A L I T Y: T H E MANIFESTATION OF RELATIONSHIPS DURING ILLNESS OF LATIN-AMERICAN ADVANCED CANCER PATIENTS (LADCA) M. Delgado-Guay1, S. McCollom2, A. Palma3, E. Duarte4, M. Grez3, L. Tupper3, E. Bruera1 1 The University of Texas MD Anderson Cancer Center, PalliativeRehabilitation- and Integrative Medicine, Houston, USA 2 Institute for Spirituality and Health, Palliative Care, Houston, USA 3 Pontificia Universidad Católica de Chile, Palliative Care, Santiago, Chile 4 Instituto Nacional de Cancerologia, Palliative Care, Guatemala, Guatemala

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Introduction Patients with a life-threatening-illness are committed to living a “spiritual”-life, and presence of spiritual pain(SP) can be textured. Spirituality is a resource to cultivate hope, faith, acceptance and healing relationships. Objectives To describe the relationships of suffering, relationships, and spirituality in this population. Methods We interviewed 325 LAdCa at a Palliative Care clinic in Chile, Guatemala, and United States. Five open-ended questions were asked about spirituality, SP, and meaning. We employed a traditional, inductive qualitative narrative. Key-concepts and patterns emerged from individual accounts and examined as part of a collective-narrative. Recurring themes and frequency of language, were referenced for majority-based reporting. An interpretive phenomenological-analysis was engaged within psychosocial and psycho-spiritual frameworks, allowing the unfolding of shared story and meaning. Results Most of LAdCa described spirituality as an essential/guiding force in their daily-life, it was largely expressed as a feeling. This was manifested as a convergence of inner life informed by a spiritual/religious framework. Most participants linked spirituality to God/divinity, while meaning was almost always derived from connections, relationships (family). Family was the deepest source of love, mirroring, and accompaniment. At the same time, the majority of LAdCa reported profound SP/suffering during the height of their illness. Their SP stemmed largely from feelings of: 1)Profound loss(of loved ones/hope/ love-itself); 2)Acute aloneness(“emptiness”); and 3)Unworthiness. It was often described with language-specific to the body: an aching-heart/chest/ or soul. Conclusions Spirituality was reported as fundamental in the life of LAdCa. Search for internal-peace through relationship with self/others/and God might be a protection/buffering of the SP/suffering. More research is needed.

eP282 PALLIATIVE RADIATION THERAPY FOR INUIT PATIENTS FROM THE CANADIAN ARCTIC TERRITORY OF NUNAVUT; A 10 YEAR REVIEW K. Dennis1, J. Chan1, K. Linden2, C. McGrath3, J. Renaud2, P. Doering4, W. MacDonald5, M. Gaudet1, J. Pantarotto1, T. Asmis6 1 The Ottawa Hospital and the University of Ottawa, Division of Radiation Oncology, Ottawa, Canada 2 The Ottawa Hospital, Radiation Medicine Program, Ottawa, Canada 3 University of Ottawa, Faculty of Science, Ottawa, Canada 4 The Ottawa Hospital, Regional Cancer Program, Ottawa, Canada 5 Government of Nunavut, Department of Health, Iqaluit, Canada 6 The Ottawa Hospital and the University of Ottawa, Division of Medical Oncology, Ottawa, Canada Introduction Canadian Inuit from the isolated arctic territory of Nunavut suffer from high rates of aggressive cancers and they face challenges in accessing timely oncologic care. Delays in presentation, diagnosis and travel make late stage presentations common. Objectives Describe the palliative radiation therapy (RT) administered to this unique population. Methods Retrospective chart review of adult Inuit patients from Nunavut treated with RT between 2005-2014 inclusive at The Ottawa Hospital, the oncology referral centre for Inuit from the Qikiqtalluq region, the most populated area of Nunavut that includes the capital Iqaluit.

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Results Of 152 total treated patients, 88 received a total of 178 courses of palliative RT. 53% were male and 47% female. Their mean age was 62 years (range 27-89 years). Their most common primary tumors were lung (72%), colorectal (9%) and breast (8%). Of 30 total courses for brain metastases, 23 treated the whole brain (median dose 20Gy, range 830Gy) and 7 treated isolated metastases with stereotactic RT. Of 60 total courses for thoracic disease, the median number of fractions was 5 (range 1-5), and the median dose was 20Gy (range 3.5-40Gy). For all 178 courses of palliative RT, the median time from a decision to treat to RT initiation was 6 days (range 0-139 days). Conclusions To our knowledge this is the first dedicated report of palliative RT administered to Canadian Inuit patients. An in-depth analysis of oncologic outcomes as well as operational and resource issues is ongoing in cooperation with the Nunavut Research Institute and the Nunavut Department of Health.

eP283 HOME CAR E FO LLOW-UP F OR PATIEN TS AFTER AMBULATORY AND INPATIENT ONCOLOGICAL SURGERY: PRACTICAL ORGANIZATION M. di Palma1, M. Lacaze1, F. Jacquot1, M. Lopes1 1 Gustave Roussy, ambulatory department, Villejuif, France Introduction Surgical and anesthesiology procedure improvements have led to hospital stay reduction for patients undergoing oncological surgery and to development of ambulatory surgery. Financial incentives have promoted this further, in order to optimize hospital resources. Objectives For these patients, there is a need for an easy access to hospital. For hospital team it is important to organize patient follow-up in coordination with home care professionals in order to avoid unnecessary return of the patient to hospital. Since 3 years we have built a specific organization for these patients, centered on a Coordination Nurse (CN). Methods All patients leaving the hospital after surgery are given a unique phone number to call in case of any problem or question related to surgery. The 1st step was to create specific documents (“decision tree”) in order to help the CN to analyze patient’s situation and give appropriate answer. All the discussion between CN and patients were recorded. Results n 2011 CN received 2733 phone calls, in 2016 4359 calls. All the different kind of surgery performed in our hospital were concerned (breast, gynecology, digestive, , plastic and reconstructive surgery). 42% of the calls did not need the patient to come to hospital, 48% led to a consultation within the next 24-48h, 10% were mistakes (ie call for administrative purpose). Only few patients required to go to ER. Details (patient profile, surgery, …..) will be available for MASCC meeting. Conclusions Specific organization is mandatory in order to assure patients follow-up after surgery. CN centered organization is adapted and efficient.

eP284 COMPARING PERSPECTIVES OF MEN WITH PROSTATE CANCER AND HEALTH CARE PROFESSIONALS ABOUT ACTIVE SURVEILLANCE: IMPLICATIONS FOR PRACTICE M. Fitch1 University of Toronto, Bloomberg Faculty of Nursing, Toronto, Canada

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Introduction The practice of active surveillance (AS) with low risk prostate cancer (PC) is growing. Consideration of AS requires individuals to shift their ideas about cancer and treatment risk during emotional upheaval. Objectives This study explored the perspectives of men diagnosed with prostate cancer and health care professionals (HCP) regarding AS and the factors that influence decision-making about pursuing AS. Methods Focus groups were held across Canada with men (7 groups, N=56) diagnosed with PC and eligible for AS and with HCPs (5 groups, N= 48) caring for these men. Viewpoints were captured about practices concerning AS and factors influencing decision-making about AS. Content analysis was performed on the verbatim transcripts and a comparison made between men’s and HCP’s viewpoints. Results Men and HCPs agreed AS is for low grade disease, is intentional, avoids side effects, and allows time for treatment if the disease changes. All agreed that men could be comfortable with AS if there was no disease progression. Disease status was a priority for clinicians and men in deciding about AS. However, men emphasized quality of life is also a key consideration. Differences were evident regarding clarity around criteria for AS, interpretation of test results, what constitutes best practice approaches, clarity of information provided, how much information is needed, and the amount of time required to make a decision. Conclusions Differences in perspectives can be a source of tension between patients and clinicians. Communication and education efforts are needed to achieve clear shared perspectives on AS.

eP285 AN EXPLORATORY STUDY ON THE USE OF TRADITIONAL, COMPLEMENTARY AND ALTERNATIVE MEDICINES (TCAM) BY CANCER PATIENTS M. Fleury1, M. Beck Popovic2, S. Peters3, F. Sadeghipour1 1 Centre Hospitalier Universitaire Vaudois, Pharmacy, Lausanne, Switzerland 2 Centre Hospitalier Universitaire Vaudois, Pediatric HematologyOncology Unit, Lausanne, Switzerland 3 Centre Hospitalier Universitaire Vaudois, Oncology Department, Lausanne, Switzerland Introduction Oncology patients commonly self-administer traditional, complementary and alternative medicines (TCAM); physicians often do not adress this point in their interviews and fail to report such co-medications in their reports. Objectives Indirectly explore the use of TCAM by our patients, as evaluated through the interventions of our oncology clinical pharmacist. Methods Retrospective analysis of questions healthcare professionals asked the oncology department’s clinical pharmacist about TCAM in 2016. Anonymized patient data included: a) adult or pediatric status, b) type and name of TCAM used, c) TCAM indication as described by the patient, d) TCAM supplier, e) pharmacist’s recommendation concerning treatment continuation and rationale. Results Staff asked 110 questions (13 concerning children); 32 involved patients self-administering combinations of multiple substances. The three main patient-identified indications for their TCAM were: management of adverse drug effects (e.g. nausea) (n=54); potential anti-tumour activity (n=32); “detoxification” (e.g. chemotherapy drainage theory) (n=32). Most TCAM were bought in pharmacies (n=46). TCAM-provider data

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was missing in 33% of cases (n=36); the rest were of diverse origin. Only 44% of TCAM therapies were acceptable for continuation. Main reasons for discontinuing TCAM were drug–drug interactions (11%), toxicity of TCAM itself (10%) (e.g. should not be ingested), and unacceptable risk of subsequent adverse reaction (8%). Conclusions Cancer patients experiencing unmet support care needs or seeking new anti-tumor treatments may self-administer TCAM. To reduce the inherent risks of TCAM (drug interactions or toxicity), they should frequently be asked about TCAM. The ethical, professional and financial challenges of TCAM have yet to be explored.

eP286 ADVERSE HEALTH OUTCOMES ASSOCIATED WITH POSTDIAGNOSIS SMOKING IN PROSTATE CANCER PATIENTS: A LITERATURE REVIEW V. Ganesh1, P. Zaki1, S. Chan1, A. Turner1, B. Bristow1, L. Di Prospero1, L. Gibson1, A. Wan1, A. Agarwal1, C. DeAngelis1, E. Chow1 1 Sunnybrook Health Sciences Centre, Odette Cancer Centre, Toronto, Canada Introduction Recent studies suggest smoking to be a risk factor for prostate cancer (PC). There is growing evidence of an association between post-diagnosis smoking and various health outcomes in this patient population. Objectives To summarize the literature regarding the association between postdiagnosis smoking and adverse health outcomes in PC. Methods A literature search was conducted using Ovid MEDLINE and Embase to identify observational studies published between 1990-2016, reporting health outcomes in current compared to former and/or never smokers undergoing surgical resection, chemotherapy, hormone therapy or radiation treatment for PC. Identified hits were screened and data extraction for studies deemed eligible was conducted by paired reviewers. Results Thirty-six eligible studies were identified, reporting disease-related outcomes (e.g. survival, recurrence) (n=26) and treatment-related outcomes (e.g. adverse effects, second malignancies) (n=11). After adjusting for potential confounding variables (e.g. clinic-pathological features), there was strong evidence across studies of higher overall mortality and progression/recurrence in current smokers compared to former and/or never smokers diagnosed with PC; and some evidence of increased PC-specific mortality. Current smoking was also associated with increased incidence of secondary bladder malignancies and gastrointestinal/ genitourinary symptoms after radiation; and increased cardiovascular events and poorer bone health following androgen deprivation therapy. Dose-response relationships between smoking intensity/duration and adverse health outcomes were reported; and significant decreases in risks were observed in former compared to current smokers. Conclusions Our findings suggest significant morbidity and mortality associated with post-diagnosis smoking in PC patients, and supports the need for counseling regarding smoking cessation in these patients for improved disease progression and mortality risk control.

eP287 PACE STUDY: PHARMACOECONOMICS OF ANEMIA IN CANCER EVALUATION STUDY V. Launay-Vacher1, G. Deray1, F. Brocard2, X. Leuleu3, A. Frikha4, E. Legouffe5, A. Eche-Gass6, L. Miglianico7, P. Agape8, E. Loppinet9, G. Salmeron10, P. Beuzeboc11, J.J. Zambrowski12, F. Scotté13

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GH Pitié-Salpêtrière, Service ICAR- Dpt of Nephrology, Paris, France Centre d'Oncologie de Gentilly, Medical Oncology, Nancy, France 3 CHU de Poitier, Hematology, Poitier, France 4 Polyclinique Maymard, Medical Oncology, Bastia, France 5 Clinique Valdegour, Hematology, Nîmes, France 6 Institut Claudius Régaud, Medical Oncology, Toulouse, France 7 CHP Saint-Grégoire, Medical Oncology, Rennes, France 8 Institut René Gauducheau, Hematology, Saint-Herblain, France 9 Hôpital Belle Isle, Hematology, Metz, France 10 CHI de Poissy, Hematology, Saint-Germain-en-Laye, France 11 Institut Curie, Medical Oncology, Paris, France 12 Economie de la santé, Medsys, Neuilly sur Seine, France 13 Hôpital Européen Georges Pompidou, Supportive Cancer Care Unit, Paris, France 2

Introduction Chemotherapy-induced Anemia (CIA) is common in cancer patients. It may impact survival, outcomes and contributes to fatigue. The treatment includes iron supplementation, blood transfusions (BT) and erythropoiesis stimulating agents (ESA). Many studies compared the clinical aspects of CIA treatments in terms of survival, quality of life, safety, and efficacy. However, very few data are available on the pharmacoeconomic aspects of these treatments. Objectives The PACE study aims at evaluating the costs of CIA treatments by ESA and BT. This first phase of the study will focus on BT and epoetin beta treatments. Methods PACE is a prospective, multicentric, observational study conducted by Service ICAR, an academic research organization. The study is neither supported, nor funded by any pharmaceutical firm or health authority. It is planned to include 400 cancer patients (non-myeloid) treated with BT or epoetin for CIA. A pharmacoeconomic evaluation will be performed based on a patient questionnaire to determine all resources involved in the treatment, matched with clinical data collected by Service ICAR. The Quality of Life (QoL)will also be measured (EORTC-QLQ-C30), in each patient included. Results The PACE study will 1) estimate the actual costs of BT in the management of CIA, 2) compare the costs of CIA treatment between BT and epoetin-beta, and 3) compare the impact of treatments on QoL. Conclusions At time of abstract submission, the PACE study is running in 21 centres in France, and 60 patients have been included to date.

eP288 PREVALENCE OF SMOKING, AWARENESS ON HEAD AND NECK CANCER (HNC), AND ATTITUDES TOWARDS HNC EDUCATION AMONGST SECONDARY SCHOOL STUDENTS IN IBOKUN TOWN, SOUTHWESTERN NIGERIA K. Kanmodi1, F. Fagbule1, T. Aladelusi2 1 Cephas Health Research Initiative, Department of Cancer Research, Ibadan, Nigeria 2 University of Ibadan, Department of Oral and Maxillofacial Surgery, Ibadan, Nigeria Introduction Head and neck cancer (HNC) is one of the leading causes of cancer deaths worldwide. Tobacco is a major risk factor for HNC. The rate of global increase in tobacco use among adolescents is alarming and this calls for urgent intervention. Objectives To determine the prevalence of smoking, to explore the level of awareness on HNC and attitudes towards HNC education among students in two secondary schools in Ibokun, Nigeria

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Methods A descriptive cross-sectional study was conducted among 198 Grades 9 to 12 students in two conveniently selected secondary schools in Ibokun town, Nigeria. Study tool was a self-administered questionnaire adapted from the Global Health Professionals Survey (GPHS) Questionnaire on tobacco use. Data collected were analyzed using SPSS version 16 software. Results The majority (54.0%) of the respondents were ≤14 years old, 56.6% were females, 41.9% were in Grade 10, 55.6% had a monogamous family background, and 30.3% were the first born child of their parents. Only 67.7% and 56.6% had ever heard of cigarettes and water pipe respectively. Only 87.4% had never smoked, 3.5% had quitted smoking, 4.5% were smokers who desired to quit smoking, while only 2.0% were smokers who desired to continue smoking. Only 47.5% have heard of HNC before, 31.8% indicated that they know the symptoms of HNC, and 81.8% would like to receive a comprehensive education on how to prevent HNC. Conclusions The prevalence of smoking among the respondents in this study is low. Many of them were unaware of HNC, yet they like to be educated on HNC.

eP289 SHOULD TOBACCO ADVERTISEMENTS, SALES, AND USE BE BANNED? - OPINIONS OF SECONDARY SCHOOL STUDENTS IN IBOKUN TOWN, STATE OF OSUN, NIGERIA F. Fagbule1, K. Kanmodi1, T. Aladelusi2 1 Cephas Health Research Initiative, Department of Cancer Research, Ibadan, Nigeria 2 University of Ibadan, Department of Oral and Maxillofacial Surgery, Ibadan, Nigeria Introduction Long-term exposure to secondhand tobacco smokes is a cancer risk factor. In 2009, the government of the State of Osun, Nigeria, passed the tobacco control bill into law, prohibiting the advertisement and use of tobacco products in public places. Objectives To explore the level of exposure to secondhand tobacco smokes among adolescents in Ibokun, Nigeria. To also explore their opinions towards public advertisement, sales, and use of tobacco Methods A cross-section of 198 Grades 9 to 12 students from two conveniently selected secondary schools in Ibokun, Nigeria, were surveyed in this questionnaire-based study. Information on the biodata, exposure to secondhand tobacco smokes, and attitudes towards public advertisement, sales and use of tobacco products were obtained from each participant. Data collected were statistically analyzed. Results The majority (54.0%) of the respondents were ≤14 years old, 56.6% were females, 41.9% were in Grade 10, while 51% reside in a flat. Only 5.1% were recently exposed to daily secondhand tobacco smoke within the past 7 days, 19.7% reported that smoking ban policy is not enforced in their schools, 70.3% opined that public advertisement of tobacco products should be completely banned, 53.0% opined that tobacco must not be sold to persons below 18 years, while 69.7% opined that smoking should be banned in restaurants, discos, bars, and pubs. Conclusions Only few adolescents in this study are at risk of developing cancers associated with secondhand tobacco smokes, if continually exposed to such smokes. The majority of the adolescents in this study were against public promotion of tobacco products.

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eP290 IMPACT OF HEAD AND NECK CANCER (HNC) EDUCATION ON NIGERIAN ADOLESCENTS’ KNOWLEDGE AND ATTITUDES TOWARDS HNC AND HNC EDUCATION ADVOCACY: THE CHANCE* PILOT STUDY K. Kanmodi1, F. Fagbule1 1 Cephas Health Research Initiative, Department of Cancer Research, Ibadan, Nigeria Introduction Cancer education has been found effective in reducing the prevalence of risky pro-cancer behaviors among adolescents. For this reason, the Cephas Health Research Initiative Inc, Nigeria, embarked on the CHANCE* (Campaign for Head And Neck Cancer Education) Program to reduce the prevalence of head and neck cancer (HNC) risk factors among Nigerian adolescents. Objectives To explore the impact of HNC education on secondary school students’ knowledge of the etiologies and symptoms of head and neck cancer (HNC). To also explore the impact of HNC education on their willingness to educate other persons about HNC Methods An interventional study was conducted among science and technical students (n=103) in a public boarding school in Ilesa Town, Southwestern Nigeria. A well-structured questionnaire was used to obtain information from each participant before and after a session of HNC education. Collected data were cleaned, and analyzed using SPSS version 16 software. Results Mean age (±SD) of respondents was 13.89 (±1.01) years, 72.8% were males, while 82.5% were Yorubas. There was a remarkable increase in the mean (±SD) knowledge scores of respondents’ knowledge of HNC etiology (7.3%[±22.5%] versus 68.3%[32.4%]) and symptoms (9.1%[±23.9%] versus 71.4%[33.3%]) after the session of HNC education. There was a statistically significant increase in the number of respondents that were willing to educate their friends about HNC cancer after the education session (87.4% [pre-test] versus 88.3% [post-test], [X2: p<0.001; df=4]). Conclusions Head and neck cancer education markedly improved adolescents’ knowledge of HNC. Adolescents can be advocates of HNC prevention if made knowledgeable about HNC.

eP291 MAKING AN INFORMED DECISION: THE DISCREPANCY BETWEEN A PATIENT’S RECALL OF INFORMATION AND THE INFORMATION NEEDED FOR ACQUISITION OF RADIOTHERAPY INFORMED CONSENT D.Y. Kim1, H.R. Lee2, C. Lim3, H.G. Yun4, S.H. Kang5 1 Dongguk University Ilsan Hospital, Department of Internal Medicine, Goyang, Republic of Korea 2 Inje University Ilsan Paik Hospital, Department of Internal Medicine, Goyang, Republic of Korea 3 Dongguk University, Biostatistics of School of Medicine, Seoul, Republic of Korea 4 Dongguk University Ilsan Hospital, Department of Radiation Oncology, Goyang, Republic of Korea 5 Inje University Ilsan Paik Hospital, Department of Radiation Oncology, Goyang, Republic of Korea Introduction To give informed consent, a patient needs to understand sufficiently the information provided by a physician to decide among treatment options.

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Although shared decision-making is becoming an important aspect of patient-centered care, little is known about decision-making by cancer patients in Korea. Objectives This study assessed patients’ understanding of treatment goals and the need to obtain further information after a physician provided information regarding radiotherapy prior to taking informed consent. Methods In this prospective study, doctors and patients completed questionnaires independently after informed consent for radiotherapy had been obtained. The questionnaires for the doctors and patients comprised matched items regarding treatment aims and the need for further information. Results The study enrolled 103 cancer patients scheduled for radiotherapy. The proportion of respondents who stated that the intent of treatment was to obtain a cure was 80.6% among the patients (83 of 103 patients) and 53.4% (55 of 103 patients) among the doctors (p=0.000). The proportion of respondents who believed that the aim was life prolongation was 17.5% and 1.9%, respectively (p=0.000). Regarding the need for further information, 42.7% (44/103) of the patients did not want further information because they had faith in the physicians’ medical expertise. Conclusions Many cancer patients misunderstood their treatment aims while half of participants did not want further information. Physicians should address whether specific interventions can solve these barriers so that Korean cancer patients can make truly autonomous treatment decision.

eP292 CLINICAL SIGNIFICANCE OF BRCA GENE TESTING AMONG OVARIAN CARCINOMA : CAN ADVANCED STAGING BE AN OBSTACLE FOR ACCEPTANCE OF COUNSELING? M.K. Kim1, M.J. Yun2, M.J. Kwon2 1 Samsung Changwon Hospital, Obstetrics and Gynecology, ChangwonSi, Republic of Korea 2 Samsung Medical Center, Obstetrics and Gynecology, Seoul, Republic of Korea Introduction BRCA testing and genetic counseling was highly recommended for women who had strong family history among ovarian cancer. There are some barriers for offering genetic counseling and acceptance according to disease severity. Objectives We undertook this study to investigate whether advanced staging can be a barrier in BRCA testing and genetic counseling. Methods A case control study was done between early (I-II) and advanced (III-IV) ovary carcinoma patients regarding BRCA mutation and genetic counseling acceptance. Total 34 patients were evenly divided between them. After complete surgical staging and pathology result, single gynecologic oncologist offered genetic counseling about risk assessment based on pathology, family history and immunohistochemistry. BRCA1/2 gene sequencing were done. Results Total 34 patients were divided by early stage (n=17) and advanced stage (n=17) respectively. Advanced stage group was older than early stage group, median age of 52.53(19~73) vs 57.77(45~75). In contrast to early stage group, advanced stage group had high proportion of serous carcinoma (6/17 (35.3%) vs 15/17 (88.2%) and short DFS (22.27 months vs 10.87 months). Among 34 patients, only 2 patients refused BRCA testing and gene counseling at each group. In early stage group, BRCA testing period after the diagnosis

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and total genetic counseling time was longer than advanced group. BRCA1 was found by three patients in advanced stage group only and BRCA2 was not detected in all groups. Conclusions Genetic counseling at advanced stage of ovary cancer by gynecologic oncologist is feasible. Therefore, advanced staging patient may not be an obstacle for early counseling by surgeon about BRCA mutation.

eP293 CARBOPLATIN-INDUCED HYPERSENSITIVITY REACTION IN CANCER PATIENTS: 5 YEARS EXPERIENCE AT PRIVATE TERTIARY CARE CENTER N. Kuchonthara1, N. Sarakosol2, S.S. Issarachai3, S. Chanthawong4 1 Bumrungrad International Hospital, Clinical Learning, Bangkok, Thailand 2 Bangkok Hospital Khon Kaen, Pharmacy Department, Khon Kaen, Thailand 3 Bumrungrad International Hospital, Horizon Cancer Center, Bangkok, Thailand 4 Faculty of Pharmaceutical Sciences- Khon Kaen University, Division of Clinical Pharmacy, Khon Kaen, Thailand Introduction The rate of hypersensitivity reactions in cancer patients receiving carboplatin has been reported to increase after multiple doses of the agent. In 2012, we studied retrospectively for Carboplatin adverse event in 91 patients who received the agent for at least 3 cycles. In this study, we conduct further to investigate the factors associated to the onset of carboplatin-induced hypersensitivity. Objectives To identify relationship between Carboplatin hypersensitivity and patients’ variables. Methods A retrospective study of 766 patients 555 of them received carboplatin containing regimen or concurrent chemotherapy of carboplatin during radiotherapy for at least three cycles. The data were collected from the medical record since January 2011 to January 2016 in Bumrungrad International Hospital and evaluated by Naranjo’s algorithm. Total of 555 patients were diagnosed with gynecologic cancer (n=290), lung cancer (n=148) and Nasopharyngeal cancer (n= 100), were treated with Carboplatin. 370 of the patients are female and 185 are male. Median age is 60 years, mean Carboplatin AUC was 5, mean Carboplatin cumulative dose was 3000 mg, and mean Carboplatin cycles was 7. Results Out of 555 patients, there were 14 events of Carboplatin hypersensitivity. All are considered moderate reaction which require treatment (interruption of infusion, given IV antihistamine) and classified as probable (score 5-8) by Naranjo’s algorithm. Ninety percent of the patients were Asian population, the rest ten percent were Caucasian. Conclusions Although Carboplatin hypersensitivity is believed to be immunologic reaction and unforeseen and relationship with patients’ characteristic is unlikely, larger population is needed to identify this relationship.

eP294 THE ROLE OF SOCIAL WORK IN THE LONG-TERM CARE OF CHILDHOOD CANCER SURVIVORS: A LITERATURE REVIEW H. Lam1, M. Lam2, A. Agarwal2, R. Chow2, S. Chow2, A. Wan2, E. Chow2, R. Besa2, B. Henry2

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Sunnybrook Health Sciences Centre, Rapid Response Radiotherapy Program- Department of Radiation Oncology- Odette Cancer Centre, Toronto, Canada 2 Sunnybrook Health Sciences Centre- University of Toronto- TorontoOntario- Canada, Rapid Response Radiotherapy Program- Department of Radiation Oncology- Odette Cancer Centre, Toronto, Canada Introduction Childhood cancers are neoplasms diagnosed between ages 0 and 19, and have increased in prevalence with improvements in management and survival rates over several decades. Childhood cancer survivors (CCS) face unique psychosocial adversities in education, employment, daily functioning and social relationships. Thus, there appears to be an important role for social work (SW) as part of the multidisciplinary team involved in care provision for CCS. Objectives To explore the nature of the role of SW in the long-term care of CCS as reflected in the peer-reviewed literature. Methods A search was conducted in Social Services Abstracts, OVID Medline, Embase, Cochrane Central Register of Controlled Trials and PsycINFO. The following search terms were used: “neoplasms”, “cancer”, “pediatric”, “social work”, and “social workers”. Articles addressing the role of SW in the care of CCS were considered eligible. Screening and data extraction were conducted by paired reviewers. Results Seventeen studies were deemed eligible for inclusion. Study findings showed that SW provides valuable assistance to CCS primarily through the following roles: participation and leadership in multidisciplinary followup service; provision of psychotherapy and counseling; assistance with returning to school; promotion of self-advocacy, empowerment and resources referral; and facilitation of quality of life research and assessment. Conclusions Though based on limited evidence, our findings suggest that SW plays a multifaceted role in the long-term multidisciplinary follow-up of CCS. More robust investigations are warranted to explore the effectiveness of SW in these roles and the effectiveness of the multi-disciplinary team in addressing CCS care needs.

eP295 THE BURNOUT OF PARAMEDICAL TEAMS IN ONCOLOGY: C O M PA R I S O N O F A D AY V S . C O N V E N T I O N A L HOSPITALIZATION J. LE FEL1, O. RIGAL2 1 Henri Becquerel Cancer Institute, Supportive care, Rouen, France 2 Henri Becquerel Cancer Institute, Oncology- Supportive care, Rouen, France Introduction In the world of work, the place of finance and economy increases to the detriment of the quality of human relations, more and more workers suffer morally. Objectives We wanted to study this phenomenon within a Cancer Center and observe how paramedical team could be confronted with this syndrome. Moreover, we wanted to see if there were any differences in the services in which these caregivers work. Methods We interviewed paramedics (i.e. nurses, nursing assistants and hospital services officers) in day hospital services and conventional hospitalization. We used Maslach's MBI inventory which is composed of three dimensions: Personal Exhaustion, Depersonalization and Personal Achievement. In addition, semi-directive interviews were conducted with the person in charge of these different services.

Results Overall, 46% (n = 25) of the caregivers interviewed suffer from burnout. Caregivers working in a conventional hospitalization service have a significantly lower level of "burnout" compared to day hospital workers [p <0.01]. The same is true for the "Depersonalization" dimension [p <0.01]. People working in day hospitals suffer significantly more "depersonalization" than other caregivers [p <0.001]. Regarding "personal accomplishment" the data are reversed, conventional hospitalization caregivers have a significantly lower degree of accomplishment than their colleagues in day hospitals [p <0.01]. Conclusions The prevalence of burnout syndrome is relatively high in oncology, but the data vary considerably from study to study. Inter-service differences must also be taken into account. Finally, means of prevention and care must be studied to support the suffering of caregivers

eP296 THYMOQUINONE OIL (TQE), A SMALL MOLECULE PLANT EXTRACT, INHIBITS THE GROWTH OF LUNG CANCER CELLS BY TARGETING MULTIPLE TYROSINE KINASES S. Liu1, N. Zhao1, J. Pang1, W. Eric2 1 University of Minnesota, The Hormel Institute, Austin, USA 2 Prairie Pharms LLC, Prairie Pharms LLC, Nora Springs, USA Introduction The therapeutic efficacy of KRAS or EGFR inhibitors in non-small cell lung cancer (NSCLC) is limited. Phytochemicals possess significant anticancer activity with low toxicity. Thymoquinone (TQ) is one such compound, which is high in a new botanical extract (TQE) from Monarda fistulosa. Objectives To investigate the effects and possible mechanisms of TQE on inhibition of NSCLC cell growth and migration. Methods The changes in KRAS, EGFR, AKT, MET and caspases were determined by Western blotting, cell apoptosis by flow cytometry, cell viability by cell counting kit-8 (CCK8), clonogenic potential by colony-forming and cell migration by wound-healing assays. Results Exposure of NSCLC A549, H1975 and H1299 cells to TQE containing 5%, 10% and 35% TQ resulted in promotion of cell apoptosis, reduction of cell viability and disruption of colony-forming and wound-healing capability with the most robust effects in 35% TQ group. Treatment with 10% TQE (dilution ratio, 1:50,000, 1:20,000, 1:10,000 or 1:5,000) remarkably and dose-dependently mediated apoptotic cell death and impaired cell viability, colony-formation and migration. Interestingly, the growth-inhibitory effects were 5-8-fold greater in TQE than synthetic TQ. Mechanistically, TQE greatly suppressed the protein expression and phosphorylation of KRAS, EGFR, AKT and MET, but increased the cleaved forms of caspase-3 and caspase-8. Conclusions Our study for the first time demonstrates that TQE exerts potent growthsuppressive activity against NSCLC cells, and that tyrosine kinase signaling is a pharmacodynamic marker for TQE-induced cancer cell death, thus opening an opportunity to develop TQE as a novel medicinal agent for management of lung cancer. eP297 EXPERT CONSENSUS AND FOCAL GROUP FOR THE SELECTION OF A SET OF ICF CATEGORIES REGARDING FUNCTIONING OF PEOPLE TREATED FOR CANCER AT HOSPITAL DISCHARGE .1 1 , Chile

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Introduction The International Classification of Functioning, Disability and Health (ICF) provides a standardized language and conceptual framework for health and health-related conditions, aiming at a unified communication between different disciplines and sciences throughout the world. Objectives To describe the process of selecting a set of representative categories for a specific health condition, people treated for cancer at hospital discharge, using the biopsychosocial model of the ICF Methods It is a descriptive study that used the methodologies of Consensus of Experts and Focus Group. Patients and health professionals from different disciplines working in the care of cancer patients in the hospital area participated in this study. Fifty-three ICF categories related to cancer patients and hospitalization were evaluated, which were obtained in a previous stage through a systematic review. Participants evaluated each categorie and classified it as: very relevant, relevant, little relevant, and not relevant at all. Only those codes that more than 50% of the experts evaluated as "very relevant" were included (cut off). In addition, in the focus group activity other ICF categories were added according to participants decision. Results Twenty-four representative ICF categories were obtained, of whom 8 (33.0%)corresponded to the body function component, 13(54.5% )to activities and participation, and 3 (12.5%)to environmental factors. Conclusions Consensus and focus group activities, using the common language of the ICF, resulted in the selection of a group of representative ICF categories of the most relevant health-related problems to people with cancer at the time of hospital discharge.

eP298 CHEMOTHERAPY INDUCED-HAIR LOSS: A DIGNI-LIFE WITH DIGNICAP. OUR EXPERIENCE AND PATIENT’S SATISFACTION. D. loparco1, L. Eufemia Stefania1, O. Laura1, R. Pietro1, F. Palma1, M. D'amico1, F. Sponziello1, P. Schiavone1, A. Quaranta1, C. Caliolo1, A. Nacci1, A. Marino1, E. Mazzoni1, M.C. Chetrì1, M. Caloro1, M. Cinefra1, P. Ferrara1, C. Saverio1 1 Antonio Perrino Hospital, Oncology, Brindisi, Italy Introduction Alopecia (A) is one of the most distressing effects of chemotherapy (CT). CT-induced A may lead to a negative body image, contributing to worsen the quality of life. The CT regimens, especially in breast cancer (BC) patients (pts), often bring with it body image challenges, causing low self-esteem and having a detrimental effect on relationships. DigniCap System (DCS) has been shown to reduce CT-induced A. Objectives The aim of this observational prospective study was to describe our experience. Methods From February to December 2016, 28 women with early stage BC who received anthracycline and/or taxane-based CT were enrolled. All pts received a psychological evaluation (EORTC QLQ-BR23/ QLQ-C30). A has been graduated according to the Dean’s scale: G1 < 25% A; G2=25–50% A; G3=50–75% A; G4 >75% A. Results Fifteen women (51.7%) received 4 courses of EC (epirubicin 90 mg/m2 and cyclophosphamide 600 mg/m2, q21) followed by 12 of paclitaxel (P) (80 mg/m2, weekly), 13 pts 4 courses of EC (44,8%). A G1 was observed in 15 pts (53,6%), G2 in 5 pts (17.8%), G3 in 7 pts (25%), G4 in 1 pt (3.5%). Among G1/2 DCS-related side effects, sore scalp and coldness

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were the main toxicity (52%). The other adverse events (AEs) were: headache G1/2 (44.8%); neck pain (34.5%) and heavy head (41.4%). Overall, 7% of pts discontinued DCS because of unsatisfactory hair preservation (n=1) or headache (n=1). Conclusions Our results confirmed DCS is a good chance to keep hair during CT. Noteworthy, 26 pts did not use wig or head cover.

eP299 EXPERIENCE WITH ENZALUTAMIDE IN PATIENTS WITH METASTATIC CASTRATION-RESISTANT PROSTATE CANCER M. Morgado1, I. Freire2, R. Moras3, S. Morgado2, J. Ribeiro2, O. Fonseca2 1 CICS - Health Sciences Research Center - Faculty of Health Sciences University, Pharmaceutical Services, Covilhã, Portugal 2 Hospital Center of Cova da Beira, Pharmaceutical Services, Covilhã, Portugal 3 Health Local Unit of Castelo Branco, Pharmaceutical Services, Castelo Branco, Portugal Introduction The new inhibitors of the signaling pathway of androgens changed the treatment paradigm of metastatic castration-resistant prostate cancer (MCRPC). Objectives To analyse the effectiveness and safety of enzalutamide (ENZ) in the treatment of males with MCRPC. . Methods Retrospective analysis of all patients with MCRPC treated with ENZ since its introduction, in February/2015, in Hospital Centre of Cova da Beira, to April/2016. The adverse effects were classified according to the Common Terminology Criteria for Adverse Events v4.03. Results A total of 11 patients were treated during the studied period. Four patients had MCRPC progressing after abiraterone acetate plus prednisolone. The mean age of patients at the beginning of treatment with ENZ was 74 (64–74) years. The mean follow-up with ENZ was 6.7 (2–15) months, with a compliance rate to this drug of 98.9%. Of the patients who started treatment with ENZ, 2 died during treatment and 3 discontinued the treatment: 1 due to grade 2 adverse events and 2 due radiological and clinical/biochemical progression. The most significant reported side effects (grade 1 and 2), attributable to ENZ, were fatigue, weight loss and thrombocytopenia. The prostatespecific antigen (PSA) response rate (≥50% decline in PSA level from baseline) was 54.5%. The mean overall survival was 11.4 months (CI95%: 8.1-14.6; median not reached). The median radiological and clinical/biochemical free-progression survival was 10 months (CI95%: 0.5-19.5). Conclusions The treatment with ENZ has been effective in our study and with a high tolerability, according to the relatively low number of dropouts due to adverse effects and high compliance rate.

eP300 HYPONATREMIA IN PATIENTS HOSPITALISED IN A MEDICAL ONCOLOGY UNIT: SOMETHING NOT TO UNDERVALUE G. Musettini1, A. Sbrana1, A. Farnesi1, E. Biasco1, F. Paolieri1, N. Virgili1, E. Pfanner1, L. Galli1, E. Vasile1, S. Ricci1, A. Falcone1, A. Antonuzzo1 1 Azienda Ospedaliero-Universitaria Pisana, Oncologia Medica, Pisa, Italy

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Introduction Hyponatremia (plasmatic sodium lower than 135 mEq/L) is the most frequent electrolytic alteration in patients with malignancies. According to NCI-CTCAE (version 4.03) classification it can be divided into three degrees: first, for a concentration between 135 and 130 mEq/L, third, between 130 and 120 mEq/L, and fourth, under 120 mEq/L (that is potentially fatal). Objectives We wanted to analyse the incidence of hyponatremia in hospitalised patients and their clinical characteristics. Methods We analysed patients hospitalised between September 2015 and April 2016 in our Medical Oncology Unit (Hospital S. Chiara, Pisa, Italy). The determination of natremia was made at the admission and analysed in the same laboratory. Results We analysed 178 patients for a total of 276 blood samples (several patients underwent different hospitalisations). We found 59 patients (33.15%) with hyponatremia. Seven patients experienced different episodes of hyponatremia, leading to 69 samples positive for hyponatremia. More precisely, 55 patients in 58 (84.06%) samples had grade-1, 8 patients in 8 (11.59%) samples grade-3, and 2 patients in 3 samples (4.35%) grade-4 hyponatremia. The most frequently associated malignancies were head-and-neck (22.03%), colorectal (15.25%), NSCLC (11.86%), and SCLC (1.69%). The majority of patients were on best supportive care (40.68%), while patients on treatment had often received cisplatin (22.03%) or carboplatin (10.17%). Conclusions Our study confirms the high frequency of hyponatremia in oncological patients. This underlines the importance of the surveillance of the electrolytes, whose alterations might have important consequences that might be avoided with a correct and early management of these patients.

eP301 POORLY DIFFERENTIATED GASTRIC ADENOCARCINOMA WITH SIGNET RING CELL: CASE REPORT AND REVIEW OF THE LITERATURE M.C. Pinheiro Freitas Costa1 1 , Brasília, Brazil Introduction Despite the apparent decline in the incidence of gastric cancer, it stills a highly aggressive type of cancer mainly because it is detected in advanced stages. The diffuse gastric adenocarcinoma (Lauren classification) is characterized by a pattern of infiltration and the presence of poorly differentiated and signet ring cells. It affects more women (3: 1) and tends to have a lymphatic invasion and also contiguity dissemination. This case report is about the progression of S.A.B., 52 years old female diagnosed with poorly differentiated gastric cancer cells with signet ring cells after a year of dyspepsia, fullness and epigastric pain. Objectives The relevance of this report is to show a rare type of cancer that was diagnosed on an advanced imaging technology screening, which did not properly detect the spread of the disease and later presented successive treatment failures. Methods It was used the medical record data collection containing information of approximately one year about the progression of the patient. Results PET / CT and CT scans did not detect lymph node invasion in distance, which was verified only at the time of surgery. In addition, patient underwent neoadjuvant chemotherapy regimen, and three lines of adjuvant treatment, not obtaining effective response in any of the approaches.

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Conclusions An important aspect of the case is to demonstrate that even highly specific tests can present problems, resulting in important changes in the management and prognosis of the disease. The presence of tumor stem cells was the key to understand the successive non-responsiveness of the chemotherapy.

eP302 CASE STUDY OF CAROTID ARTERY RUPTURE: EDUCATING FOR BETTER PATIENT OUTCOMES. N. Ramrup1, V. Whetstone1, R. Bujno1 1 Memorial Sloan Kettering Cancer Center, Nursing, New York, USA Introduction Carotid artery rupture (CAR) is a rare and fatal condition as a result of Head and Neck cancer. This complication is potentially lifethreatening condition that requires swift action by the nurse. Preventive measures and effective emergency management of hemodynamic instability contributes to better patient outcomes. It is fundamental to have the necessary education to provide quality care for this unpredictable complication. Objectives Nurses caring for these patients must be aware of the potential risk that exists for the development of CAR. This event places an onerous responsibility on the individual charged with its management. Educating staff regarding carotid precautions protocol, emergency management and astute nursing care will broaden their clinical skills and nursing judgment, thereby improving clinical outcomes. Methods In our effort to improve clinical outcomes and enhance clinical skills, a staff-driven educational inservice was presented. A case study detailing carotid artery precautions and nursing care was presented to all staff. Additionally, guidelines for resuscitation, precautions and preventive measures discussed. Results Through our educational initiative, staff now possesses sound knowledge base in providing quality care to patients with actual/potential CAR. Conclusions The multi-disciplinary team should decide, in advance of an impending rupture, on the optimum plan of care. Collaborative partnership with the patient and caregivers decision regarding resuscitation should be clearly documented in the patient’s records. Nurse’s play a significant role in the management of this condition.

eP303 S U P P O RT I V E C A R E I N PAT I E N T S U N D E R G O I N G IMMUNOTHERAPY; EXPERIENCE OF IMMUNE RELATED ADVERSE EVENTS ASSOCIATED WITH IPILIMUMAB AND NIVOLUMAB IN A SINGLE CENTRE B.L. Rapoport1, T. Smit2, R. van Eeden2 1 The MedicalOncology Centre of Rosebank, Department of Oncology, Johannesburg, South Africa 2 The Medical Oncology Centre of Rosebank, Medical Oncology, Johannesburg, South Africa Introduction Ipilimumab and nivolumab induce immune-related adverse events (IrAEs) to the skin, gastrointestinal, liver, endocrine and other systems. Objectives Describe the IrAE’s associated with 19 pts treated with ipilimumab and 25 pts treated with nivolumab.

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Methods Retrospective data review. Results A total of 44 pts (28 males, 16 females) were analyzed. The median age was 63 years. The median PS was 1. Three pts with metastatic melanoma, 18 with non-small cell lung cancer (NSCLC), 2 with renal cell carcinoma and 2 with Hodgkin’s disease were treated with nivolumab and 19 with metastatic melanoma received ipilimumab. In total 167 cycles of nivolumab (median = 4, range 1-16) and 60 cycles of ipilimumab (median = 4 cycles, range 1-4) were administered. Seven IrAEs are described in 15 ipilimumab treated pts. These include endocrinopathy in 3 pts (hypophysitis in pt and hyphothyroidsm in 2 pts), colitis in 3 pts (1 required infliximab) and hepatitis in 1 pt. Among the pts treated with nivolumab, 7 IrAEs were documented. These included pneumonitis in 2 pts, skin rash in 3 pts, mild diarrhea in 1 pt and mild uveitis in 1 pt. One pt developed autoimmune thrombocytopenia, nephritis and PRES (posterior reversible encephalopathy syndrome). Three chest infections were documented including pulmonary tuberculosis in a NSCLC pt. No IrAE related deaths were document. Conclusions A plethora of irAEs are described with anti-PD1 and anti-CTLA4 antibodies. Colitis was more common with ipilimumab while pneumonitis more common with nivolumab. Prompt IrAE’s diagnosis will result in decreased morbidity and mortality.

eP304 THE ACTIVITY OF THE FIRST DEDICATED SUPPORTIVE CARE IN CANCER UNIT (SCCU) IN A COMPREHENSIVE CANCER CENTER IN ITALY C. Ripamonti1, M. Guglielmo1, M.L. Ferrara1, M.A. Pessi1, P. Di Pede1 1 Fondazione IRCCS Istituto Nazionale dei Tumori, Supportive Care in Cancer, Milano, Italy Introduction A dedicated out-patients SCCU of the Istituto Nazionale Tumori (INT) of Milan (born June 2009) has four approaches: to collaborate with the individual specialists of INT through integrated and ancillary specific pharmacological interventions; to assess all patients’ needs through Italian validated tools (physical and emotional symptoms, hope, existential/search of meaning/religious and communication needs) in order to ensure early holistic care of the patient; to support family members, survivors and healthcare professionals; and to promote research and educational programs. Pharmacological intravenous therapies consist of: blood product transfusions, infusion of immunoglobulins, human albumin, human plasma, antibiotics, antifungals and antivirals, iron, analgesics, diuretics, steroids, glutathione, antiemetics, antihistamines, bisphosphonates, denosumab, hydration post high-dose chemotherapy, prevention of acute and chronic renal failure, electrolyte supply and/or multivitamin, protein, lipid supply, in patients with compromised ability to eat and drink properly, or with toxicity due to radio- chemo- targetedimmuno therapies, (i.e., diarrhea, nausea, vomiting and oropharyngeal mucositis), collection of blood samples and blood cultures from central and/or peripheric vein; maintenance of central venous catheters. Objectives Of the study is to evaluate the trend of activity of the SCCU from June 2009 till 31st December 2016 Methods The analysis is based on data obtained from the administrative registries of the Management Control Department and of the Transfusion Medicine Service of the INT

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Results Figures 1-4 show the marked increase of any kind of activity from June 2009 till December 2016 at the SCCU

Conclusions The activities of Dedicated out-patients SCCU are integral part of the cure of patients on oncologic therapies.

eP305 A S S E S S I N G E Q U I T Y I N PAT I E N T- P R O V I D E R COMMUNICATION REGARDING TREATMENT-RELATED SYMPTOMS AND HRQOL AMONG BREAST CANCER SURVIVORS C. Samuel1, J. Schaal2, L. Robertson3, E. Eng4, J. Kollie1, C. Yongue5, B. Smith6, K. Black7, K. Ellis8, A. Lightfoot4, C. Morse9, N. Padilla2, S. Cykert10 1 University of North Carolina at Chapel Hill, Health Policy and Management, Chapel Hill, USA 2 The Partnership Project, The Partnership Project, Greensboro, USA 3 University of Pittsburgh Medical Center, Department of Medicine, Pittsburgh, USA 4 University of North Carolina at Chapel Hill, Health Behavior, Chapel Hill, USA 5 University of North Carolina- Greensboro, Public Health Education, Greensboro, USA 6 Moses Cone Regional Cancer Center, Moses Cone Regional Cancer Center, Greensboro, USA 7 University of North Carolina at Chapel Hill, Maternal and Child Health, Chapel Hill, USA 8 University of North Carolina at Chapel Hill, Center for Health Equity Research, Chapel Hill, USA 9 Guilford College, Department of Psychology, Greensboro, USA 10 University of North Carolina at Chapel Hill, Department of Medicine, Chapel Hill, USA Introduction Compared with White breast cancer patients, Black patients more often report inadequate symptom control and worse health-related quality of life (HRQOL). Racial differences in patient-provider communication (PPC) are well-documented and linked to worse outcomes for minorities; however, less is known about inequities in symptom and HRQOL discussions among cancer patients and providers. Objectives As part of an NCI-funded systems change intervention to improve racial equity in cancer treatment, we assessed racial differences in PPC regarding treatment-related symptoms, HRQOL (e.g., physical, psychosocial, financial, and spiritual well-being), and symptom management among breast cancer survivors (BCS). Methods We conducted 6 focus groups (FGs) and semi-structured interviews with 22 stage 1-4 BCS (3 Black FGs; 3 White FGs) from 2 cancer centers. Our

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diverse community-academic-medical team facilitated FGs and conducted qualitative analyses. Results Both Black and White BCS described some positive PPC experiences, including providers’ thorough explanations of treatment side effects and responsiveness to symptom concerns. However, White BCS expressed greater satisfaction with PPC, while Black BCS more often described concerns regarding providers’ verbal (e.g., dismissiveness) and non-verbal communication (e.g., unapproachability) skills in the context of symptom management. Most BCS, regardless of race, indicated that providers discussed physical symptoms/HRQOL issues, but often failed to mention non-physical side effects of treatment (e.g., financial toxicity). Conclusions Racial differences in PPC exist among BCS and may contribute to inequities in symptom management and HRQOL. Inadequate communication regarding non-physical symptoms likely represents a critical missed opportunity for improving the quality and equity of supportive cancer care.

Results Several Black and White BCPs reported undergoing treatment changes to address their treatment related symptoms. Compared with Black BCPs, White BCPs reported more shared decision making with providers regarding treatment changes. Yet, Black BCPs more often stopped/delayed treatments without consultation with providers due to several factors, including medical mistrust, care dissatisfaction, poor provider communication, and spiritual guidance. Conclusions Treatment changes as a form of symptom management is a common practice. However, stopping or delaying treatments, without provider consultation, may jeopardize supportive cancer care quality and lead to worse cancer care outcomes (e.g., worse quality of life, treatment incompletion) among Black BCPs. Future studies should further examine barriers to and strategies for improving equity in shared decision-making regarding cancer treatment-related symptom management.

eP306 EVALUATING RACIAL DIFFERENCES IN PATIENTPROVIDER DECISION MAKING REGARDING TREATMENTRELATED SYMPTOM MANAGEMENT TO ADVANCE SUPPORTIVE CANCER CARE

F. Scotte1, S. Morin2, P. Leroy2, C. Aubaret2, K. Legeay2, A. Saadi2, C. Brami2, L. Waechter2, C. Herve3, M.F. Mamzer3, S. Hans4 1 Georges Pompidou European Hospital, Medical Oncology and Supportive Care Department, Paris, France 2 Georges Pompidou European Hospital, Supportive Care in Cancer Unit, Paris, France 3 Paris Descartes University, Ethics Department, Paris, France 4 Georges Pompidou European Hospital, Head Neck Cancer Department, Paris, France

J. Kollie1, J. Schaal2, L. Robertson3, E. Eng4, C. Yongue5, F. Guerrab6, N. Jones2, K. Black7, K. Ellis8, A. Kotey4, D. Edwards9, O. Mbah1, J. Broadus1, C. Samuel1 1 University of North Carolina at Chapel Hill, Health Policy and Management, Chapel Hill, USA 2 The Partnership Project, The Partnership Project, Greensboro, USA 3 University of Pittsburgh Medical Center, Department of Medicine, Pittsburgh, USA 4 University of North Carolina at Chapel Hill, Health Behavior, Chapel Hill, USA 5 University of North Carolina at Greensboro, Public Health Education, Greensboro, USA 6 North Carolina Central University, Public Health Education, Durham, USA 7 University of North Carolina at Chapel Hill, Maternal and Child Health, Chapel Hill, USA 8 University of North Carolina at Chapel Hill, Center for Health Equity Research, Chapel Hill, USA 9 University of North Carolina at Greensboro, Human Development and Family Studies, Greensboro, USA Introduction Black breast cancer patients report worse treatment-related symptom management compared to their White counterparts. Previous studies also indicate that Blacks report less shared decision making regarding treatments. However, little is known about whether racial differences in shared decision making are associated with racial inequities in treatment-related symptom management. Objectives We examined racial differences in shared decision making regarding use of treatment changes (switching, stopping, prolonging, or delaying treatment) to manage treatment-related symptoms in breast cancer patients (BCPs). Methods We conducted six focus groups (N=3 Black groups; N=3 White groups) and semi-structured interviews with 22 stage 1-4 B.P. at two cancer centers. Based on key community-based participatory research principles, our team of community, academic, and medical partners facilitated focus groups and conducted qualitative analyses.

eP307 A SUPPORTIVE CARE UNIT CAN BE COST EFFECTIVE!

Introduction Supportive care in cancer (SCC) may create a financial burden, compared to a standard cancer department. In 2011, a specific SCC inpatient unit was developed in an academic hospital, based on a multidisciplinary approach in order to anticipate patient’s disability and limit emergency hospitalization. Objectives Assess the cost effectiveness of the SCC unit expenses and benefits compared to Medical (MO) and Gastro-Intestinal (GI) oncology departments. Methods Data were analyzed over a six year period (2011-2016). Cost of hospital stays and cost per year were calculated based on the hospital’s standard cost accounting method. Hospital benefits were calculated as the difference between total incomes and total expenses (cost and Diagnosis Related Group tariffs for the stay) and results were compared (period available for comparison 2011 to 2014). Results Total costs for the hospital, primarily due to staff expenses, were lower for the SCC unit compared to MO and GI in 2011 and 2014, as well as the daily cost per stay (DCS). Benefit per year was also higher for the SCC unit permitting it, to benefit financially compared to the two other oncology units (Table). Incomes reimbursed by the National Health system for SCC unit were 1,632,601 euros in 2015 and 2,096,285 euros in 2016. Conclusions The SCC unit was less expensive to operate compared to our other oncology units. Our results suggest that its development permitted the oncology department to enhance its quality of care without any additional expenses. eP308 IN-PATIENT SUPPORTIVE CARE UNIT IN ONCOLOGY: A SIX YEARS’ ASSESSMENT (2011-2016) M. Sophie1, L. Pauline2, A. Christophe2, L. Karine3, S. Alexandre2, B. Cloé2, W. Lorraine2, G. Claire2, S. Florain4

Support Care Cancer (2017) 25 (Suppl 2):S21–S266 1 Geroges Pompidou European Hospital, supportive care in cancer- oncology and ethics department- Paris Descartes university, paris, France 2 Georges Pompidou European Hospital, supportive care in cancer- oncology, Paris, France 3 Geroges Pompidou European Hospital, supportive care in cancer- oncology, Paris, France 4 Georges Pompidou European Hospital, supporitve care in cancer- oncology and ethics department- Paris Descartes university, Paris, France

Introduction An in-patient unit for supportive care in oncology (SCCU) was created in 2011 in a university hospital to improve patient care management during their cancer treatment. Objectives We conducted an 8 beds unit’s activity analysis based on the interdisciplinary approach. Methods A 6-year follow-up’s data were retrospectively collected. Results A total of 1688 stays were included in the study. The predominant disease observed were head and neck cancer (28%), lung cancer (20%). Source and discharge of patients were principally home oriented (Table 1). The main reasons for hospitalization were bad performance status (26%), invasive procedures (23%), pain (13,4%). In SCCU, a multidisciplinary approach remains the cornerstone of treatment with a daily collaboration of dieticians, psychologists, physiotherapists, social workers and palliative care team (Table 2). Based on this policy, the patient’s average length of stay was reduced to 7.2 days in 2016, compared 10,2 in 2011. Table 1.

Table 2.

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Cardiff University, School of Medicine, Cardiff, United Kingdom Cardiff University, Support Unit for Research Evidence SURE, Cardiff, United Kingdom 3 Cardiff University, Marie Curie Palliative Care Research Centre, Cardiff, United Kingdom 2

Introduction Upper gastrointestinal cancers have one of the highest number of emergency admissions and length of stay. Malignant upper gastrointestinal bleeding (UGIB) has a three-fold hospital mortality rate compared with non-malignant UGIB. Identifying an effective treatment to control bleeding rapidly will facilitate earlier discharge. Currently, there is no consensus guideline on palliative management for those who are not suitable for surgery or radiological interventions. Objectives To examine the evidence relating to palliative interventions [pharmacological, endoscopic therapy (ET) and radiotherapy] in achieving early haemostasis and preventing or delaying re-rebleeding in malignant UGIB. Methods Four databases were searched using text words and medical subject headings from 2005 until April 2016. Furthermore, supplementary search methods were used to identify additional papers. Two reviewers independently performed study selection, critical appraisal and data extraction. Results Seven studies were identified pertaining to ET and radiotherapy. In total, 554 patients were included. The majority had gastric cancer. In the radiotherapy group, effective treatment achieved haemostasis between 50% and 80% with re-bleeding rate of 30% to 50%. In the ET group, the immediate haemostasis rate ranged between 70% and 90%. It did not differ between those receiving ET or not. The re-bleeding rate for ET was similar to radiotherapy. Conclusions From the limited available evidence, radiotherapy seems to provide good immediate and longer haemostasis. The role of ET is unclear. There is no direct evidence from proton pump inhibitors, tranexamic acid and Hemospray © in reducing tumour bleeding but on-going trials may provide further evidence.

eP310 GENOMIC RISK PREDICTION OF AROMATASE INHIBITORRELATED ARTHRALGIAS (AIA) IN BREAST CANCER (BC) PATIENTS USING A NOVEL ANALYTICAL ALGORITHM (NAA)

Conclusions With the development of an interdisciplinary strategy and by anticipating admissions at an early stage of the treatment complications, we greatly amended patient management. These positive results improve the supportive care organization but also the patient’s quality of life.

eP309 A RAPID REVIEW: WHAT IS THE MOST EFFECTIVE TREATMENT IN ACHIEVING EARLY HAEMOSTASIS AND P R E V E N T I N G O R D E L AY I N G R E - B L E E D I N G I N MALIGNANT UPPER GASTROINTESTINAL BLEEDING? J. Sui1, M. Mann2, A. Woodward3, P. Gee3, S. Dolwani1, A. Byrne3

M. Lustberg1, S.T. Sonis2, C.D. Timmers3, J.L. Fernández-Martínez4, E.J. deAndrés-Galiana4, S. Hashemi5, K. Miller6, B. Ramaswamy1, R. Wesolowski1, A.M. Noonan1, S.J. Dewani1, N. Williams1, S. Sardesai1, R. Pilarski7, R. Raquel1 1 The Ohio State University Comprehensive Cancer Center, Medical Oncology, Columbus, USA 2 Dana-Farber Cancer Institute, Oral Medicine, Boston, USA 3 The Ohio State University, Comprehensive Cancer Center, Columbus, USA 4 University of Oviedo, Mathematics, Oviedo, Spain 5 Harvard University, School of Dental Medicine, Cambridge, USA 6 Johns Hopkins University, Pathology, Baltimore, USA 7 The Ohio State University Comprehensive Cancer Center, Human Genetics, Columbus, USA Introduction BC patients on aromatase inhibitors (AIs) can develop AIA. Results of candidate gene studies to identify AIA risk are limited in scope.

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Objectives In this case-controlled study, we evaluated the potential of a NAA to predict AIA using germline single nucleotide polymorphism (SNP) data. Methods Systematic chart review of 700 AI-treated patients with stage I-III BC identified asymptomatic patients (n=39) and those with AIA leading to AI termination or therapy switch (n=123). Germline DNA was obtained and SNP genotyping performed using the Affymetrix UK BioBank Axiom Array to yield 695,277 SNPs. The identity of the cluster of SNPs that most closely defined AIA risk was discovered using an NAA that sequentially combined statistical filtering and a machine learning algorithm. NCBI PhenGenI and Ensemble databases were used to define gene attribution of the 200 most discriminating SNPs. Phenotype, pathway, and ontologic analyses assessed functional and mechanistic validity. Results Cases and controls were similar in demographic characteristics. A cluster of 70 SNPs, correlated to 57 genes (accounting for linkage disequilibrium), was identified. This SNP group predicted AIA occurrence with a maximum accuracy of 75.93%. Strong associations with arthralgia, breast cancer, and estrogen phenotypes were seen in 19/57 genes (33%) and were functionally and ontologically consistent. Conclusions We identified a 70 SNP cluster that predicted AIA risk with fair accuracy. Phenotype, functional, and pathway analysis of attributed genes was consistent with clinical phenotypes. This study is the first to link a specific SNP/gene cluster to AIA risk independent of candidate gene bias.

eP311 USE, PREVALENCE AND PATTERN OF ALTERNATIVE MEDICINES AMONG INDIAN CANCER PATIENTS V. Talwar1 1 Rajiv Gandhi Cancer Institute & Research Centre, Medical Oncology, Delhi, India Introduction Use of traditional and alternative medicine has been identified by oncologists as one of potential reasons for delay in seeking medical attention, but very limited research has been conducted to verify such claims. Objectives To understand the prevalence and pattern of alternative medicines among Indian cancer patients. Methods An exploratory design was adopted for study. Using purposive sampling method, patients (N=303, M:146 & F:157) undergoing cancer treatment at Rajiv Gandhi Cancer Hospital and Research Center, Delhi, India; aged 15-88 years were included. Structured in-depth interviews were conducted. These interviews were recorded, transcribed and analyzed. Results Irrespective of age, gender and education, 34% patients had taken alternative medicine while 21% were considering it. Commonest form of alternative therapy was Ayurveda reported by 85% patients. Majority of patients 61% had taken alternative medicines before starting medical treatment and 39% were taking it along with conventional treatment. Common reasons for taking alternative therapies were influence media (44%), suggestions from family (31%) and fellow patients (19%). Majority 81% believe that there are no side effects of alternative treatment and 40% were satisfied with it, while 41% were not satisfied and 19% did not answer the question. Only 3% patients had discussed with their treating oncologist about this treatment. Conclusions This study suggest that alternative medicines are used frequently and increasingly. Detail history of use of alternative Medicines should be elicited in clinical practice as this will help counselling the patient about

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adverse effect and possible drug interactions. The effectiveness of this type of treatments remain to be determined.

eP312 MODERN ONCOLOGY AND ANCIENT AYURVEDIC MEDICINE – ARE THEY ALTERNATIVE OR COMPLEMENTARY TO EACH OTHER? AN EDUCATED VIEW OF CLINICAL ONCOLOGIST AND PALLIATIVE CARE PHYSICIAN D.A. Thaker1 1 Royal Brisbane & Women's Hospital RBWH, Medical Oncology, Brisbane, Australia Introduction In current practice, we always encounter many questions about alternative medicine. Most of the time, the advice is not to mix both treatment strategies. The main reason is that there is very little to almost no research about safe and effective integration of both medical sciences. With development of targeted and immune therapy agents, modern oncology is moving fast towards personalised medicine. Ancient Indian medical science (Ayurveda) already uses holistic approach to decide a specific treatment strategy for individual patient after identifying causative factors behind the diagnosis. The Sanskrit meaning of Ayurveda is ‘science of the preservation of life’. Unlike modern medicine, it is a comprehensive system, which focuses on interconnectedness of the body and mind and maintains or restores innate harmony and equilibrium of the individual. Ayurvedic therapeutics includes nutrition, lifestyle, Vedic exercise (Yoga and Asana), mind-body practices (meditation, breathing practices) and herbal/botanical therapies. This approach can be used along side of standard treatment strategies of modern oncology (Chemotherapy, Radiotherapy, immunotherapy) to minimise acute and delayed toxicity of the treatment, to improve physical, psychological and spiritual health of the patient which in turn improve rehabilitation and survivorship of cured patients, it will also help to palliate patients with progressive disease. Ayurveda has an important role to play as complementary medicine in preventive, supportive and palliative oncology. My international multi institutional clinical trial is underway to identify the ways to integrate both great sciences, which will help cancer patients by improving their physical health and psychological, emotional and spiritual wellbeing. Objectives Methods Results Conclusions -

eP313 USES AND CONTRIBUTIONS OF COMPLEMENTARY AND A LT E R N AT I V E M E D I C I N E I N B R E A S T A N D GYNECOLOGICAL CANCER - SURVEY AT A FRENCH TEACHING HOSPITAL P. Théret1, C. Bihan2, B. Chauffert2, J. Gondry1, R. Fauvet3 1 CHU Amiens, Gynaecology, Amiens, France 2 CHU Amiens, Medical Oncology, Amiens, France 3 CHU Caen, Gynaecology, Caen, France Introduction The growing popularity of complementary and alternative medicine (CAM) both in the general population and in patients with cancer is

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unquestionable. However, the attitude of caregivers in this area often leads patients to hide the use of CAM to their doctors. Objectives These reasons led us to conduct a survey in the University Hospital of Amiens (France) in order to evaluate their use in patients with gynecological or breast cancer. Methods From January 1st to august 31st 2013, we conducted a prospective study about CAM; All the patients who underwent chemotherapy for gynecological or breast cancer during the study period in Amiens University Hospital were included. Results 68 patients were included. CAM use rate was 27.9%. The only significant CAM use predictive factor was a high level of education (p = 0.04). The two most frequently used CAM types were homeopathy (70.6%) and acupuncture (64.7%). The aims were to reduce the side effects of conventional treatment (63.2%) and to improve the overall condition (52.6%). Patients were informed about CAM mostly from their families (57.9%). Almost 80% considered that the information provided by the hospital practitioners was inadequate. However, 88.2% wanted to receive this information from their oncologist. Conclusions The CAM use rate will increase in the coming years and the French health care system, health care providers and institutions, should apply itself to support these changes rather than follow them.

eP314 PREDICTING HOSPITAL READMISSIONS AND ASSOCIATED MORTALITY IN ONCOLOGY S. Thirlwell1, K.A. Donovan1, R.R. Reich2, D. Portman1, T.N. Hembree3 1 H. Lee Moffitt Cancer Center, Supportive Care Medicine, Tampa, USA 2 H. Lee Moffitt Cancer Center, Biostatistics Core Facility, Tampa, USA 3 H. Lee Moffitt Cancer Center, Internal and Hospital Medicine, Tampa, USA Introduction Many indices exist to predict readmission and mortality in general medical settings, but their ability to predict events with sensitivity and specificity in oncology are unknown. Objectives Identify predictors of oncology readmission and readmission-associated mortality. Methods The LACE Index’s ability to predict unplanned 30-day readmissions was characterized using receiver operating characteristics (ROC) curve analyses among all medical oncology patients readmitted over 6 weeks, beginning 03/2016. Survival analyses sought to identify whether 30-day readmission was a predictor of mortality among patients admitted from 01-09/2016. Results Of 329 patients with unplanned admissions, 17.9% were 30-day readmits. There was no difference in median LACE scores between those readmitted and those not (Md = 10.0; p = .93). ROC curve analysis yielded an AUC estimate relative to 30-day readmissions of .45 indicating poor overall accuracy. The previously established LACE cutoff score of 10 had sensitivity of .54 and specificity of .57 relative to readmissions. The positive predictive value was .81 and the negative predictive value was .18. Of 240 patients, the median overall survival time of those readmitted within 30 days was less than half that of those not readmitted (37 months compared to 83 months; p<.001). Conclusions The LACE Index performed poorly in predicting 30-day readmission. Survival analyses demonstrated that 30-day readmission is associated with decreased median overall survival. Further research is needed to

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identify which oncology-specific factors predict 30-day readmission and mortality in the oncology population.

eP315 TRANSLATION AND CULTURAL ADAPTATION OF THE ATTENTIOANAL FUNCTION INDEX I. Utne1, E.K. Grov1, L.E. Kjerland2, M. Rønning1, C. RodriguesAranda3, H.L. Rasmussen1, B. Løyland1 1 Oslo and Akershus University College of Applied Sciences, Nursing and Health Promotion, Oslo, Norway 2 None, None, Bergen, Norway 3 Psychology, University of Tromsø, Tromsø, Norway Introduction The incidence of cancer among older adults is rapidly increasing, and as a result of treatment cancer patients may be subject to cognitive changes. Many cancer survivors experience reduced attention and concentration, as well as poorer memory. Attentional Function Index (AFI) is an instrument for mapping cognitive functions, developed in the USA. Objectives To describe the translation and pilot testing of the Norwegian version of AFI. Methods Three researchers with knowledge of psychology, nursing and cancer, one psychologist with specialist knowledge of cognitive instruments, and a user representative, constituted the expert group in translation and cultural adaptation of the instrument. An accredited translator participated actively in the work. In the pilot testing of the Norwegian version persons >60 years were recruited using ”snowball sampling”. A total of 114 persons between 60 – 90 years were recruited for the testing, twelve of these were specifically asked to comment on the instrument. Results The expert group members provided feedback based on their competence. The user representative wanted a simple and understandable, non-offensive, language, and the translator provided linguistic comments. Few users expressed having any problems with completing the AFI. Conclusions The inclusion of users and translator in the translation process can improve the validation. We recommend that the process is made available for future users of translated instruments.

eP316 PICTORIAL ESSAY OF RADIOLOGIC FINDINGS FOLLOWING PALLIATIVE TREATMENT FOR BONE METASTASES N. Christakis1, A. Wan1, A. Agarwal1, E. Chow1, L. Probyn2, M. Christakis3 1 Odette Cancer Centre- Sunnybrook Health Sciences Centre- University of Toronto, Radiation Oncology, Toronto, Canada 2 Sunnybrook Health Sciences Centre- University of Toronto, Diagnostic Imaging, Toronto, Canada 3 Odette Cancer Centre- Sunnybrook Health Sciences Centre- University of Toronto, Diagnostic Imaging, Toronto, Canada Introduction Bone is one of the most common sites of cancer metastases. Bone metastasis can lead to a variety of symptoms such as pain, bone fracture, and spinal cord compression that adversely affect patient quality of life. To prevent or ameliorate these symptoms, patients with bone metastasis are often treated palliatively with surgery, chemotherapy, radiation therapy or a combination of therapies. Imaging plays a vital role in enabling the diagnosis, treatment, and monitoring of bone metastases. It facilitates the identification of bone metastases, pinpoints sites of bone metastases

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to guide radiation treatment, and orients interventional radiologists and surgeons to operate on weakened bones. Objectives In this pictorial essay, we aim to illustrate some of the common radiologic findings following palliative treatment for bone metastases. Methods Examples of tumors on radiographs, computed tomography (CT), magnetic resonance imaging (MRI), nuclear medicine such as bone scans, and positron emission tomography (PET) from patients presenting with bone metastases are shown. Results The cases illustrate typical imaging appearances, responses of the tumors to treatment and radiographic changes to the surrounding tissues. Conclusions As radiology has the potential to provide a wealth of information regarding the extent and manifestation of bone metastases, its interpretation is invaluable in the appropriate management of cancer patients with bone metastases. With advancements in technology and more widespread use, radiology will likely play an increased role in the palliation of bone metastases. Therefore, it is important for radiologists and the palliative care team to understand the common presentations and radiological findings of bone metastases.

eP317 THE USE OF MEDICAL CANNABIS IN CANCER PATIENTS P. Zaki1, A. Blake2, A. Wolt2, S. Chan1, L. Zhang1, A. Wan1, H. Lam1, C. DeAngelis1, M. Slaven3, E. Shaw3, V. Ganesh1, E. Chow1, S. O'Hearn2 1 Odette Cancer Centre - Sunnybrook Health Sciences Centre - University of Toronto, Radiation Oncology, Toronto, Canada 2 MedReleaf, Research, Markham, Canada 3 Hamilton Health Sciences, Juravinski Cancer Centre, Hamilton, Canada Introduction Therapeutic applications of medical cannabis within the cancer population, particularly for pain, treatment-related nausea and vomiting, and loss of appetite, have been investigated by few studies. Objectives The present study aimed to examine the efficacy of cannabis treatment for symptom relief among cancer patients receiving cannabis treatment from a single Canadian medical cannabis provider. Methods Data was obtained from a voluntary online survey that consisted of questions related to demographic information, current medical conditions, presence and severity of symptoms, and quality of life (QOL). Followup (FU) surveys were completed at 4 and 10 months following initial use. Results 164 patients reported a current or previous diagnosis of cancer, of which the most common types of primary tumours were gastrointestinal (17.7%, n=29), breast (13.4%, n=22), leukemia and lymphoma (13.4%, n=22), gynaecologic (9.2%, n=15), prostate (7.3%, n=12), and lung (7.3%, n=12). While improvements were seen in commonly reported symptoms, including pain, depression, anxiety, exhaustion, and sleep problems, the observations were not statistically significant. Statistical significance was demonstrated in patients’ ability to cope with pain at 4-month FU (p<0.0001). QOL was stable from baseline to 4-month FU, where most reported good QOL (66.7%). Of associated QOL factors, only experience with sleep was found to be improved with statistical significance (p=0.02). Side effects of cannabis use included dry mouth, psychoactive effects, decreased concentration and memory, and sleepiness. Conclusions Further studies are needed to determine the efficacy of medical cannabis in comparison to conventional first-line therapies for management of symptoms in cancer patients in both short- and long-term treatment.

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eP318 EFFICACY OF DIFFERENT VARIETIES OF MEDICAL CANNABIS IN RELIEVING SYMPTOMS A. Wan1, P. Diaz1, A. Blake2, S. Chan1, A. Wolt2, P. Zaki1, L. Zhang1, M. Slaven3, E. Shaw3, C. DeAngelis1, H. Lam1, V. Ganesh1, E. Chow1, S. O'Hearn2 1 Odette Cancer Centre - Sunnybrook Health Sciences Centre - University of Toronto, Radiation Oncology, Toronto, Canada 2 MedReleaf, Research, Markham, Canada 3 Hamilton Health Sciences, Juravinski Cancer Centre, Hamilton, Canada Introduction Traditionally, Cannabis sativa and Cannabis indica species of cannabis have been bred together to create new varieties that possess unique properties for managing different symptoms in the clinical setting. Unique sativa/indica ratios and levels of compounds such as the cannabinoids tetrahydrocannabinol (THC) and cannabidiol (CBD) are thought to contribute to these effects. Objectives To assess the efficacy of different cannabis varieties in patients using medical cannabis to treat a variety of symptoms. Methods Patients from one Canadian licensed provider completed a voluntary online survey at baseline and 4 and 10 month follow up intervals to collect information pertaining to their current medical conditions, symptoms, and quality of life. Results Information about cannabis use was collected from 807 patients at baseline. At 4 months, varieties perceived by patients to cause improvements in the most prevalent conditions included SedamenMR (70% indica, 21-24% THC, 0% CBD) for pain (30.1%), and LuminariumMR (20% indica, 25-28% THC, 0% CBD) for anxiety disorder (30.4%) and depression (33.8%). Patients most commonly attributed improvements in sleep (29.0%), appetite (24.8%), and bowel function (24.6%) to MidnightMR (40% indica, 8-11% THC, 11-14% CBD), improvements in concentration (22.0%) to CognitivaMR (40% indica, 15-18% THC, 0% CBD), and improvements in sexual function (26.5%) to LuminariumMR. Conclusions The efficacy of different cannabis varieties in managing various symptoms should be further investigated in a controlled clinical setting, to allow patients and physicians to make more informed decisions on variety selection to achieve optimal symptom management. The results of this study will be valuable in informing future study design.

eP319 COMMON INFLAMMATORY BIOMARKERS OF CANCER PROGNOSIS A. Wan1, M. Lam1, A. Furfari1, R. McDonald1, L. Rowbottom1, S. Chan1, P. Zaki1, C. DeAngelis1, R. Chow1, G. Charames2, H. Lam1, E. Chow1, A. Azad1 1 Odette Cancer Centre - Sunnybrook Health Sciences Centre - University of Toronto, Radiation Oncology, Toronto, Canada 2 Mount Sinai Hospital, Pathology and Laboratory Medicine, Toronto, Canada Introduction Biomarkers have the potential to act as important tools in predicting prognosis of cancer patients. In addition to being easy to obtain, blood samples can provide protein and cell biomarkers from which valuable information on the degree of inflammation and prognosis may be derived.

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Objectives To summarize the currently available literature reporting on common inflammatory blood biomarkers, excluding cytokines and chemokines, and their association with prognosis in cancer patients. Methods A literature search was conducted on Medline and Embase utilizing keywords such as “neoplasm,” “inflammation,” “biomarker,” “allele,” and “genomics.” Articles that reported on the levels of commonly implemented prognostic biomarkers (C reactive protein, albumin, white blood cell and platelet counts) and their derivative scores or ratios relating to prognosis were selected for inclusion. Results 23 studies were included in the review. CRP and albumin was often measured through a combined scoring system such as the Glasgow prognostic score (GPS) and its variants, or the CRP albumin ratio. High albumin and low CRP produce high scores, which were found in 21 studies to be associated with poor survival across 9 different primary cancer types. The most commonly reported cellular biomarker was the neutrophillymphocyte ratio, for which high neutrophil and low lymphocyte levels were found to be significantly associated with poor outcome across 12 studies spanning at least 6 different types of malignancies. Conclusions Blood biomarkers associated with inflammation are a common prognostic tool due to the ease of blood sampling and its widespread significance across a range of cancers.

eP320 GENETIC BIOMARKERS OF CANCER PROGNOSIS A. Wan1, M. Lam1, A. Furfari1, L. Rowbottom1, R. McDonald1, S. Chan1, P. Zaki1, C. DeAngelis1, A. Azad2, R. Chow1, H. Lam1, E. Chow1, G. Charames2 1 Odette Cancer Centre - Sunnybrook Health Sciences Centre - University of Toronto, Radiation Oncology, Toronto, Canada 2 Mount Sinai Hospital, Pathology and Laboratory Medicine, Toronto, Canada Introduction Prognosis after a cancer diagnosis ranges widely depending on the type of cancer, as well as on individual characteristics of the tumour and patient. Historically, most biomarkers used clinically have been biologically based; however, the genetic revolution of the last decade has spurred the investigation and discovery of numerous genetic biomarkers, which relate to aspects of DNA or RNA that are associated with cancer prognosis. Objectives To summarize the currently available literature reporting on genetic biomarkers and their association with prognosis in cancer patients. Methods A literature search was conducted on Medline and Embase utilizing keywords such as “cancer,” “inflammation,” “prognosis,” and “biomarkers.” Articles that reported on genetic biomarkers relating to prognosis were selected for inclusion. Results A total of 18 studies were included in this select review. 9 studies reported on DNA biomarkers relating to prognosis and the remaining 9 studies investigated RNA biomarkers of prognosis. 23 significant single nucleotide polymorphisms (SNPs) from 16 genes were associated with survival, with variants found in genes of many immune, inflammation, and angiogenesis pathways such as IL6, STAT3, PTSG1, and VEGF. High mRNA levels of growth genes such as MYCN, ERG, and immune genes such as IL6R, IL10 were also associated with poor prognosis. 6 studies provided a multi-gene model predictive of prognosis. Conclusions As the utility of genomics and the number of cancer diagnoses is expected to increase, genetic biomarkers in predicting cancer survival is likely to be of increased significance to both oncologists and patients.

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eP321 BIOMARKERS OF SUSCEPTIBILITY TO RADIATION RELATED TOXICITIES A. Furfari1, S. Chan1, P. Zaki1, A. Wan1, L. Rowbottom1, R. McDonald1, A. Azad2, R. Chow1, C. DeAngelis1, M. Lam1, H. Lam1, E. Chow1, G. Charames2 1 Odette Cancer Centre - Sunnybrook Health Sciences Centre - University of Toronto, Radiation Oncology, Toronto, Canada 2 Mount Sinai Hospital, Pathology and Laboratory Medicine, Toronto, Canada Introduction Radiation therapy (RT) is a commonly used modality to treat cancer patients with either curative or palliative intent. However, RT may induce toxicities that range from being negligible to severe. Sometimes, radiation-induced toxicities may be dose-limiting, preventing patients from completing treatment and receiving the full benefit of RT. Genetic and protein biomarkers could potentially allow physicians to predict the risk of each patient developing a toxicity, thus improving patient-centred care and providing patients with more information to help them make treatment-related decisions. Objectives The aim of the present literature review was to summarize the findings of all human studies analysing the potential of different biomarkers in predicting the risk of toxicities in cancer patients receiving radiotherapy. Methods A search was conducted on Medline and Embase databases using keywords including “inflammation,” “cancer,” “radiation,” “pain,” “biological marker,” “allele,” and “genomics.” Results The search generated 5480 and 7 were included in the final review. Variant alleles from several genes involved in the inflammation and immunity pathways such as IL6, IL16, TNF, PTGS2, MIF, and NOS3 were found to be associated with susceptibility to radiation toxicity. Several studies generated risk scores that improved current models to more accurately predict risk of radiation toxicity. Conclusions Future studies should analyse more genes in larger sample sizes while considering ethnicity, patient characteristics, and dosimetric factors.

eP322 BRCA 1 STATUS AND ITS ASSOCIATION WITH FAMILY HISTORY S.S.A. Zaidi1, A. Fatima2 1 , Lahore, Pakistan 2 SGRH, Oncology, Lahore, Pakistan Introduction Germline mutations in the tumor suppressor genes BRCA1 predispose individuals to Breast Cancer. Objectives To determine the status BRCA 1 in cancer patients of Pakistan Methods An observational study was conducted Sir Ganga Ram Hospital, Lahore and 100 patients were selected. The selection was done by various clinical, laboratory investigations and with a family history of breast cancer. Peripheral blood films were prepared after collecting blood samples. Subsequent to DNA extraction, mutational analysis of BRCA1 exons 2, 5, 6, 16, 20 and 22 was carried out using single strand conformation polymorphism (SSCP) assay while protein truncation test (PTT) was used to examine mutations in exon 11. All BRCA1 sequence variants were confirmed by DNA sequencing.

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Results Forty one patients were diagnosed with early onset breast cancer, 39 patients had moderate family history. At the time of diagnosis, the median age of enrolled patients was 36 years (range 24-65 years). Out of 100 patients, mobility shift was detected in exon 6, 16 and 20 of three patients, whereas ten patient were tested positive for mutation in exon 11 by PTT assays. All patients with BRCA1 mutations were further confirmed by DNA sequencing analysis. In exon 16 c.4837A > G was confirmed, which is a common polymorphism reported in several populations including Asians. Conclusions Several BRCA1 mutations were observed in Pakistani breast cancer patients with moderate family history. Therefore, mutation-based genetic counselling for patients with moderate family history can facilitate management.

eP323 SEPSIS AND LONG-TERM FUNCTIONAL OUTCOMES IN SURVIVORS OF CHILDHOOD ACUTE LYMPHOBLASTIC LEUKEMIA Y.T. Cheung1, A.C. Eskind2, H. Inaba3, L.L. Robison1, M.M. Hudson3, C.H. Pui3, J. Wolf2, K.R. Krull1 1 St. Jude Children's Research Hospital, Epidemiology and Cancer Control, Memphis, USA 2 St. Jude Children's Research Hospital, Infectious Diseases, Memphis, USA 3 St. Jude Children's Research Hospital, Oncology, Memphis, USA Introduction Infection is a common complication of treatment for childhood acute lymphoblastic leukemia (ALL) but its effect on long-term neurocognitive function, behavior and health-related quality of life (HRQoL) are unknown. Objectives To explore associations between bacteremic sepsis during treatment for childhood ALL and long-term functional outcomes in survivors. Methods Eligible survivors included ALL patients who were treated with chemotherapy without cranial radiation. At ≥5 years post-diagnosis, 212 survivors (mean[SD] age 13.8[4.8] years; 7.7[1.7] years post-diagnosis) completed neurocognitive assessment. Parent-report of survivors’ behavior and HRQoL were collected. Medical records were reviewed to identify patients who experienced bloodstream infection (BSI) with or without clinical diagnosis of sepsis (need for fluid bolus, supplemental oxygen or ICU admission). Age-adjusted Z-scores for functional outcomes were compared to population norms (μ=0, σ=1.0), and between survivors with history of sepsis and survivors without BSI, using Mann-Whitney U test. Results Sixty patients (29.2%) had ≥1 episode of BSI (14 with sepsis; 46 without sepsis). At long-term follow-up, survivors as a group performed worse than norms on measures of executive function and processing speed (P’s<0.05) and HRQoL (P’s<0.0001). Survivors with history of sepsis demonstrated poorer abstract reasoning (-0.74[0.6] vs -0.07[0.8]; P=0.002), verbal fluency (-0.90[0.8] vs -0.39[1.0]; P=0.047) and visual-spatial skills (-0.80[0.9] vs -0.17[1.0]; P=0.031) than survivors without BSI. They also developed more conduct problems (P=0.016) and poorer emotional functioning (P=0.020). Conclusions Sepsis during chemotherapy is associated with worse long-term neurocognitive and behavioral outcomes in childhood ALL survivors. While prevention of sepsis is a priority, patients who experience sepsis may benefit from preventative cognitive/behavioral interventions.

eP324 DEVELOPMENT OF A CLINICAL PRACTICE GUIDELINE FOR ASSESSMENT, PREVENTION AND TREATMENT OF PAIN IN CHILDREN WITH CANCER: PHASE 1

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E.A.H. Loeffen1, A. Font-Gonzalez2, R.L. Mulder2, L.L. Dupuis3, M.D. Van de Wetering2, L.C.M. Kremer2, F. Campbell4, W.J.E. Tissing1, O.B.O.T.P.I.C. with Cancer Guideline Working Group1 1 University of Groningen- Beatrix Children’s Hospital- University Medical Center Groningen, Department of Pediatric Oncology/ Hematology, Groningen, The Netherlands 2 Emma Children’s Hospital- Academic Medical Center, Department of Pediatric Oncology, Amsterdam, The Netherlands 3 The Hospital for Sick Children, Department of Pharmacy and Research Institute, Toronto, Canada 4 The Hospital for Sick Children, Department of Anesthesia and Pain Medicine, Toronto, Canada Introduction High-quality evidence-based guidelines for supportive care in children with cancer are needed. Pain in children with cancer has been identified as an area where many clinicians seek guidance. Objectives To develop a clinical practice guideline (CPG) for pain in children with cancer with recommendations on 1) assessment of pain; 2) pharmacological prevention and treatment of a) tumor-related pain, b) treatmentrelated pain, and c) procedure-related pain; and 3) physical and psychological prevention and treatment of a) tumor- and treatment-related pain, and b) procedure-related pain. Methods The international and inter-professional guideline panel is comprised of a core group and six working groups and includes 44 individuals. In phase 1, clinical questions were formulated for each topic and prioritized (maximum 5 per working group) using GRADE methodology. The scope and possible outcomes for each clinical question were delineated. The critically important outcomes for decision making for each clinical question were then identified via electronic voting. Results The six working groups prioritized a total of 25 clinical questions to be answered through systematic literature reviews (see Figure 1). The number of critical outcomes differed per question, with a minimum of 4 and a maximum of 13. Figure 1. Overview of working groups, included clinical questions and rated outcomes NB. Higher resolution is available upon request

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Conclusions We have developed the framework for CPG development. In the next phase, systematic literature reviews will be undertaken and evidence-to-decision frameworks will be used to formulate recommendations. We expect to finalize the guideline in the spring of 2018.

eP325 SYMPTOM AND BIOLOGICAL PROFILES OF LEUKEMIA PATIENTS DURING CHEMOTHERAPY: PRELIMINARY RESULTS N. Lukkahatai1, T. Naydonova1, J.D. Barcelo1, T. Ogburn2, M. Tejada1, A. Ikeda3, L. Saligan4 1 University of Nevada Las Vegas, School of Nursing, Las Vegas, USA 2 University of Nevada Las Vegas, School of Life Sciences, Las Vegas, USA 3 Children's Specialty Center of Nevada, Children's Specialty Center fo Nevada, Las Vegas, USA 4 National Institutes of Health, National Institute of Nursing Research, Bethesda, USA Introduction With successful treatment, the survival rate in Leukemia children is increasing, the effect of treatment related symptoms adverse on the health related quality of life is increasingly relevant. However, the etiology of these symptoms is unknown. Objectives The study aims to understand symptoms profile and potential biological correlates of children with leukemia during chemotherapy. Methods This preliminary report is a part of an active IRB approved research protocol. Children age 5-21 diagnosed with Leukemia were recruited into the study. A Patient Reported Outcome Measurement Information System (PROMIS) questionnaire and blood sample were collected at before starting chemotherapy and second visit chemotherapy. Data was analyzed by SPSS version 22. Results Ten participants age 5-16 years old (6 boys and 4 girls) diagnosed with B cell Acute Lymphoblastic Leukemia (ALL) were included in this preliminary analysis. Participants were receiving chemotherapy in the maintenance and consolidation phase. PROMIS score showed participants experienced decreasing of anxiety and depression, increasing of fatigue and no change of pain severity from baseline to the second visit. Laboratory result showed a significant increase of creatinine, cholesterol, and triglyceride at the second visit (p <0.05). At the second visit, boys reported significant lower depression score (38.67 ± 2.4) than girls (46.35 ± 6.8) (p =0.03). Conclusions This preliminary result open an interesting discussion on the potential involvement of lipid homeostasis in treatment related symptoms. This finding is a basis for future studies for an appropriate measurement of the children experiences and biological correlates of symptoms.

eP326 PRACTICES, ATTITUDES AND BELIEFS OF PALLIATIVE CARE PHYSICIANS TOWARDS THE USE OF LONG-ACTING OPIOIDS IN CHILDREN WITH ADVANCED CANCER K. Madden1, J. Williams1, D. Liu1, E. Bruera1 1 UT MD Anderson Cancer Center, Department of Palliative Care, Houston, USA

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Introduction Palliative care physicians assist with pain management in children, yet their practices, attitudes and beliefs of towards long-acting opioids are not well documented. Objectives Determine the practices, attitudes and beliefs of palliative care physicians towards the use of long-acting opioids in children with advanced cancer. Methods A survey was sent to all members of The American Academy of Pediatrics (AAP) Section of Hospice and Palliative Medicine (SOHPM) and those who self-identified as physicians who provide palliative care to children on the AAP SOHPM LISTSERV®. Results 116/188 (62%) physicians responded. ≥ 84% reported being “comfortable” to “extremely comfortable” using fentanyl, methadone, morphine ER and oxycodone ER versus 37% for hydromorphone ER. 63% of adult trained physicians reported titrating oxycodone ER and morphine ER as “easy” or “extremely easy” compared to 46% for oxycodone ER and 51% for morphine ER among pediatric trained physicians (p = 0.0594) and (p = 0.0742) respectively. 53% of pediatric trained physicians “agreed” or “strongly agreed” that the main reason for starting methadone is because existing formulations of other long-acting opioids are unsuitable compared to 36% of adult trained physicians (p = 0.0503). Cost as a barrier for methadone was low but family resistance was high. Conclusions Most palliative care physicians report comfort using long-acting opioids, except for hydromorphone ER. As compared to pediatric trained physicians, adult trained physicians perceived titration of oxycodone ER and morphine ER to be easier but less likely to agree that the main reason for starting methadone is because existing formulations of other long-acting opioids are unsuitable for children.

eP327 SCREENING FOR PSYCHOLOGICAL PROBLEMS AMONG CHILDREN WITH CANCER M. Cardoni1, L. Berry2, A. Mohamed3 Warren clinic, pediatric, tulsa, USA 2 University of Oklahoma- college of medicine Tulsa, pediatrics, tulsa, USA 3 Warren clinic/St Jude Children Research Hospital, Pediatrics, tulsa, USA 1

Introduction Emerging data suggest that routine screening of symptoms improved psychological wellbeing in children. Objectives assess the prevalence of psychological problems among children with cancer Methods Behavior Assessment Scales for Children (BASC-2): proxy ParentRating Scales (PRS) and Self-Report Scales (SRS) were used. BASC-2 clinical and elevated (sub-clinical) T Scores were recorded, Results

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11,250 units. Changes translated into a total saving of 19,000 $ per admission. Over the 6 months following the implementation no critical calls or intensive care admission were needed.

44 patients (age 2-21 years) with diagnosis of cancer were offered the surveys (PRS and/or SRS), 95% completed it. 18 were on therapy and 24 survivors. 40% of children were in the clinically significant range for at least one psychological problem with 10% showing ≥3 problems. Most frequent problems on Parent proxy-report were: Atypicality 17%, Withdrawal and Attention 11%, Hyperactivity, Anxiety, Somatization 9%. In SRS: most clinical problems were related to school, school attitude problems 10%, Attention problems 6%, Attitude to Teacher 5%. Parents (proxy report) indicated significantly higher frequency of clinical problems compared to the children’s Self-Report P=0.004. Survivors had higher percentages of externalizing symptoms (hyperactivity, conduct, aggression) compared to the on therapy group p=0.03. There was a striking contrast seen between parents’ proxy report and children’s' self-report regarding atypicality and somatization with 17 % versus zero and 9 % versus zero which might reflect a gap in how parents perceive their children’s problems. Conclusions This study showed a high prevalence of psychological problems among children with cancer. School related problems seem to be high. BASC-2 is a useful screening tool in pediatric cancer patients to detect psychological problems that warrant further evaluation or intervention. eP328 A MULTI-DISCIPLINARY APPROACH FOR PERSONALIZED PATIENT CARE IMPROVES SAFETY AND COST OF CARE

Conclusions Education and standardized order set resulted not only in better patient outcome but also shorter length of hospital stay and healthcare dollars’ savings.

eP329 PALLIATIVE CARE UTILIZATION IN THE ADOLESCENT AND YOUNG ADULT (AYA) CANCER POPULATION

L. Berry1, C. Pileri1, A. Soliman2, M. Michalopulos1, A. Mohamed2 1 University of Oklahoma Health science- Tulsa, Pediatrics, Tulsa, USA 2 St Francis Children' Hospital, Pediatrics, tulsa, USA

D. Noreika1, B. Cassel1, N. Skoro1, L. Kelly2, E. Del Fabbro1 1 Virginia Commonwealth University, Division of Hematology- Oncology and Palliative Care, Richmond, USA 2 Virginia Commonwealth University, Division of Pediatric HematologyOncology and Palliative Care, Richmond, USA

Introduction 16-year-old with Glanzmann’s thromasthenia and frequent ER visits with life threatening epistaxis. Significant patient safety concerns arose after a critical hospital admission with hemorrhagic shock. Objectives Improving patient safety, decreasing LOS and total blood product utilization Methods We analyzed the patient’s admissions for the following measures: Hgb level on arrival, time prior to first factor VII dose and blood product infusion, number of units of blood products received, LOS & the cost of care per admission. A cross/multi-disciplinary care team was assembled and we used the PDSA cycle for QI. Intervention: 1- We educated patient and her care giver about the importance of early presentation to the ER. 2- To Standardize patient management and decrease the time to start therapy: a disease specific order set was developed. Results shortened LOS from 36 to 26 hours. Shortened duration of pre ER bleeding as measured by the hemoglobin on admission from 7.6 g/dL to 8.4 g/dL, time to first dose of Factor VIIA from 2 hours to 1, first blood product administration from 4 ¾ hrs to 2 hrs. 4 less blood product units per admission, factor VIIa per admission decreased by an average of

Introduction Adolescent and Young Adult (AYA) patients with cancer (ages 15-39) are a distinct group with unique support needs. Although multiple studies describe survivorship in this age group, few publications have characterized their palliative needs and outcomes. Objectives Characterizing the use of palliative care (PC) consultation at our institution in the AYA patient population, including reasons for palliative care referral, and health care utilization. Methods Retrospective chart review of 225 AYA cancer decedents between 20122016 at an Academic Medical Center. Results No PC consultation in 52% or late consultation (last 30 days of life) in 30.2%. Only 8.4% received PC consultation >90 days before death. The most common reason for consultation in patients receiving early PC consultation was symptom management, especially pain management. Females were more likely to have PC consultation (55.0%) compared to male patients (41.4%) (p=.046); there were no racial disparities noted to PC consultation (p=.790). The most common insurance payor was Virginia Medicaid. Hematologic malignancy patients were less likely to have PC consultation compared to patients with solid malignancy. Hospitalization was common and 84% of patients were hospitalized at least once in the 6

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months prior to death. At least one ICU visit occurred in 41% of these patients. Conclusions AYA cancer decedents frequently required hospitalizations and intensive care at our institution. PC may provide support for earlier goals of care discussions however consultation occurs late or not at all in this population. Further research is needed to describe the barriers to PC consultation in this patient population.

eP330 IMPACT OF A PATIENT NAVIGATOR PROGRAM ON PEDIATRIC ONCOLOGY CLINICAL CARE AND PATIENT OUTCOMES IN A LOW RESOURCE SETTING. J. Mafwimbo1, F. Alvi2, N. Masalu1, K. Schroeder3 1 Bugando Medical Centre, Oncology, Mwanza, Tanzania 2 Washington University in St. Louis, School of Medicine, St. Louis, USA 3 Duke University Medical Center, Pediatric Hematology/ Oncology, durham, USA Introduction Oncology patient navigation programs have been successfully implemented at hospitals throughout the U.S., enhancing the quality of care. With increased barriers to cancer care in low resource settings, a patient navigator has the potential to significantly impact outcomes. However, there is limited research on the efficacy of such programs in these settings. Objectives At Bugando Medical Centre (BMC) in Mwanza, Tanzania, a patient navigation program was established with the goals of reducing time to oncology evaluation and diagnosis, and ultimately improving survival outcomes. Methods A retrospective analysis was conducted of all pediatric oncology patients seen at BMC from 2010-2016, separated by presentation date before or after establishment of navigation program. Collected data includes demographics, diagnosis, and time from presentation to oncology evaluation and diagnosis and outcomes. Results A total of 305 patient files were reviewed, with 185 pre- and 120 post- program initiation. Patient groups did not differ by age or gender (p=0.329 and 0.744), or diagnosis distribution. After establishing a patient navigator program, the average time to oncology evaluation decreased from 49.7 to 16.6 days (p=0.015), and time to diagnosis decreased from 49.1 to 23.6 days (p=0.07). Patient abandonment decreased from 44% to 32% (χ2=9.7, p=0.001), and patient 1-yr overall survival increased from 18% to 39% (χ2=15.4, p<0.001). Conclusions This study has shown that a patient navigation program has the potential to significantly impact patient outcomes through reductions in time to evaluation and diagnosis, and treatment abandonment, and should be included in comprehensive pediatric cancer care programs.

eP331 SALT-SODA SOLUTION - A LOW COST, EFFECTIVE INTERVENTION TO PREVENT ORAL MUCOSITIS IN CHILDREN WITH ACUTE LEUKAEMIA: EXPERIENCE FROM DEVELOPING COUNTRY SET-UP S. Tahura1 1 Dhaka Shishu Hospital, paediatric haematology and oncology, Dhaka, Bangladesh

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Introduction Oral mucositis is one of the most debilitating side effects of induction protocols for acute leukaemia which causes severe pain and difficulty in swallowing. Though various drugs have been used to prevent it, the effectiveness of such therapies has not been confirmed in children. Moreover, in a developing country set-up, expensive drugs are difficult to apply because of the cost. Objectives To find out the effectiveness of salt-soda solution comparing with chlorhexidine mouthwash to prevent oral mucositis in children with Acute Leukaemia under induction chemotherapy. Methods This prospective study had been conducted at the department of Paediatric Haematology and Oncology of Dhaka Shishu (Children) Hospital from March 2015 to February 2016. Fifty six children (age ranging from 6-16 year) having Acute Leukaemia (ALL or AML) under induction chemotherapy were randomly selected and assigned to salt-soda solution (SSS) group or chlorhexidine (CHX) mouthwash group. Patients were asked to rinse their mouth five times a day from the 1st day of chemotherapy and continue for five weeks. Mucositis was assessed at baseline and at weekly intervals by World Health Organization mucositis grading. Results There was no significant difference in occurrence rate of oral mucositis between two groups but the onset of ulcerative mucositis was significantly delayed (p<0.05) and cost was significantly (p<0.05) low in SSS group than CHX group. Conclusions Salt-soda solution was an effective and low cost intervention to prevent oral mucositis in children with Acute Leukaemia undergoing induction chemotherapy.

eP332 CHALLENGES OF MANAGING CHILDREN WITH LIFE LIMITING CONDITIONS IN A COUNTY HOSPITAL IN WESTERN KENYA P. Were1 1 Moi Teaching and Referral Hospital, Nursing, Eldoret, Kenya Introduction Community mobilization and outreach activities to comb out all children with Burkitts Lymphoma (BL) in Western Kenya Region had not only resulted into BL cases presenting to the hospitals but also huge number of children with chronic/terminal disease presenting to these facilities and needing special attention. A child with Life limiting conditions not only face the challenges of pain but rejection by peers and community members who do not understand their plights but relates their dilemma with a taboo or a bad omen that has befallen the family. These children are really stigmatized especially those whose appearances have been disfigured Objectives This is an experience paper highlighting plight of children that presented with life limiting conditions and the challenges they go through as they try to seek treatment from Health Care Providers (HCPs) who are not Palliative Care trained Methods A few HCPs have gone through basic training on palliative care. However, use of morphine which most of them associate with addiction is not optimized. Cases enrolled included sickle cell disease. Results 300 cases spotted in a 4 year span. 140 enrolled in the BL treatment program. 70 were lost t follow-up and the remaining enrolled in the palliative care clinic that takes care f both adults and children. Parents and children reported improved comfort of distressing symptoms. This initiative registered marked improvement in quality of life.

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Conclusions A strong structure for management of children with life limiting conditions should be put on the ground which can only be achieved through collaboration and networki

eP333 ALTERNATE METHOD TO PROVIDE PALLIATIVE CARE WHERE THERE ARE SHORT CAREGIVERS M. Aditya1 , Purba Medinipur, India

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Introduction Due to financial incapability and absence of manpower poor families often fail to carry their advanced cancer patients to the nodal centres. This pilot study will explore whether communication by mobile phone can lessen this burden. Objectives To identify and try to solve to the extent possible the main difficulties in giving palliative care to the terminal cancer patients of the area. Methods Initially a plan was generated regarding management of an advanced cancer patient in a nodal centre at District Head Quarter. Subsequently every two week a trained social worker attached to nodal centre will follow up and give necessary advice and emotional support to the patients and their families through their registered mobile phone number. Patient’s family were also encouraged to communicate with the team by phone in case of fresh complain and urgency in between. Results Since initiation cancer patients were contacted by mobile phone every two weeks to enquire about their difficulties. In 76% of the situation trained social workers could give necessary advice by phone regarding management of their physical symptoms. Moreover patient’s family were really overwhelmed by the emotional support offered by the team over phone. Only 24% of cancer patients has to attend the nodal centre for expert advice from Palliative Care specialists. Conclusions This novel approach helped:In providing regular physical and emotional support to the patients and their families. In significantly reducing the financial and manpower problems of carrying patients to the nodal units. In improve the quality of life of patients by continuous guidance.

eP334 DIFFICULTIES IN PROVIDING PALLIATIVE CARE IN RURAL INDIA (WEST BENGAL) – EXPERIENCE OF AN NGO M. Aditya1 , Purba Medinipur, India

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Introduction As in any developing countries state of West Bengal in India has a huge burden of cancer patients in advanced stage coming from rural area where awareness regarding the usefulness of palliative care in rather poor. Objectives Our goal is to give a pain free good quality of life in these advanced stage cancer patients. Objective of this study is to identify the main difficulties in achieving the above goal in a rural village setting in India. Methods Advanced cancer patients in need of palliative care in various villages in of rural India were selected for this study. Their symptoms and managements in that rural surroundings were evaluated by an NGO (under the guidance of a senior palliative care specialist) working in that area. An

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attempt was made to identify the main obstacles in getting proper palliative care in a rural setting. Results Pain, fatigue are the main symptoms effecting these patients. In most patients pain and other symptoms control were grossly inadequate due to lack of properly trained manpower in the rural India. However regular homecare visits by a group of social workers were of immense help in the last few months of life. NGO team was well guided by a palliative care specialist. Conclusions There is a wide gap of trained manpower in this filled in rural areas of India. Dedicated groups from rural area itself need encouragement and proper training, so that difficult symptoms can be managed locally along with necessary social and psychological support to these patients.

eP335 SYMPTOM EXPERIENCE OF PATIENTS WITH CANCER PRESENTING TO AN ACADEMIC OUTPATIENT PALLIATIVE / SUPPORTIVE CARE CLINIC G. Bagcivan1, M. Bakitas2, J. Palmore3, E. Kvale3, A.C. Nichols4, S.L. Howell3, J.N. Dionne-Odom2, G.A. Mancarella2, O. Osisami2, J. Hicks3, C. McCarty3, S. Huang3, R. Tucker3 1 Gulhane Training and Research, Bakim Hizmetleri Mudurlugu, Ankara, Turkey 2 University of Alabama at Birmingham, Nursing School, Birmingham/ AL, USA 3 University of Alabama at Birmingham, Department of MedicineDivision of Gerontology- Geriatrics and Palliative Care, Birmingham/ AL, USA 4 Birmingham- VAMC- University of Alabama at Birmingham, Department of Medicine- Division of Gerontology- Geriatrics and Palliative Care, Birmingham/AL, USA Introduction Although Alabama is among the US states with the poorest palliative care access, the University of Alabama at Birmingham (UAB) launched one of the first comprehensive palliative supportive care outpatient programs. Objectives To examine temporal trends in the symptom experience of cancer patients presenting to an outpatient palliative care clinic. Methods We reviewed an outpatient database during 2 time periods (January 2006 to September 2009 and July 2012 to March 2016) to examine trends in clinical and demographic characteristics of cancer patients who presented to an outpatient PC clinic. Results 238 cancer patients presenting to a PC outpatient clinic were a mean of 52.22±13.0 years, 63.9% female, 76.9% white, and 24.8% married. Most (63.4%) patients had pain and over a quarter (29.8%) reported <50% pain relief from their treatments in the last 24 hours. Patients’ most common symptoms were fatigue, disturbed sleep, and pain. Most (62.2%) presented with mild to severe depression. Compared to the early time period, more patients in the later time period presented with a higher symptoms severity (except for appetite) and moderate to moderately-severe depression. Conclusions The UAB PC outpatient clinic has demonstrated robust growth in since inception, served a substantial number of racially diverse outpatients who present with mores severe symptoms than patient in the earlier time period.

eP336 CULTURAL AND RELIGIOUS CONSIDERATIONS IN CANCER CARE: WHERE DO DESIRES FOR LIFESUSTAINING CARE AND MIRACLES COME FROM?

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E. Bain1, M. Puopolo1, A. Agarwal1, M. Lam1, E. Chow1, B. Henry1 1 Sunnybrook Health Sciences Centre- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Toronto, Canada Introduction Religious and cultural competencies are important in providing excellent palliative care. In some populations, religious/cultural factors are known to influence decision-making at the end-of-life. However, there is a lack of literature that summarizes attitudes towards life-sustaining treatments and desires for miracles, particularly in the palliative cancer population. Objectives To examine religious/cultural factors contributing to the desire for miracles or life-sustaining treatments in the palliative cancer population, and to outline guidelines for managing requests for such treatments. Methods A scoping review was conducted across five electronic databases using pre-established criteria. Two independent reviewers screened all sources. Results The search strategy produced 615 unique articles, 9 of which were deemed eligible for inclusion. Findings suggested that cancer patients expressing stronger religious beliefs may have greater desires for and utilization of lifesustaining care, but this use may be reduced if patients received timely spiritual support from their medical teams. Furthermore, patients from Indian or African American communities placed a relatively high importance on life-sustaining care when compared to patients from Caucasian and Hispanic populations. No studies provided data to support a correlation between desires for miracles due to religious or cultural reasons. Conclusions Current guidelines suggest early communication with patients surrounding requests for life-sustaining care for religious/cultural reasons, in line with our findings suggesting greater desires for such care among these patients, which can be managed with timely communication and spiritual support. Further research is necessary to explore these correlations and establish a stronger basis for consensus on how to optimally respond to these requests.

eP337 DEVELOPING PALLIATIVE CARE AT THE STATE LEVEL: IS IT POSSIBLE?

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eP338 EARLY PALLIATIVE CARE FOR PATIENTS WITH SOLID TUMORS AND HEMATOLOGICAL MALIGNANCIES: IMPACT ON QUALITY METRICS AND COSTS OF CARE B. Cassel1, D. McCLish2, T. Albrecht3, N. Skoro3, D. Noreika1, E. Del Fabbro1 1 Virginia Commonwealth University, Hematology/Oncology & Palliative Care, Richmond, USA 2 Virginia Commonwealth University, Biostatistics, Richmond, USA 3 Virginia Commonwealth University, Massey Cancer Center, Richmond, USA Introduction Prior research on the effects of early palliative care (PC) on utilization and costs has been mixed. Objectives To evaluate the impact of early versus late PC on the intensity and cost of endof-life care; and to compare solid and hematological malignancies regarding that association. Outcomes included quality metrics endorsed by ASCO. Methods Observational study using billing and administrative data from 2008-2016 at an NCI-designated cancer center. Patients receiving early PC (more than 90 days prior to death) were matched 1:1 to those receiving PC later using propensity-based scores derived from race, sex, socio-economic status, age, year of death, and comorbidities. There were 478 solid tumor pairs and 60 heme-malignancy pairs. Outcomes were assessed in the final 30 days of life. Results Late PC is associated with all 8 measures of utilization among solid tumor patients, and 4 of the 8 measures among hematologic patients (Table 1). For example, the odds of having an emergency department visit for patients with late PC was 3.00 time (solid) or 3.67 times (hematological) greater compared to early PC. A composite utilization score (Hui 2014) was lower for early PC patients in both cancer groups, but costs were only lower for early PC patients with solid tumors (Table 2). There were no significant differences in magnitude of impact between solid and hematological patients for any measures. Table 1.

N. Carafizi1 Charity Foundation for Public Health Angelus-Moldova, Hospice Angelus, Chisinau, Moldova 1

Introduction Palliative care in Moldova has been growing gradually since 2000 at the level of non-governmental organizations as absolutely new concept. It was introduced into the National Healthcare structure by the first medical order only in 2008. Objectives To assess palliative care development in Moldova in regards of the developed state medical regulations. Methods Review of the national medical legislation on palliative care. Results From 2008 to 2015 there have been passed several medical laws which included implementation and development of palliative care in the country; national palliative care standards, including those for HIV/AIDS patients; prescription and access to drugs, including weak and strong opioids; clinical protocols on the basic symptoms’ management and costs for home-based and in-patient palliative care services. Conclusions Despite the fact that palliative care in the country makes only first steps during 7 years there has been laid the legislation basis for implementation and further development of palliative care in the country.

Table 2.

Conclusions Receiving earlier palliative care is associated with less hospital and ED utilization in the final month of life, regardless of cancer group. eP339 TREATMENT OF MALIGNANT BILIARY OBSTRUCTION (MBO) WITH TRANSPARIETOHEPATIC ENDOPROTHESIS (TE) M. Cavanagh1, M. Soria Tristán1, A.M. Sanchez Peña1, J.M. Martin Martínez1, M.T. Diaz Puente1, L. Diaz Paniagua1, J. cobos1, M. vicente1, B. García García1, M.J. Boya1, S. Enrech Francés1 1 Hospital Universitario Getafe, Oncology, Madrid, Spain

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Introduction Placement of biliary endoprothesis with palliative intention in patients with MBO not amenable to surgical treatment is a frequently used technique. Objectives To present our clinical experience in the treatment of MBO with TE. Methods Data were collected retrospectively from 7 patients with MBO that were treated with TE from 2014 to 2017. Clinical evolution, complications and overall survival were measured after TE. Results Median age 64 years (SD 10,33), 71% men, localization: pancreatobiliar 42%, colon 28%, other 28%. The most common complications were cholangitis and obstruction (71,4%), second TE was necessary in 5 patients (71.4%). The average survival after TE employment was 7,1months. Chemotherapy was administered in 4 patients (57,1%) after TE employment. Conclusions This technique demonstrates benefits in the palliative management of metastatic patients allowing the possibility of further chemotherapy treatments. However, it´s necessary to highlight the high risk of associated complications. Physicians should be aware of this at the moment of considering this technique in patients with MBO.

eP340 COULD TIME OF WHOLE BRAIN RADIOTHERAPY DELIVERY IMPACT OVERALL SURVIVAL IN PATIENTS WITH MULTIPLE BRAIN METASTASES? S. Chan1, L. Rowbottom1, R. McDonald1, L. Zhang1, G.A. Bjarnason2, M. Tsao1, C. Danjoux1, E. Barnes1, H. Lam1, P. Marko1, C. DeAngelis3, A. Agarwal1, B.A. Wan1, E. Chow1 1 Odette Cancer Centre - Sunnybrook Health Sciences Centre - University of Toronto, Radiation Oncology, Toronto, Canada 2 Odette Cancer Centre - Sunnybrook Health Sciences Centre - University of Toronto, Medical Oncology, Toronto, Canada 3 Odette Cancer Centre - Sunnybrook Health Sciences Centre - University of Toronto, Pharmacy, Toronto, Canada Introduction Whole brain radiotherapy (WBRT) is commonly used to treat brain metastases. Objectives The present study evaluated the influence of treatment time on overall survival (OS) in patients receiving WBRT. Methods Patients who received WBRT from 2004 to 2016 were included. Based on different percentages of treatment times falling into one time frame (i.e., 100%, ≥80%, ≥70%, or ≥60%), patients were allocated to three cohorts (8:00–11:00 AM, 11:01 AM–2:00 PM, 2:01– 5:00 PM). Demographics were compared among cohorts using the Kruskal-Wallis nonparametric test and Fisher exact test. To control the multiple comparisons on select demographic variables, a Bonferroni adjusted P value was used to determine statistical significance. Kaplan-Meier curves were created for OS. Univariate and multivariate Cox proportional hazard models were used to find predictive factors of OS in all patients, females only, and males only. Results A total of 755 patients were included with a median age of 66 years. The actuarial median OS was 2.37 months. Treatment time was not associated with OS for all patients or males only. In elderly female patients (>65 years), a significant difference in OS was found among treatment cohorts (P=0.02). Treatment time (when ≥80% or ≥70% of treatment times were in one time frame), age, and Karnofsky performance status (KPS) were significant predictive factors of OS in univariate analysis for females. Only age and KPS remained significant in multivariate analysis.

Conclusions Time of WBRT delivery for brain metastases was significantly related to OS upon univariate analyses in elderly females only. eP341 EFFECTS OF CIRCADIAN RHYTHMS AND TREATMENT TIMES ON THE RESPONSE TO RADIOTHERAPY FOR PAINFUL BONE METASTASES S. Chan1, L. Zhang1, L. Rowbottom1, R. McDonald1, G.A. Bjarnason2, M. Tsao1, C. Danjoux1, E. Barnes1, M. Popovic1, H. Lam1, C. DeAngelis3, A. Agarwal1, B.A. Wan1, E. Chow1 1 Odette Cancer Centre - Sunnybrook Health Sciences Centre - University of Toronto, Radiation Oncology, Toronto, Canada 2 Odette Cancer Centre - Sunnybrook Health Sciences Centre - University of Toronto, Medical Oncology, Toronto, Canada 3 Odette Cancer Centre - Sunnybrook Health Sciences Centre - University of Toronto, Pharmacy, Toronto, Canada Introduction Previous studies have observed how the time of radiotherapy delivery can impact toxicities and outcomes. Objectives The goal of this study was to determine whether treatment time influenced radiotherapy response for bone metastases. Methods Patients who received radiation treatment to painful bone metastases from 2000 to 2010 were included in our analysis. Demographic and treatment

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information were collected prospectively. Treatment times were extracted from patient medical records. Patients were allocated to 8:00 AM–11:00 AM, 11:01 AM–2:00 PM, or 2:01 PM–5:00 PM cohorts based on their treatment times. The Fisher exact test was used to compare treatment response between the three cohorts. A two-sided P value of <0.05 was considered statistically significant. Analysis was repeated by sex. Results A total of 194 patients were included. The median age was 68 years and 55.5% of patients responded to treatment. The dose and fraction of radiation received differed significantly between treatment cohorts using all allocation methods. Females in the 11:01 AM–2:00 PM cohort exhibited a significantly higher response rate (P=0.02) and differing proportions of response types (P=0.03) compared to the 8:00 AM– 11:00 AM and 2:01 PM–5:00 PM cohorts when allocated using all treatment times. No significant differences in response were seen between cohorts when all patients were analyzed together or analyzed for males only.

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eP342 THE ACCURACY OF CLINICIANS' PREDICTIONS OF SURVIVAL IN ADVANCED CANCER: A REVIEW S. Cheon1, A. Agarwal1, M. Popovic1, M. Milakovic1, M. Lam1, W. Fu1, J. DiGiovanni1, H. Lam1, B. Lechner1, N. Pulenzas1, A. Wan1, E. Chow1 1 Sunnybrook Health Sciences Centre, Radiation Oncology, Toronto, Canada Introduction The process of formulating an accurate survival prediction is often difficult but important, as it influences the decisions of clinicians, patients, and their families. Untimely or inaccurate predictions may hinder optimal management. Advanced cancer is typically characterized by an accelerated decline in health over the final weeks of life. Due to the predictability of this decline, prognostication of advanced cancer patients may be easier relative to patients with early stage disease. Objectives The current article aims to review the accuracy of clinicians’ predictions of survival (CPS) in advanced cancer patients. Methods A literature search in Cochrane Central, Embase, and Medline was conducted. Studies were included if the subjects consisted of advanced cancer patients, and estimated and observed survival data indicative of clinicians’ predictive ability was reported. Studies reporting on the predictive value of biological and molecular markers were excluded. Results A total of 1,481 articles were identified in the literature search, of which 15 studies met the eligibility criteria. Clinicians in five studies underestimated patients’ survival (estimated-to-observed survival ratio between 0.5 and 0.92). In contrast, 12 studies reported clinicians’ overestimation of survival (ratio between 1.06 and 6). Conclusions CPS in advanced cancer patients are often inaccurate and overestimated. Given these findings, clinicians should be aware of their tendency to be overoptimistic with survival predictions. Further investigation of predictive patient and clinician characteristics is warranted to improve clinicians’ ability to predict survival.

eP343 PREDICTIVE MODELS FOR SURVIVAL IN ADVANCED CANCER: A SYSTEMATIC REVIEW S. Cheon1, A. Agarwal1, M. Popovic1, M. Milakovic1, W. Fu1, G. Fu1, B. Lechner1, N. Pulenzas1, A. Wan1, E. Chow1 1 Sunnybrook Health Sciences Centre, Radiation Oncology, Toronto, Canada

Conclusions Treatment time may affect response in female patients receiving radiotherapy for painful bone metastases. Subsequent chronotherapy studies in radiation should investigate these gender differences.

Introduction The ability to accurately predict survival in advanced cancer patients is important for patients, their families, clinicians, and researchers. However, there remains substantial uncertainty surrounding survival prediction, and efforts to identify important prognostic factors that may reduce this uncertainty are underway. Objectives The objective of this systematic review is to identify and appraise evidence-based prognostic models that predict the survival of advanced cancer patients, and to ascertain variables that may affect the predictive ability of these models. Methods A literature search of Cochrane Central, Embase, and Medline was conducted to identify relevant articles. Studies were included if: a) models were designed for metastatic cancer patients; and b) a primary or secondary outcome was to design or validate a prognostic or survival model consisting of three or more prognostic factors. Studies solely focusing

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on biological and molecular markers and those not explicitly reporting a concordance index (c-index) were excluded. Results The literature search returned 1,671 articles, of which 29 studies were deemed eligible. Performance status, metastasis-related factors, and several laboratory variables were identified as common prognostic factors included in survival prediction models. The median c-index was 0.656 (range: 0.58-0.83). Conclusions A combination of clinical and laboratory variables are often used in predictive models of survival in advanced cancer patients. Further investigation into the utility of treatment-related factors as prognostic predictors is suggested to improve accuracy in the ability of prognostic models to predict survival.

eP344 EFFICACY OF MULTIPLE FRACTION CONVENTIONAL RADIATION THERAPY FOR PAINFUL UNCOMPLICATED BONE METASTASES: A SYSTEMATIC REVIEW R. Chow1, P. Hoskin2, S. Chan1, A. Mesci1, D. Hollenberg1, H. Lam1, C. DeAngelis1, E. Chow1 1 Odette Cancer Centre - Sunnybrook Health Sciences Centre - University of Toronto, Institute of Evaluative Clinical Sciences, Toronto, Canada 2 Mount Vernon Hospital - Imperial College, Department of Clinical Oncology, London, United Kingdom Introduction Radiation therapy is effective for painful uncomplicated bone metastases, with multiple fraction radiation therapy (MFRT) administered frequently. The optimal dose for MFRT to yield maximum pain relief remains unclear. Objectives The aim of this systematic review was to determine pain response across MFRT doses. Methods A literature search was conducted in Ovid MEDLINE (R) (1946 to July Week 3 2016), Embase Classic & Embase (1947 to 2016 Week 30) and Cochrane Central Register of Controlled Trials (June 2016). Pain response rates and the side effects for MFRT doses were extracted. Results From the 3,719 articles identified from the search, 17 were included for quantitative synthesis. 22.5Gy/5 had the highest overall response (OR) rate, 30Gy/15 had better complete response (CR) rate and 20Gy/2 had better partial response (PR) rate. Only 4 of the 17 included studies directly compared MFRT with each other – one reported marginally-better OR for 24Gy/6 over 20Gy/2; another found 20Gy/10 to be slightly more efficacious than 30Gy/15 and 22.5Gy/5 for OR. Two randomized trials compared 20Gy/5 and 30Gy/10 – one favoured 20Gy/5 while the other concluded 30Gy/10 to be the better option. The overall rate of GI toxicities, nausea and vomiting did not differ greatly between MFRT doses. Conclusions No major difference exists between the schedules and toxic events studies in these trials consistent with the wealth of randomized data which shows no dose response for pain relief after radiotherapy for metastatic bone pain.

eP345 EFFICACY OF SINGLE FRACTION CONVENTIONAL RADIATION THERAPY FOR PAINFUL UNCOMPLICATED BONE METASTASES: A SYSTEMATIC REVIEW AND METAANALYSIS R. Chow1, P. Hoskin2, D. Hollenberg1, M. Lam1, K. Dennis3, S. Lutz4, H. Lam1, A. Mesci1, C. DeAngelis1, S. Chan1, E. Chow1

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Odette Cancer Centre - Sunnybrook Health Sciences Centre - University of Toronto, Institute of Evaluative Clinical Sciences, Toronto, Canada 2 Mount Vernon Hospital - Imperial College, Department of Clinical Oncology, London, United Kingdom 3 The Ottawa Hospital - University of Ottawa, Division of Radiation Oncology, Ottawa, Canada 4 Blanchard Valley Hospital, Department of Radiation Oncology, Ohio, USA Introduction Single fraction radiotherapy (SFRT) and multiple fraction radiotherapy (MFRT) are effective for painful uncomplicated bone metastases and have been shown to be of similar efficacy. The optimal conventional external beam SFRT dose for maximum pain relief remains uncertain. Objectives The aim of this systematic review was to comprehensively review and synthesis overall pain response rates by dose. Methods A literature search was conducted in Ovid MEDLINE (R) (1946 to June 2016 Week 3), Embase Classic & Embase (1947 to 2016 Week 26) and Cochrane Central Register of Controlled Trials (May 2016) using keywords such as bone metastases, radiotherapy and single-fraction. Results The 635 results from the search were screened, and ultimately 27 were included for quantitative synthesis. The review indicated that 10Gy and 6Gy may produce superior overall response (OR) and complete response (CR) rates compared to 8Gy, and 6Gy may result in better partial response (PR) than 8Gy. However, only a few studies documented doses other than 8Gy. In trials that directly compared 8Gy to 4Gy or 6Gy, 8Gy was deemed statistically superior. Conclusions 8Gy SFRT was the most commonly administered dose for palliation of bone metastases supporting its efficacy and safety. Future studies should explore the efficacy of 10Gy while minimizing its side effects.

eP346 INTER-RATER AGREEMENT BETWEEN PALLIATIVE CARE C L I N I C A N S W H E N E VA L U AT I N G A B D O M I N A L RADIOGRAPHS TO QUANTIFY THE DEGREE OF FAECAL SHADOWING VISIBLE K. Clark1, N. Byfieldt2, N. Talley3 1 Northern Sydney Local Health District, Cancer and Palliative Care Network, Sydney, Australia 2 Calvary Mater Newcastle, Palliative Care, Newcastle, Australia 3 The University of Newcastle, Global Research, Newcastle, Australia Introduction The validity of extrapolating the appearance of a plain abdominal radiograph as a marker of the severity of constipation in palliative care is questionable. Recently, poor inter-rated agreement between 4 clinician’s reports of faecal shadowing was demonstrated. Acknowledged weaknesses of this work included the number of participating clinicians was small (n=4) and their clinical experience disparate. Objectives This study’s aim was to investigate whether a larger group of palliative care clinicians’ training and experience affected their levels of agreement of their assessments of faecal shadowing visible on plain abdominal radiographs Methods Six Australian hospital-based palliative care services were approached. This resulted in 50 clinicians (medical specialists, registrars, junior medical officers (RMO) and nurses) each consenting to individually report the degree of faecal shadowing in the right colon, left colon and sigmoid on the same 10 radiographs. De-identified demographic details were

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summarised and Fleiss’s Kappa (FK) was used to evaluate concordance between multiple raters within clinical groupings. The regression coefficient was calculated to assess whether there was any differences between the group scores of the most experienced clinicians and the least experienced clinicians Results When the medical clinicians’ reports were examined, very little agreement was identified either within (table 1) or between groups (table 2), regardless of the level of experience of the doctors.

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We developed a SST identifying patients in need of PC when Palliative Performance Scale <50 was present with at least one of these indicators: ≥1 admission within the last 12 months; hospital admission from HCS; awaiting admission to HCS/Hospice; dialysis; home oxygen use; non-invasive ventilation. This SST showed a good agreement with the SIAARTI one as sensitivity (97.8%), specificity (92.8%), and accuracy (94.5%). Conclusions Our study estimated that >1/3 of people with chronic diseases awaiting to be hospitalized after an ED-visit were in need of PC and can be identified with this easy-to-use, non-disease-specific SST.

eP348 POOLED ANALYSIS OF TWO PHASE 3 TRIALS: BODY WEIGHT RESPONSE WITH ANAMORELIN IN ADVANCED NON-SMALL CELL LUNG CANCER (NSCLC) PATIENTS WITH ANOREXIA/CACHEXIA

Conclusions Regardless of the level of experience, clinicians fail to agree when quantifying the appearance of faecal shadowing on plain abdominal radiographs making this an unreliable investigation on which to base treatment decisions.

eP347 FEASIBILITY OF AN EMERGENCY DEPARTMENT-INITIATED SCREENING TO IDENTIFY SERIOUSLY ILL PATIENTS IN NEED OF PALLIATIVE CARE P. Cotogni1, A. De Luca1, A. Evangelista2, C. Filippini3, G. Macchi1, A. Scarmozzino4, G. Ciccone2, L. Brazzi3 1 AOU Città della Salute e della Scienza, Anesthesia and Intensive CarePain Management and Palliative Care, Torino, Italy 2 AOU Città della Salute e della Scienza, Clinical Epidemiology- CPO, Torino, Italy 3 University of Turin, Surgical Sciences, Torino, Italy 4 AOU Città della Salute e della Scienza, Health Management, Torino, Italy Introduction Early identification of palliative care patients is valuable. Objectives The aims of this study were to evaluate feasibility of an Emergency Department (ED)-initiated screening to identify seriously ill patients in need of PC and to develop a simplified screening tool (SST). Methods Eligible patients with known diagnosis of chronic heart, lung, liver, and kidney failures, progressive neurological diseases or advanced cancer, awaiting to be hospitalized after an ED-visit, were assessed with the screening tool from the Italian Society Anaesthesia Analgesia Resuscitation Intensive Care (SIAARTI). Results Out of 1,497 patients with an ED-visit, 485 were hospitalized and 257 met the inclusion criteria. Of 257 enrolled patients, 91 (35%) were identified as in need of PC. Comparing patients with 4 positive criteria to those with <4, the general clinical indicators more frequently positive were: ≥1 admission within the last 12 months (P<0.001); hospital admission from or awaiting admission to health care services (HCS)/Hospice (P<0.001); cachexia (P<0.012); home oxygen use (P<0.001); dialysis (P<0.008).

D. Currow1, J. Temel2, A. Abernethy3, J. Friend4, R. Giorgino5 1 IMPACT- Faculty of Health- University of Technology, -, Sydney, Australia 2 Massachusetts General Hospital, -, Boston MA, USA 3 Flatiron Health, -, New York NY, USA 4 Helsinn Therapeutics US- Inc., -, Iselin NJ, USA 5 Helsinn Healthcare SA, -, Lugano, Switzerland Introduction Anorexia/cachexia occurs in patients with advanced NSCLC. In the randomized, double-blind, placebo-controlled phase 3 trials ROMANA 1 (NCT01387269; N=484) and ROMANA 2 (NCT01387282; N=495) in NSCLC patients with cachexia, the ghrelin receptor agonist anamorelin was well tolerated and significantly increased body weight, lean and fat mass, and anorexia/cachexia symptoms over 12 weeks compared with placebo. Objectives An involuntary weight loss of ≥5% is an established diagnostic criterion for anorexia/cachexia. Therefore, an analysis was performed to determine the proportion of patients with ≥5% body weight increase. Methods Stage III/IV NSCLC patients with cachexia (BMI<20 kg/m2 or ≥5% weight loss during prior 6 months) were randomized 2:1 to 100 mg once daily oral anamorelin or placebo for 12 weeks. A pooled post-hoc analysis measured the proportion of patients with ≥5% body weight increase at the end of study (or last observation carried forward since week 6 or 9) in the modified intent-to-treat population (N=829). Results The percentage of patients with ≥5% body weight increase was significantly higher in the anamorelin arm (N=188/552, 34.1%) compared with placebo (N=37/277; 13.4%; p<0.0001). In patients with BMI<20kg/m2 at baseline (N=182), 47.3% (N=53/112) anamorelin-treated patients had a ≥5% body weight increase compared with 17.4% (N=12/69) placebotreated patients (p<0.0001). Conclusions In advanced NSCLC patients with anorexia/cachexia anamorelin produced a clinically relevant increase in body weight, as shown by the higher weight response rate when a stringent cut-off ≥5% weight gain was applied. These results indicate that patients with more advanced cachexia may still benefit from anamorelin treatment. eP349 THE FRE QU ENCY AT WHICH DOSES AND DR UGS ADMINISTERED BY CONTINUOUS SUBCUTANEOUS INFUSION ARE CHANGED: A SERVICE EVALUATION OF CLINICAL PRACTICE IN THE UNITED KINGDOM J. Baker1, A. Dickman2, S. Mason2, J. Ellershaw2, P. Skipper1

S190 1 Royal Liverpool and Broadgreen University Hospitals, Pharmacy Department, Liverpool, United Kingdom 2 University of Liverpool, Marie Curie Palliative Care Institute Liverpool, Liverpool, United Kingdom

Introduction A continuous subcutaneous infusions (CSCI) is an effective method of multiple drug administration in end of life care when the oral route is compromised. At present, currently available chemical and microbiological stability data limits the infusion time of a CSCI to a maximum of 24 hours. The ability to deliver prescribed medication by a CSCI over 48 hours may have numerous benefits in both patient care and health service resource utilisation. Objectives To identify most frequently prescribed CSCI drug combinations and the frequency at which CSCI prescriptions are altered. Methods Anonymised prescription details of CSCIs containing a minimum of two drugs were collected by hospital pharmacists or members of palliative care teams across seven acute NHS hospitals daily for a minimum of 2 days, to a maximum of 7 days over a 6-month period. Results A total of 1301 prescriptions from 288 patients were recorded across the seven sites during the data collection period. Of the 1301 CSCI prescriptions record, 89.3% (n=1162) included an opioid, while midazolam was the most-commonly prescribed drug, being present in 46.5% (n=605) of CSCIs. The 10 most-common CSCI drug combinations represented 35% (n=454) of the 1,301 prescriptions recorded. Median duration of an unchanged CSCI prescription across all sites was 2 days. Conclusions This service evaluation shows that there is potential for the utilisation of 48-hour CSCI in a large proportion of this patient population. However, before a clinical feasibility study can be initiated, robust chemical and microbiological stability data will be required.

eP350 WHO STILL RECEIVES WHOLE BRAIN RADIOTHERAPY? A. Fairchild1, A. Duimering1, S. Ghosh2, D. Ma1, P. Li1, K.P. Chu1, W. Roa1, T. Nijjar1, S. Patel1, D. Severin1, F. Huang1, R. Scrimger1, J. Amanie1, D. Yee1, B. Debenham1, B. Danielson1 1 Cross Cancer Institute, Radiation Oncology, Edmonton, Canada 2 Cross Cancer Institute, Experimental Oncology, Edmonton, Canada Introduction With increasing availability of stereotactic radiosurgery, and appreciation for neurologic radiotoxicity, whole brain radiotherapy (WBRT) is being used less frequently as first-line treatment for brain metastases (BM). Objectives We describe the patient population administered WBRT through a dedicated palliative radiation oncology clinic. Methods Demographic, clinicopathologic, and radiotherapy (RT) data were collected for consecutive patients receiving WBRT included in a larger study on clinical prediction of survival (CPS). Karnofsky performance status (KPS) and Mini-Mental Status Examination (MMSE) score were available for 87.5% and 71.9%, respectively. Summary statistics and KaplanMeier estimates of actual survival (AS) were calculated. Results 224 patients received WBRT (06/2010-12/2014): 46.9% male; median age 64 years; 64.7% with lung cancer. 54.6% had KPS >70 and 52.5% a suboptimal MMSE score. 160/224 had multiple (average 4.1) BM and 62/224 had a single BM. 72.8% had extracranial metastases. Median AS was 102 days (SD 198d) vs CPS of 150 days (SD 101d). 79.0% and 17.0% received 5 vs 10 fraction WBRT. RT occupied an average of

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11.7% of patients’ remaining days (range 0.7-76.5%). 6.7% (15/224) had a solitary BM (average 2.3cm) without extracranial disease: 53.3% male; median age 69 years; 73.3% with lung cancer, 66.7% had KPS >70 and 41.7% suboptimal MMSE. Median AS was 171 days (SD 208d) vs CPS of 180 days (SD 82d). Conclusions In this cohort primarily of patients with widely metastatic lung cancer, median AS after WBRT was just over three months. However, those with oligometastases fared better, and should be considered for aggressive therapy up-front.

eP351 KNOWLEDGE AND ATTITUDES TOWARDS PALLIATIVE SEDATION AT HOME FOR TERMINALLY ILL CANCER PATIENTS: A SURVEY OF PALLIATIVE CARE DOCTORS IN ITALY R. Giusti1, L. Verna2, D. Iacono3, P. Marchetti1, C. Ficorella2, G. Porzio2 1 Sant'Andrea Hospital, Medical Oncology, Rome, Italy 2 San Salvatore Hospital, Università degli Studi dell'Aquila Dipartimento di Scienze Cliniche Applicate e Biotecnologiche, L'Aquila, Italy 3 San Camillo Forlanini Hospital, Tharacic Oncology Division, Rome, Italy Introduction Home setting has been reported as the preferred one by most patients and relatives and seems to be the favorite place of death. Just few clearly structured data on clinical practice in palliative sedation (PS) at home are available. Objectives Aim of this study is to obtain valid and accurate descriptive data regarding the practice and attitudes of palliative care specialists in PS for terminally ill cancer patients at home. Methods In 2015, a structured questionnaire was administered to 125 physicians regarding their attitudes and knowledge about PS, focusing on home care setting. Results All returned questionnaires were analyzed. 58% were women and 33% were younger than 40. 42% of participants have a formal qualification on palliative care, 45% have less than 5-years work’s experience in Home Care. 92% regularly perform PS at home. Principal indication for PS was refractory symptoms (52%) but family distress was another indicated option (38%). 34% of participants indicate the combination of benzodiazepines plus neuroleptics and opioids as the most commonly used drugs to induce sedation, but opioids still represent the most frequently single agents for PS (8%), followed by benzodiazepines (6%). Ethical concerns about informed consent and maintaining hydration were also investigated. Conclusions Our experience was the first one carried out in Italy. Palliative sedation at home is feasible and secure but standards for PS at home must be the same as for sedation in an institutional setting. On this way, more studies are requested.

eP352 THE ASSOCIATION AMONG SPIRITUAL PAIN AND END OF LIFE CARE AMONG ADVANCED CANCER PATIENTS AT A COMPREHENSIVE CANCER CARE CENTER A. Haider1, J. Williams1, M. Park1, E. Bruera1, M.O. Delgado Guay1 1 The University of Texas M. D. Anderson Cancer Center, PalliativeRehabilitation and Integrative Medicine, Houston, USA

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Introduction High religious coping strategies and low spiritual needs addressed have been related to treatment decisions at the end of life (EOL). Limited literature has explored the role of Spiritual Pain (SP) and its association with aggressive EOL care of patients with advanced cancer (AdCa). Objectives Primary objective was to determine the association between SP and receiving aggressive EOL care in AdCa patients. Methods This is a secondary analysis of 3 prior prospective studies evaluating spirituality, religiosity and SP, and financial distress done in Supportive Care clinic. 219 eligible electronic health records were reviewed. We analyzed the relationship among SP (Pain deep in your soul/being that is not physical; ≥1/10), and Aggressive EOL care (chemotherapy within 14 days prior to death, or ≥ ER visits, or ≥ 2 hospitalizations or intensive care unit (ICU) admissions within 30 days prior to death, or who died in ICU or general medical floor or refused hospice enrollment). Results 129(59%) were females, and 145(66%) were Christian. SP was found in 94(45%). Patients with SP underwent more aggressive EOL care (65% v. 35% p=0.0246). Only 38(40%) patients with SP had documented spiritual support. Advance care planning was documented in only 88(59%) of the cohort and it did not differ in patients with or without SP (60% v. 52%). Aggressive EOL care was associated with race; African American and Hispanic (p=.049) and SP (p=<0.024). Conclusions Significant number of AdCa expressed SP. Its presence is significantly associated with aggressive EOL care. Despite this low spiritual support was provided. Further studies are needed.

eP353 THE ECONOMIC COST OF FAMILY CAREGIVING FOR PATIENTS WITH ADVANCED CANCER: A QUALITATIVE STUDY B. Hannon1, A. Pope1, N. Swami1, C. Zimmermann1 1 Princess Margaret Hospital, Supportive Care, Toronto, Canada Introduction Advanced cancer can impose a significant economic burden on family caregivers. Although Canada has a publicly funded healthcare system, there are gaps in coverage, including prescription drugs and extended homecare supports. Much of the literature to date has focussed on settings with privately funded healthcare, and on direct costs of medical services. Less is known about the indirect costs associated with informal family caregiving. Objectives To explore the direct and indirect costs incurred by family caregivers of patients with advanced cancer at the end-of-life. Methods Family caregivers of patients who had participated in a randomised controlled trial of early palliative care at a tertiary cancer centre in Toronto, Canada, were recruited a mean of 3 years after the patient’s death, and were invited to complete one-on-one, semi-structured qualitative interviews. Results Sixty-one interviews were completed. There were no obvious differences between themes in the control and intervention groups. Although many patients and caregivers had access to additional private insurance, several areas of economic burden were identified. Caregivers described experiences related to out-of-pocket payments for prescription drugs (especially chemotherapies), or hiring of private professional carers; as well as significantly reduced household income and loss of future financial security (with bankruptcy in one case), and ancillary costs related to transportation, or purchasing of

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medical equipment. Wide variability existed in awareness and utilisation of compassionate programs aimed at reducing financial burden. Conclusions The economic burden associated with family caregiving is not insignificant. Greater attention to economic support interventions targeting family caregivers is needed.

eP354 PRELIMINARY RESULTS FROM DANSAC-EPI: A DANISH MULTICENTER TRIAL TO INVESTIGATE THE PREVALENCE AND TREATMENT OF NAUSEA AND/OR VOMITING IN PATIENTS WITH ADVANCED CANCER S. Harder1, J. Herrstedt1, M.A. Neergaard2, L. Pedersen3, S.S. Ottesen4, M. Groenvold3,5 1 Odense University Hospital, Department of Oncology, Odense C, Denmark 2 Aarhus University Hospital, The Palliative Team- Department of Oncology, Aarhus, Denmark 3 Bispebjerg Hospital, The Research Unit- Department of Palliative Medicine, Copenhagen, Denmark 4 Zealand University Hospital-, Department of Clinical Oncology and Palliative Care, Roskilde, Denmark 5 University of Copenhagen, Department of Public Health, Copenhagen, Denmark Introduction Despite continuing progress in treatment of chemotherapy-induced nausea and vomiting, knowledge of nausea and vomiting (N/V) in patients with advanced cancer in the palliative phase is sparse. According to recent MASCC/ESMO guidelines “the evidence base in this field is minimal with largely poor quality trials or uncontrolled trials and case studies”. Consequently, current recommendations propose aetiology-based treatment approaches. Objectives To assess prevalence, causes and predictors of nausea and correlation to quality-of-life (QoL) in patients with advanced cancer not receiving oncologic treatment. Methods Patients with advanced cancer (metastatic cancer, no curable treatment options) from five Danish departments were screened using an extended version of the EORTC-QLQ-C15-PAL. In eligible patients the treating physician evaluated possible causes (none, one or more). Results Overall, 51 % of 307 patients reported having nausea. Being female or having a diagnosis of either gastrointestinal, gynecological or stomach cancer increased numerical risk of feeling nauseated (Table 1). The most common causes of nausea were constipation (25 %), opioid-induced (10 %) and other causes like gastric reflux, infection or oral candidiasis (Table 2). Patients experiencing nausea were more likely to suffer from poor QoL (p = 0.001) (Table 3).

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Conclusions Age, reason for admission, symptom burden on admission and development of delirium are variables that can inform clinicians about probable discharge disposition on an APCU.

eP356 THE ETHICS OF PALLIATIVE SEDATION: A SCOPING REVIEW AND UPDATE IN 2016 B. Henry1 1 Sunnybrook Health Sciences Centre, Ethics Centre`, Toronto, Canada

Conclusions These preliminary results suggest that palliative cancer patients with nausea are numerically but not statistically significant more likely to be female and having either gastrointestinal, gynecological or stomach cancer. Nausea was associated with poor overall QoL, although the presented statistics did not adjust for the effect of other symptoms. Further results await completion of the DANSAC-protocols.

eP355 PREDICTORS OF DISCHARGE DISPOSITION ON AN ACUTE PALLIATIVE CARE UNIT D. Hausner1, N. Kevork1, L.W. Le2, C. Zimmermann1 1 Princess Margaret Cancer Centre- University Health Network, Department of Supportive Care, Toronto, Canada 2 Princess Margaret Cancer Centre- University Health Network, Department of Biostatistics, Toronto, Canada Introduction Acute palliative care units (APCUs) admit patients with cancer for symptom control, transition to longer-term inpatient settings (community PCU/ hospice [CPCU/H]) or end-of-life care. Prognostication is crucial for facilitating clinical decisions, goals-of-care discussions and discharge planning. Objectives We retrospectively evaluated predictors of patients’ discharge disposition on a 12-bed APCU in a comprehensive cancer center. Methods We evaluated administrative (admission reason and source), demographic and clinical data for all patients admitted to the APCU in 2015. Clinical data included cancer diagnosis, palliative performance status (PPS), delirium screening using Confusion Assessment Method (CAM) and symptoms using Edmonton Symptom Assessment System (ESAS). Multivariable analysis identified predictors of patients’ discharge disposition in a 3-level (home vs. died or CPCU/H) multinomial logistic regression. Results Among 280 patients, median age was 65.5, length of stay 10 days and PPS 50 on admission. Dispositions were: 55.7% died, 21.8% CPCU/H and 22.5% home. On multivariable analysis, older patients were less likely to die on the APCU (Odds Ratio [OR] 0.97, p=0.03), as were those admitted for symptom control vs. transition (OR 0.05, p<0.001). Patients with positive CAM during hospitalization and those with initial ESAS distress score 31-60 vs. 0-30 were more likely to die on the APCU than return home (OR 6.04, p=0.03 and OR 4.20, p=0.004, respectively). The only factor distinguishing CPCU/H from home was reason for admission (symptom control vs. transition, OR 0.05, p<0.001).

Introduction The use of palliative sedation (PS) in the treatment of intractable suffering at the end of life continues to be a controversial practice. Objectives This review will provide an update from a 2010 review of PS which identified the following 4 areas of concern: Inconsistent terminology; its use in non-physical suffering; reports on the experience of emotional and more distress when PS is used; and, concern that the practice of PS may hasten death. This review looks at the literature over the past 6 years and provides an update on these concerns. Methods A scoping review was undertaken using the major academic databases for English manuscripts published between 2010 and 2015 related to the use of palliative sedation. Abstracts were further reviewed and articles presenting empirical data relating to the 4 areas of concern were reviewed in full to update areas of growing consensus and continued contention for this practice. Results A total of 33 relevant articles formed the basis of this review. In terms of consistent terminology little progress has been made over the past 6 years. However what was notable is that for PS- terminology does matter. PS used to support non-physical suffering continues to controversial and required further research. All carefully controlled studies continue to show no impact on hastening death. Family and Nursing distress in experiencing PS can be effectively controlled with good psycho-social education and support. Conclusions Conclusions Movement towards a community-based consensus on PC will require the promulgation and support evidence-informed PS practice guidelines.

eP357 LORAZEPAM AS AN ADJUVANT TO HALOPERIDOL FOR AGITATED DELIRIUM AT THE END-OF-LIFE: A DOUBLEBLIND RANDOMIZED CONTROLLED TRIAL D. Hui1, S. Frisbee-Hume1, A. Wilson1, S.S. Dibaj2, T.T. Nguyen1, M.G. De La Cruz1, P.W. Walker1, M.O. Delgado Guay1, M. Vidal1, D.S. Zhukovsky1, D. Epner1, A.S. Reddy1, K.C. Tanco1, J.L. Williams1, S. Hall1, D.D. Liu2, K.R. Hess2, S.R. Amin3, B. William4, E. Bruera1 1 University of Texas MD Anderson Cancer Center, Department of Palliative Care- Rehabilitation and Integrative Medicine, Houston, USA 2 University of Texas MD Anderson Cancer Center, Department of Biostatistics, Houston, USA 3 University of Texas MD Anderson Cancer Center, Department of Investigational Pharmacy, Houston, USA 4 Memorial Sloan Kettering Cancer Center, Department of Psychiatry and Behavioral Sciences, New York, USA Introduction Agitated delirium is a highly distressing neuropsychiatric syndrome common in the last days of life. The use of benzodiazepines for agitated delirium is highly controversial.

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Objectives We compared the effect of lorazepam versus placebo as an adjuvant to haloperidol for persistent agitated delirium. Methods In this double-blind trial, we randomly assigned patients with advanced cancer admitted to an acute palliative care unit with agitated delirium despite scheduled haloperidol to either lorazepam 3 mg IV or placebo, in addition to haloperidol 2 mg IV upon the onset of agitation. The primary outcome was the Richmond Agitation Sedation Scale (RASS) over the first 8 hours, ranging from -5 (unarousable) to +4 (combative). Secondary endpoints were rescue neuroleptic use, perceived comfort, delirium-related distress, adverse effects and overall survival. Results 52 of 58 (90%) patients who received the medications completed 8 h of observation. RASS decreased significantly within 30 min of treatment in both arms (Figure). The lorazepam arm was associated with significantly greater reduction of RASS (P<0.001, Figure), less rescue neuroleptics (mean haloperidol equivalent dose 1 mg v. 3 mg, P=0.02), and greater comfort as perceived by blinded caregivers (84% v. 37%, P=0.007) and nurses (77% v. 30%, P=0.005) compared to placebo. We found no significant between-group differences in delirium-related distress, adverse effects and overall survival (median 68 v. 73 h, P=0.56).

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0=none and 10=worst possible) every minute during each 6MWT. Secondary outcomes included walk distance, vital signs, adverse effects and global impression. Results Among 22 patients enrolled, 20 (91%) completed the study (9 FBT, 11 placebo). FBT was associated with a significant within-arm reduction in dyspnea NRS between the 6MWTs (mean change -2.4, 95% confidence interval [CI] -3.5, -1.3; Figure). Placebo was also associated with withinarm decrease in dyspnea albeit not statistically significant (mean change 1.1, 95% CI -2.5, 0.2). This study was not powered for between arm comparison, although we observed a non-statistically significant trend favoring FBT (estimate -0.25, P=0.07). More patients in the FBT arm than placebo arm reported their dyspnea was at least “somewhat better” (4/9 vs. 0/11, P=0.03). The other secondary outcomes did not differ significantly between study arms.

Conclusions These data support our hypothesis that proportionally dosed FBT was associated with improvement in exertional dyspnea, and highlights the need for larger confirmatory trials.

Conclusions The combination of lorazepam/haloperidol resulted in rapid and significant reduction of agitation compared to haloperidol alone. Our study supports the judicious use of single dose lorazepam/haloperidol for persistent agitated delirium.

eP358 EFFECT OF PROPHYLACTIC FENTANYL BUCCAL TABLET (FBT) ON EXERCISE-INDUCED DYSPNEA IN CANCER PAT I E N T S : A P I L O T D O U B L E B L I N D , P L A C E B O CONTROLLED RANDOMIZED TRIAL D. Hui1, K. Kilgore1, S. Frisbee-Hume1, M. Park2, D. Liu2, E. Bruera1 1 University of Texas MD Anderson Cancer Center, Department of Palliative Care- Rehabilitation and Integrative Medicine, Houston, USA 2 University of Texas MD Anderson Cancer Center, Department of Biostatistics, Houston, USA Introduction Episodic dyspnea is one of the most common, distressing and difficult-totreat symptoms in cancer patients. Objectives We tested the hypothesis that FBT, a rapid onset opioid, given prophylactically prior to exertion can improve exercise-induced dyspnea. Methods In this parallel (1:1) RCT, we asked cancer patients who were opioid-tolerant and had exertional dyspnea to complete a 6 minute walk test (6MWT) at baseline, and then randomly assigned them to either FBT proportional to 20-50% of daily dose or placebo 30 minutes before a second 6MWT. The primary outcome was a validated 11-point dyspnea NRS assessing dyspnea “now” (where

eP359 AUTOMATIC REFERRAL VERSUS CLINICIAN-BASED REFERRAL TO OUTPATIENT PALLIATIVE CANCER CARE: AN INTERNATIONAL DELPHI SURVEY D. Hui1, M. Mori2, Y.C. Meng1,3, S. Watanabe4, A.T. Caraceni5, F. Strasser6, T. Saarto7, N. Cherny8, P. Glare9, S. Kaasa10, E. Bruera1 1 University of Texas MD Anderson Cancer Center, Department of Palliative Care- Rehabilitation and Integrative Medicine, Houston, USA 2 Seirei Mikatahara General Hospital, Palliative Care Team, Hamamatsu, Japan 3 Tan Tock Seng Hospital, Department of Palliative Care, Singapore, Japan 4 University of Alberta, Department of Oncology, Edmonton, USA 5 Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Pain Therapy and Rehabilitation, Milan, Italy 6 Cantonal Hospital, Department of Hematology-Oncology, St. Gallen, Switzerland 7 Helsinki University Central Hospital, Department of Palliative Care, Helsinki, Finland 8 Shaare Zedek Medical Center, Department of Medical Oncology, Jerusalem, Israel 9 Memorial Sloan Kettering Cancer Center, Department of Medicine, New York, USA 10 Oslo University Hospital and University of Oslo, Department of Cancer Research and Molecular Medicine- Norwegian University of Science and Technology- Trondheim and Department of Oncology, Oslo, Norway Introduction Currently, palliative care referral is primarily based on clinician judgement, resulting in highly variable access. Standardized criteria to trigger automatic referral has been published, but it remains unclear how best to apply them in practice.

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Objectives We conducted a Delphi study of international experts to identify a consensus for the use of standardized criteria to trigger automatic referral. Methods 60 international experts stated their level of agreement for 14 statements regarding the use of clinician-based referral and automatic referral over 2 Delphi rounds. A consensus was defined as an agreement of ≥70% a priori. Results The response rate was 59/60 (98%) for the first round and 56/60 (93%) for the second round. 26 (43%), 19 (32%) and 11 (18%) respondents were from North America, Asia/Australia and Europe, respectively. The panelists agreed that automatic referral criteria may increase the number of referrals (agreement=98%), facilitate earlier palliative care access and help administrators to set benchmarks for quality improvement (agreement=86%). There was no consensus on whether automatic referral would decrease the autonomy of oncologists (agreement=58%), hinder their ability to refer patients (agreement=9%), increase clinical burden related to screening (agreement=23%) or result in more conflicts between oncology and palliative care (agreement=43%). The panel reached consensus that outpatient palliative care referral should be based on both automatic referral and clinician-based referral (agreement=86%), but not clinician-based referral alone (agreement=18%) nor automatic referral (agreement=7%) alone. Conclusions Our panelists favored the combination of automatic referral to augment clinician-based referral. Further studies are needed to examine these augmented models empirically.

eP360 IMPLEMENTATION OF THE EDMONTON SYMPTOM AS S ES SME NT SY ST E M F OR S YMP TOM DI ST RE S S SCREENING AT A COMMUNITY CANCER CENTER: A PILOT PROGRAM D. Hui1,2, A. Titus3, T. Curtis3, V.T. Ho-Nguyen3, D. Frederickson3, C. Wray4, T. Granville3, E. Bruera1, D.K. McKee3, A. Rieber2 1 University of Texas MD Anderson Cancer Center, Department of Palliative Care- Rehabilitation and Integrative Medicine, Houston, USA 2 University of Texas MD Anderson Cancer Center, Department of General Oncology, Houston, USA 3 Harris Health System, Harris Health System, Houston, USA 4 University of Texas Medical School at Houston, Department of Surgery, Houston, USA Introduction Distress screening is mandated by the American College of Surgeons Commission on Cancer; however, there is limited literature on its impact in actual practice. Objectives We examined the impact of a pilot distress screening program on access to psychosocial care. Methods Edmonton Symptom Assessment System (ESAS) screening was routinely conducted at our community-based medical oncology program. Patients who screened positive for severe distress were sent to a social worker for triage and referred to the appropriate services if indicated. We compared the proportion of patients who had ESAS completed, the proportion of patients who screened positive, and the number of patients who had social work assessment and palliative care consultation over the preimplementation (September 2015), training (October/November 2015) and post-implementation (December 2015) periods. Results A total of 379, 328 and 465 cancer patients were included in the preimplementation, training and post-implementation periods, respectively.

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The proportion of patients who completed ESAS increased over time (83% vs. 91% vs. 96%, P<0.001, Table). Among the patients who had completed ESAS, between 11-13% were positive for severe distress, which remained stable over the 3 periods (P=0.64). We observed a significant increase in social work referrals for psychosocial assessment (21% vs. 71% vs. 79%, P<0.001). There was also an increased number of palliative Care referrals, albeit not statistically significant (12% vs. 20% vs. 28%, P=0.21).

Conclusions Our community-based cancer center implemented distress screening rapidly in a resource-limited setting, with a notable increase in symptom documentation and psychosocial referral.

eP361 THE CHARACTERISTICS OF FAMILY MEMBERS ABOUT UTILIZATION OF HOSPICE PALLIATIVE CARE IN TERMINAL CANCER PATIENTS S.W. Hwang1 1 catholic university st paul hospital, family medicine, Seoul, Republic of Korea Introduction Cancer patients are increasing nowadays and almost 1/4 of people are dying because of cancer in Korea, so hospice units and hospice utilization are increasing, and family members are important to decide admission to hospice palliative unit but there are few studies about family memer characteristics in hospice palliative unit utilization. Objectives To examine the characteristics of family structures of terminal cancer patients admitted to hospice palliative unit and determine family factors related to hospice utilization. Methods We retrospectively analyzed the medical records of 134 terminal cancer patients from January 2012 and March 2016 at university Hospital hospice palliative center. We examined the patients’ general and family characteristics. We calculated the interval between cancer diagnosis and hospice admission and its association with family members. Results The interval from diagnosis to admission was 13 months. There was a higher proportion of single, divorced, separated, or widowed patients in group A (within 13 months), whereas there was a higher proportion of patients living with their spouses in group B (> 13 months);(p<0.001). The admission decision makers were patient`s children (59.3%) in group A and spouses (50.7%) in group B( p<0.04). Conclusions In patients who admitted more than 13 months after diagnosis of cancer, there was a higher proportion of patients married and living with their spouses, And the presence of children and spouses is an important factor associated with hospice palliative care utilization in terminal cancer patients.

eP362 PATIENT AND CAREGIVER-REPORTED ASSESSMENT TOOLS FOR PALLIATIVE CARE: SUMMARY OF THE 2017 AGENCY F O R H E A LT H R E S E A R C H A N D Q U A L I T Y ( A H R Q ) TECHNICAL BRIEF

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S. Isenberg1, R. Aslakson2, S. Dy3, R. Wilson3, J. Waldfogel4, A. Zhang3, A. Blair5, J. Sixon6, R. Karen3 1 Johns Hopkins Bloomberg School of Public Health, Health- Behavior and Society, Baltimore, USA 2 The Johns Hopkins School of Medicine, Department of Anesthesiology and Critical Care Medicine, Baltimore, USA 3 Johns Hopkins Bloomberg School of Public Health, Health Policy and Management, Baltimore, USA 4 Johns Hopkins Medicine, The Sidney Kimmel Comprehensive Cancer Center, Baltimore, USA 5 Johns Hopkins Medicine, Department of Surgery, Baltimore, USA 6 Florida International University, Herbert Wertheim College of Medicine, Miami, USA Introduction Assessment tools are psychometrically evaluated data collection instruments completed by patients or caregivers. No recent reviews have comprehensively addressed palliative care (PC) assessment tools. Objectives To summarize how PC assessment tools have been used for clinical care, quality indicators, and evaluation of interventions. Methods We completed: (1) a systematic review of systematic reviews; (2) a supplemental search of reviews and websites; (3) a targeted search for primary articles when no tools existed in a domain. Paired investigators screened search results, assessed risk of bias, and abstracted data. We organized tools by domains from the National Consensus Project Clinical Practice Guidelines for PC and selected the most relevant, recent, and highest-quality systematic review for each domain. Results We included ten systematic reviews and identified 152 tools. Gaps included: no systematic review for pain and few tools assessing structural, cultural, spiritual, or ethical/legal domains, or patient-reported experience. Psychometric information was available for many tools, but few studies evaluated responsiveness and no studies compared tools. Few studies evaluated the use of assessment tools in quality indicators or clinical practice. A systematic review found 25 PC interventions included physical, psychosocial, and quality of life tools, but tools varied, and only nine included patient experience. Conclusions Few to no tools address the spiritual, ethical, or cultural domains or patient-reported experience. While psychometric data exists, the responsiveness of tools and comparisons between tools have not been evaluated. Future research should develop or test tools for domains with few tools, clinical practice, and quality of care.

eP363 ARE LITERATE NIGERIANS AWARE OFANESTHESIOLOGISTS? – EVIDENCE FROM A CONFERENCE SURVEY A. Badru1, K. Kanmodi2 1 University College Hospital, Emergency Department, Ibadan, Nigeria 2 Cephas Health Research Initiative, Department of Cancer Research, Ibadan, Nigeria Introduction Anesthesiologists are doctors that play decisive roles in pain management, patient monitoring, and critical care of patients. Objectives To explore the level of awareness of anesthesiologists among students, academic and non-academic staff members of various South-western Nigerian tertiary institutions Methods This study was a descriptive cross-sectional study conducted among students, academic and non-academic staff members attending the

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South-western Nigeria Zonal Congress of Deeper Life Campus Fellowship in October 2014. Study tool was a well-structured anonymous questionnaire, which was administered to 2,996 consenting participants. Out of the 2,996 self-administered questionnaires, only 2,760 were returned filled; 12 questionnaires were discarded due to incomplete data. Data of 2,748 respondents were analyzed in this study. Results The mean age of the 2,748 respondents was 22.6 years, 95% were single, 85.7% were Yorubas, 69.2% were students, and 53% were affiliated to a university. Only 26.1% (717/2748) have heard of Anesthesiology, and the top three sources of their information were books (321/717 [44.8%]), internet (245/717 [34.2%]), and media (141/717 [19.7%]). Only 62.5% of these 717 respondents knew that anesthesiologists are responsible for the induction and maintenance of sleep during surgical operations, while only 18.7% of them knew that anesthesiologists render palliative care to patients with chronic diseases (e.g. cancer patients). Conclusions The level of awareness of this studied population on the medical roles of anesthesiologists in clinical care is very low. Anesthesiologists need to be at the forefront of awareness creation on their medical specialty.

eP364 A SURVEY TO EVALUATE FACILITATORS AND BARRIERS TO QUALITY MEASUREMENT AND IMPROVEMENT: ADAPTING TOOLS FOR IMPLEMENTATION RESEARCH IN PALLIATIVE CARE PROGRAMS S. Dy1, N. Abu Al Hamayel2, S. Hannum3, R. Sharma2, S.R. Isenberg3, K. Kuchinad2, J. Zhu2, K. Smith2, K. Lorenz4, A.H. Kamal5, A.M. Walling6, S.J. Weaver7 1 Johns Hopkins Bloomberg School of Public Health- Johns Hopkins School of Medicine, Health Policy and Management- Armstrong Institute for Patient Safety, Baltimore, USA 2 Johns Hopkins Bloomberg School of Public Health, Health Policy and Management, Baltimore, USA 3 Johns Hopkins Bloomberg School of Public Health, Health Behavior and Society, Baltimore, USA 4 Stanford University of Medicine, Medicine, Stanford, USA 5 Duke University, Duke Cancer Institute, Durham, USA 6 University of California- Los Angeles, VA Greater Los Angeles Health System, Los Angeles, USA 7 National Cancer Institute, Healthcare Delivery Research Program, Bethesda, USA Introduction Though critical for improving patient outcomes, palliative care quality indicators have not yet been widely implemented. Better understanding of facilitators and barriers to palliative care quality measurement and improvement may improve implementation and overall program quality. Objectives Development of a survey tool to assess perspectives on facilitators and barriers to quality indicator implementation in palliative care programs. Methods We used the adapted Consolidated Framework for Implementation Research to define domains and constructs to select instruments. We assembled a draft survey and assessed content validity through pilot testing and cognitive interviews with experts and front-line practitioners for key items. We analyzed responses using a constant comparative process to assess survey item issues and potential solutions. Based on these results, we developed a final survey. Results The survey includes five published instruments and two additional item sets. Domains include organizational characteristics, individual and team characteristics, intervention characteristics and process of implementation.

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Survey modules include Quality Improvement in Palliative Care, Implementing Quality Improvement in the Palliative Care Program, Teamwork and Communication, Measuring the Quality of Palliative Care, and Palliative Care Quality in Your Program. Key refinements from cognitive interviews included item wording on palliative care team members, programs and quality issues.

Conclusions In this project, we developed a novel, adaptable instrument to assess palliative care team perspectives on barriers and facilitators for quality measurement and improvement in palliative care programs. Next steps include evaluation of construct validity of the survey and how survey results correlate with findings from program quality initiatives.

eP365 CLINICIANS' VIEWS ON PALLIATIVE SEDATION FOR EXISTENTIAL SUFFERING: A SYSTEMATIC REVIEW AND THEMATIC SYNTHESIS OF QUALITATIVE STUDIES M. Lam1, H. Lam1, A. Agarwal1, R. Chow1, S. Chow1, A. Wan1, E. Chow1, C. DeLonghi1, B. Henry1 1 Sunnybrook Health Sciences Centre- University of Toronto- TorontoOntario- Canada, Rapid Response Radiotherapy Program- Department of Radiation Oncology- Odette Cancer Centre, Toronto, Canada Introduction Palliative sedation (PS) is a pharmacological intervention aimed at providing relief to intolerable, refractory symptoms in terminally ill patients. Physicians employ PS to diminish distress due to uncontrollable symptoms when other treatment modalities fail. While PS is primarily used for alleviation of physical symptoms, its use for existential suffering (ES) remains an area of controversy. Objectives To systematically review the literature on the views of clinicians in regards to PS primarily for ES in terminally ill patients, and to look at how the coexistence of physical symptoms and short life expectancy affect clinicians’ attitudes towards PS use. Methods A comprehensive literature search was conducted in Ovid Medline, Embase, Cochrane Central, Cinahl and PsycInfo. Primary studies including interviews, surveys and focus groups exploring attitudes of clinicians in regards to PS for ES were identified. Screening and data extraction were conducted by paired reviewers, and qualitative results were analyzed using a thematic synthesis approach. Results Of the 123 identified hits, 7 studies were deemed eligible for inclusion, of which 1 was a focus group study, 4 were interviews, and 2 were vignettesurveys. We found that most clinicians did not accept PS primarily for ES. Clinicians who were willing to consider ES as part of a refractory state at end-of-life often required that intractable physical symptoms and short life expectancy coexisted for justification. Conclusions Our findings suggest that clinicians are generally against administration of PS primarily for ES, particularly when refractory physical symptoms or short life expectancy are not present.

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eP366 BARRIERS TO DYING AT HOME FOR CANADIAN CANCER PATIENTS: A LITERATURE REVIEW M. Lam1, H. Lam1, A. Agarwal1, H. Lam1, R. Chow1, S. Chow1, S. Chan1, P. Zaki1, A. Wan1, E. Chow1 1 Sunnybrook Health Sciences Centre- University of Toronto- TorontoOntario- Canada, Rapid Response Radiotherapy Program- Department of Radiation Oncology- Odette Cancer Centre, Toronto, Canada Introduction Cancer remains the leading cause of morbidity and mortality globally. Various recent studies and polls have shown that most patients prefer to die at home. However, despite these wishes, most cancer patient deaths take place in the hospital setting. Objectives To review the peer-reviewed literature regarding existing barriers to dying at home in Canada for cancer patients wishing to do so. Methods A comprehensive literature search was conducted in OVID MEDLINE, Embase, Cochrane Central, PsycInfo, and Cinahl to identify studies discussing barriers faced by Canadian cancer patients in dying at home as per their wishes. Screening and extraction were conducted by paired reviewers. Results Out of 61 retrieved hits, 7 qualitative studies and 8 population-based cohort studies were deemed eligible for inclusion. Four main barriers to facilitating deaths at home for Canadian cancer patients were identified based on study findings: inadequacy of support services, insufficient family caregivers, home location and sizes, and discontinuation of care by a family physician. Conclusions Main barriers identified for Canadian cancer patients wishing to die at home were centered around inadequate supports and home environment limitations. In order to overcome these barriers, having well-prepared and welleducated family caregivers, extending support services to remote communities, and increasing consistent availability of family physicians for patients with palliative stages of cancer may be important considerations.

eP367 A COHORT STUDY ON EFFECT OF WHOLE BRAIN RADIOTHERAPY IN PATIENTS WITH BRAIN METASTASES FROM SOLID CANCERS M.Y. Lim1, K.Y. Wong1, C.Y. Liu1 1 Princess Margaret Hospital, Department of Oncology, Hong Kong, Hong Kong S.A.R. Introduction Whole brain radiotherapy (WBRT) was known to improve tumor control and survival over best supportive care. However, its effect on patientrated symptoms and quality of life is conflicting. Objectives This study aims to evaluate the change in the patient self-reported symptoms after WBRT. Overall survival, change in use of steroids and karnofsky performance status (KPS) will also be studied. Methods This is a single center, prospective observational cohort study. A selfdesigned 9-items symptom checklist was done at baseline, 1 month and 3 months after WBRT to evaluate any changes in the symptoms score at 1 month and 3 months. Results Between March 2015 to September 2015, a total of 19 patients were recruited. Median age was 66 (range 30-89) and median KPS was 70 (range 40-100). Majority (85%) of them had lung cancer. The mean

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scores of most symptoms remained either static or decreased with time after WBRT, except nausea, fatigue and limb weakness. At 3 months, about half (45%) of patients tailed off the use of steroids and majority (80%) had stable or improved performance status. The median overall survival was 4.6 months (range : 3.8-5.4 months). Conclusions To conclude, WBRT helps to stabilize symptoms except nausea, fatigue and limb weakness. It also prevents neurological deterioration while allow tapering of use of steroids. Overall life expectancy remained short in terms of few months and most are attributed to extracranial disease progression. Future research is needed to better select the more appropriate patient group which would benefit most from WBRT.

eP368 KNOWLEDGE AND ATTITUDES TOWARDS ADVANCES DIRECTIVES AND QUALITY OF PALLIATIVE CARE IN INTENSIVE CARE UNITS: A PERSPECTIVE COMPARISON BETWEEN PHYSICIANS AND REGISTERED NURSES C.C. Lin1 Taipei Medical University, College of Nursing, Taipei, Taiwan R.O.C.

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Introduction The knowledge and attitudes of medical personnel towards advance directives (ADs) may exert influence on their communication with patients and patient’s quality of end of life care. Objectives To understand the knowledge and attitudes of physicians and nurses toward advance directives and their viewpoints on the quality of palliative care in an ICU. Methods A cross-sectional study. 56 physicians and 120 nurses in ICU in Taiwan. Results The score for physician's knowledge of advance directives was higher than that of the nurses'. The physicians and nurses adopted a positive attitude toward participating in making end-of-life medical decisions. The average score for the quality of the palliative care of the physicians was 6.59, which was significantly lower than that of the quality of the nurses’ palliative care. In addition, 96.7% nurses think they should participate in end-of-life decision making, whereas around 83.9% doctors and 59.5% nurses agreed to get consensus when end-of-life decision was made. The physicians and nurses exhibited unsatisfactory performance in the domains of spiritual support of patients and families and the domain of the hospital support the provision of emotional support for medical staff caring dying patients, and continuity of care. The predictive factors for the self-assessed quality of nurses for end-of-life palliative care were attitude toward making end-of-life medical decisions, and nurse participation in making end-of-life medical decisions. Conclusions Providing ICU clinicians with emotional and educational support regarding end-of-life care and encouraging nurses to participate in making end-of-life medical decisions may improve the quality of palliative care in ICU.

eP369 NEXT-GENERATION SEQUENCING ORDERING TRENDS IN THE CANCER TRAJECTORY J. Ma1, C. Hagmann2, A. Dullea2, W. Wang2, W. Yau3, C. Revta2, J. Armstrong2, E. Roeland2 1 UC San Diego, Skaggs School of Pharmacy & Pharmaceutical Sciences, La Jolla, USA 2 UC San Diego, Moores Cancer Center, La Jolla, USA 3 UC San Diego, Skaggs School of Pharmacy & Pharmacuetical Sciences, La Jolla, USA

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Introduction Next-generation sequencing (NGS) molecular tumor profiling is increasingly being ordered for advanced cancer patients to evaluate nontraditional therapeutic options. Objectives The study objective was to examine NGS ordering patterns among cancer patients. Methods This was a retrospective data analysis in patients with cancer between January 2011 and February 2016. Adult, cancer patients were identified from a tumor registry and matched to an existing NGS tumor profiling database. Differences in the date of when NGS was ordered compared to date of diagnosis, palliative care (PC) consultation, and/or date of death were determined. A Mann-Whitney rank sum test examined differences in patients where NGS was ordered relative to the date of PC consultation. Results Analysis included 1596 (807 women) cancer patients. Mean±SD age was 55.5±15.2 years and 30.8% (n=492) of patients had metastatic disease. The difference between date of cancer diagnosis and date of NGS order was 1053.6±1568.5 days (n=1546). The difference between date of NGS order and date of death was 221.2.4±186.6 days. Two-hundred and fiftyone patients (15.7%) received a PC consultation, of which 82 patients had a NGS order before the PC consultation and 169 patients had a NGS order after the PC consultation. The mean difference in number of days between a NGS order before versus after a PC consultation was 147.3±216.8 vs. 179.8±169.7 days (p<0.005). Conclusions NGS was ordered near the time of death. PC consultations were completed in a minority of patients. NGS ordering in cancer patients may serve as a trigger for PC consultation and needs to be explored further.

eP370 EMOTION AND SYMPTOM-FOCUSED ENGAGEMENT (EASE): FEASIBILITY AND PRELIMINARY EFFICACY OF AN INTERVENTION FOR INDIVIDUALS WITH ACUTE LEUKEMIA (AL) G. Rodin1, C. Malfitano1, A. Rydall1, C. Lo1, A. Schimmer2, C. Marmar3, C. Zimmermann1 1 Princess Margaret Cancer Centre- University Health Network, Supportive Care, Toronto, Canada 2 Princess Margaret Cancer Centre- University Health Network, Medical Oncology and Hematology, Toronto, Canada 3 NYU School of Medicine, Psychiatry, New York, USA Introduction AL patients may experience severe physical and psychological distress. To address this, we developed a novel intervention called EASE, which includes: 1) tailored psychotherapy; and 2) physical symptom screening, with distressing symptoms triggering early involvement of palliative care. Objectives To assess the feasibility and preliminary efficacy of EASE. Methods Patients were recruited within 2 weeks of admission to a comprehensive cancer center and randomized to receive either EASE or usual care (UC). Physical and psychological symptoms were assessed at baseline, 4, 8 (primary endpoint), and 12 weeks. Intervention patients received 6-10 psychotherapy sessions over 8 weeks, weekly assessment of physical symptoms, and referral to palliative care, triggered by symptoms. Oneway ANOVA was performed to assess mean change scores over time between groups. Results Forty-two patients were randomized to EASE (n=22) or UC (n=20). Predefined feasibility outcomes were met: 86% (19/22) of EASE participants (goal >64%) completed >50% of psychotherapy sessions; 64%

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(14/22) completed symptom screenings (goal >50%); and 100% of those with distressing symptoms had >1 meeting with palliative care (goal 100%). There were statistically significant findings favoring EASE for satisfaction with care at 8 (Δ: 7.39 vs -3.12, p<0.04) and 12 (Δ: 0.01 vs 6.19, p<0.03) weeks and trends favoring EASE for traumatic stress, depression, quality of life, attachment security, and number, severity, and distress related to physical symptoms at 4, 8, and 12 weeks.

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Objectives To identify the cultural and family structure factors that influence end-oflife decision-making and EoL care in the Philippines. Methods Ethnographic case study, which used the theoretical framework of medical anthropology. Data were collected through semi-structured interviews with family caregivers of patients admitted in the ICU in a private tertiary hospital in the Philippines. Results Identified cultural factors affecting end-of-life decision-making and EoL care include: patient's and family’s perspective on death and dying, collective decision-making, perception of pain and request for pain relief, role of religion and faith, and perception regarding hospice and palliative care. The Filipino family unity is more and more disrupted by migration. It is becoming increasingly common to conduct family meetings using Face Time or Skype conferencing. It is the children abroad who serve as financier and primary decision-makers. They oftentimes request for aggressive, heroic measures for their sick family members and the family has to wait for them before considering possible withdrawal or withholding of life-support measures. Conclusions A greater awareness and understanding of cultural and family structure factors influencing end-of-life decision-making will assist the hospital staff in providing effective end-of-life care.

eP372 PALLIATIVE WHOLE BRAIN RADIOTHERAPY: 5 VERSUS 10 FRACTIONS T. Mehmood1 1 Shaukat Khanum Memorial Cancer Hospital and Research Centre, Radiation Oncology, Lahore, Pakistan

Conclusions This randomized pilot trial of EASE showed promising reductions in psychological and physical distress and supports feasibility and need for a larger randomized controlled trial.

eP371 CULTURAL AND FAMILY STRUCTURE FACTORS AFFECTING END-OF-LIFE DECISION-MAKING AND END-OF-LIFE CARE IN THE PHILIPPINES M.F. Manalo1 1 The Medical City, Internal Medicine, Pasig, Philippines Introduction There is complete centrality of the family for the Filipino. Most informal care for chronically-ill and terminally-ill people is provided by partners and adult children. Changes in family structure, whether it may be from having fewer children and starting families later, increased levels of marital disruption and more complex family relationships or greater geographical separation of families, may have an effect on the availability of care.

Introduction The optimal dose for palliative whole brain radiotherapy (WBRT) continues to be debated. Common regimens include 20 Gy in five and 30 Gy in 10 fractions. Objectives We aimed to identify factors associated with WBRT dose schedules, hypothesizing that clinical prediction of survival (CPS) would influence prescribing practice. Methods Demographic and clinicopathologic data were collected for consecutive patients with brain metastases receiving WBRT. At initial consultation, CPS were prospectively collected from treating radiation oncologists. Karnofsky performance status (KPS) and Mini-Mental Status Examination were available for 88.6% and 75.1%, respectively. Dose fractionation was collected and summary statistics calculated. Results 193 patients underwent WBRT. 46% were male, mean age was 64.7 years (SD 11.6), and 63.7% had lung cancer. Median KPS was 70 (range 20100) and median MMSE score was 27/30 (range 13-30). Median CPS and actual survival were 150 days (range 21-730d) and 96 days (range 111029d), respectively. 19% received WBRT within 30 days of death. 78% and 22% received five and 10 fractions, respectively. On multivariate analysis, patients with KPS ≤ 70 were 5.93 times more likely to have received 5-fractions (95% CI 2.51-14.1; p < 0.0001). CPS, age, gender, MMSE, histology, disease extent, and extracranial irradiation were not predictive of WBRT schedule. Conclusions Patients treated with WBRT with KPS ≤70 and those treated more recently were more likely to receive five fractions. Oncologist CPS was not a statistically significant predictor of schedule in this cohort.

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eP373 RADIATION THERAPY TECHNIQUES IN THE TREATMENT OF BONE METASTASES T. Mehmood1 1 Shaukat Khanum Memorial Cancer Hospital and Research Centre, Radiation Oncology, Lahore, Pakistan Introduction In recent years, there has been a transition from two-dimensional radiation therapy (2DRT) planning towards more advanced techniques such as three-dimensional conformal radiation therapy (3D-CRT). Objectives Our study aim was to analyze these trends in the treatment of bone metastases. Methods All patients aged above 18 who had received palliative intent RT for bone metastases between 2009-2014 reviewed. Summary statistics were used to describe radiation technique patterns. Results We identified 350patients; overall, 97.9% of courses were achieved by 2DRT and 2.1% by 3D-CRT. Despite the low overall use of advanced technique, its use was significantly higher in all subsequent years compared to 2009 (p < 0.05 for all years). The median age for patients treated with 2DRT was 67.0 versus 66.0 years for advanced technique. There did not appear to be a statistically significant difference in age at the time of treatment start (p < 0.05). Compared to lung cancers, thyroid (p < 0.001) and kidney cancers (p < 0.001) were significantly more likely to be treated with advanced technique, while breast ( p = 0.58) and prostate cancers (p = 0.73) were not any more likely. Patients were also more likely to complete RT with 2DRT than with advanced techniques (98.3% versus 95.8%, p < 0.05). Conclusions The vast majority of treatment of bone metastases is still done by 2DRT but a trend towards increasing use of more advanced techniques was observed.

eP374 PATIENT PERCEPTIONS REGARDING PROVISION OF OUTPATIENT PALLIATIVE CANCER CARE C.C. Moon1,2, A. Husain3,4, L.A. Dawson5,6, G. Rodin7,8, L.W. Le9, C. Zimmermann7,10 1 Princess Margaret Cancer Centre, Department of Supportive Care, Toronto, Canada 2 University of Toronto, Institute of Medical Science, Toronto, Canada 3 Mount Sinai Hospital, Temmy Latner Centre for Palliative Care, Toronto, Canada 4 University of Toronto, Department of Family & Community Medicine, Toronto, Canada 5 Princess Margaret Cancer Centre, Department of Radiation Oncology, Toronto, Canada 6 University of Toronto, Department of Radiation Oncology, Toronto, Canada 7 Princess Margaret Cancer Centre, Campbell Family Research Institute, Toronto, Canada 8 University of Toronto, Department of Psychiatry, Toronto, Canada 9 Princess Margaret Cancer Centre, Department of Biostatistics, Toronto, Canada 10 University of Toronto, Department of Medicine, Toronto, Canada Introduction In cancer centres, early palliative care is increasingly provided in oncology palliative care clinics (OPCC), but may also be provided by a number of other healthcare professionals.

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Objectives To examine perspectives of patients with advanced cancer regarding their physicians’ involvement in their palliative care. Methods Patients with advanced cancer attending an OPCC at a tertiary cancer centre completed a survey including questions concerning the involvement of healthcare providers in their care. Eligible patients were Englishspeaking, ≥18 years old, had at least one prior OPCC visit, passed a cognitive screen, and had seen a family physician within five years. McNemar’s test determined differences between actual and preferred providers. Results Of 79 participants to date, 46(58.2%) were female, with mean age 58.3 ±13.1 years, and 25(55%) currently receiving treatment. The median of number of previous OPCC visits was 3.0 (range 1-27). Fifty-three percent (42/79) felt that there was someone managing their overall health care: for 57%(24/42) this was their oncologist, 17%(7/42) their palliative care physician (PCP), 14% 6/42) their family physician and 7%(3/42) oncologist/PCP jointly. The Table shows patients’ actual vs. preferred providers of care. There was a discrepancy only for symptom management related to cancer treatment: 31%(20/64) received such care mainly from their PCP although 50%(33/66) preferred this (p=0.01).

Conclusions Among patients attending an OPCC, family physicians mainly manage non-cancer chronic illness; PCP, cancer-related symptoms and advance care planning; and oncologists, treatment-related symptoms. A significant proportion of patients would prefer PCP play a more active role in the latter.

eP375 END OF LIFE CARE EXPERIENCE AT THE PEDIATRIC WARD AT THE UGANDA CANCER INSTITUTE: WHAT ROLE CAN ONCOLOGY NURSES PLAY? I. Mulyowa1 1 Uganda Cancer Institute, Oncology, Kampala, Uganda Introduction Although the majority of childhood cancers are curable, this is not yet true for low resource countries. In Uganda, cancer care is only at the Uganda Cancer Institute. Between Jan 1st and Dec 31st, there were 4,321 new cancer cases registered and about 8% were among children. The mortality rate is 70% annually, that is every 3 in 5 children diagnosed with cancer will not survive past one year after cancer diagnosis. Here, we review the factors contributing to poor outcomes and potential solutions.

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Objectives 1. To determine the role of an oncology Nurse at the end of life care of cancer children. Methods Experience and observation Results Majority of the children present with advanced disease at cancer diagnosis. The chemotherapy is prescribed for palliative intent more frequently and high rates of complications are observed. Family involvement in decisions regarding the role of palliative chemotherapy at end of life is low. The concept of quality of life for cancer patients with advanced cancer is not well perceived among caretakers and some clinicians at UCI. Nurses play an integral role, identifying symptoms, providing care coordination, and assuring clear communication. Conclusions Educational initiatives for patients, families and health-care providers, are essential. The oncology nurses play a key role in the multidisciplinary team approach to paediatric patients at end of life care.

eP376 IS INTEGRATION OF PALLIATIVE CARE INTO ONCOLOGY SERVICES OF ANY BENEFIT TO THE PATIENTS. S. Rithara1, E. Muriithi2 1 Kenya medical training college, Nursing, Nairobi, Kenya 2 Kenyatta National Hospital, Nursing, Nairobi, Kenya Introduction Integration is about the organization of various tasts (care) which need to be performed in order to prrovide a population with good qualify health services Objectives To find out from nurses working in palliative care units and oncology clinics the challeges and benefits Methods 30 nurses attended two days oncology symposium, 18 working in oncology clinics and 12 in palliative care units. All agreed oncolgy is a specialized field for nurses in cancer care as well as palliative care. Working in partnership and avoiding isolation improve patient care Results Training of oncology and palliative care nurses is vital in order to improve the quality of life for our patients. Palliative care ia an essential component of quality oncology care. There is a need for higher education in oncology nursing training in Kenya for a quality of care and job satisfaction Challenges in integration services and training issues in cancer, the training of nurses at the bedside is not sufficiently adequate as a necessary tool in fight against cancer. Shortage of nurses in referral hospitals and other health institution noted. Most training is inadequate and does not include cancer care. Integration provides quality care to patients in managing their symptoms, while allows oncologists to spend time to evaluate new patients Conclusions PCU-oncology integration benefits by improving quality of life. Need shared in nursing school as well as in continuing medical education to overcome the knowledge barrier among providers. There is need to determine at what stage should palliative care be involved in oncology care

eP377 A PILOT STUDY TO ASSESS FEASIBILITY OF STARTING ADVANCE DIRECTIVE IN ADVANCED CANCER PATIENTS AT THE INITIATION OF TREATMENT WITH FIRST-LINE PALLIATIVE CHEMOTHERAPY K. Park1, S.Y. Oh2

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Pusan National University Yangsan Hospital, Medical Oncology and Hematology- Department of Internal medicine, Seoul, Republic of Korea 2 Pusan National University Yangsan Hospital, Medical Oncology and Hematology- Department of Internal medicine, Yangsan-si, Republic of Korea Introduction The appropriate initiation time of advance directive (AD) has not been clarified yet. Objectives The aim of this stud was to investigate changes of depression/anxiety scores and attitude for chemotherapy after AD at the initiation of 1st line palliative chemotherapy. Methods Patients with advanced cancer who were planned to undergo a first-line palliative chemotherapy were prospectively enrolled between February 2014 and October 2016. We assessed attitude for chemotherapy and hospital anxiety and depression scale (HADS) after completion of first cycle chemotherapy. At subsequent cycle, AD was recommended and performed. Follow up evaluations including the attitude for therapy and HADS were done in the next cycle. Results During the study period, 105 patients started palliative chemotherapy. Among them, 45 patients (11 cases with cognitive impairment, 14 with clinical deterioration after 1st cycle, 6 with follow-up loss, 6 without proxy, 3 with protocol violation) were excluded and the other 65 were recommended for AD (feasibility of AD recommendation, 62%). Among them, 20 patients refused AD, and the other 45 patients consented AD (approval rate 69%). Finally, 42 patients completed AD including followup evaluations. The changes of depression and anxiety score were not different before and after AD [depression scale, 7.22(±3.64) vs 7.13(±3.86); p=1.000; anxiety scale, 5.34(±4.61) vs 5.80(±4.69); p=0.422]. Totally 39 patients (87%) followed physician's medical recommendations except 6. Conclusions Considering our results that showed no significant changes in depression and anxiety scores after AD and few follow-up loss, AD at initiation of 1st line chemotherapy could be feasible and contribute development strategies of AD.

eP378 FACTORS RELATED WITH THE DECISION FOR THE PLACE OF CARE AMONG TERMINAL CANCER PATIENTS AFTER CONSULTATION WITH PALLIATIVE CARE TEAM S.J. Park1, E.J. Nam1, H.J. Jho1, Y.J. Chang1, Y.J. Lee2 1 National Cancer Center, Department of Hospice & Palliative Service, Goyang-si, Republic of Korea 2 Gangnam Severance Hospital, Department of Family Medicine, Seoul, Republic of Korea Introduction Recently, utilization of hospice palliative care (HPC) has been promoted by national policy in Korea. However, there are very few researches on the pattern of health care utilization and related factors among terminal cancer patients in Korea. Objectives We aimed to identify patterns of decision for the place of care and related factors among terminal cancer patients who received consultation from palliative care team (PCT). Methods We retrospectively analyzed medical records for 1,028 terminal cancer patients who were referred to PCT of National Cancer Center in 2010 and 2014. Data of the decision for the place of care, the reasons why participants chose non-HPC units (HPCU), and related factors were collected

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and analyzed by using descriptive statistics and logistic regression analysis. Results The percentage of HPCU utilization among referred patients was 53.9% in 2014, which was increased from 44.6% in 2010. The patients’ mean age was 61.0±12.2 years; 55.1% were male. Lung cancer patients (24.3%) comprised the largest percentage. Patient’s age and awareness of terminal illness were positively associated with the utilization of HPCU. The most common reason for not selecting HPCU was refusing hospice care (34.9%), followed by near death (34.7%), poor accessibility to HPCU (17.7%), and caregiving problems (12.7%). Conclusions The use of HPC has been increasing due to the positive effect of government policies. To promote HPC for terminal cancer patients, it is necessary to bring forward the timing of discussing end of life care and introducing HPC and to improve regional accessibility to HPCU.

eP379 SAFETY AND EFFICACY OF NIMOTUZUMAB AS A SINGLE A G E N T F O R PA L L I AT I V E T R E AT M E N T O F E G F R EXPRESSING TUMORS A. Suresh1, D. Pawar2, C. Sunkavali3 1 Continental Hospital, Oncology Department, Hyderabad, India 2 Biocon Ltd, Medical Affairs and Clinical Development, Bangalore, India 3 Apollo Hospital, Surgical Oncology, Hyderabad, India Introduction Nimotuzumab is a humanized IgG1 Mab that has been evaluated in solid tumors as a single agent or in combination with chemotherapy and radiation. We tried Nimotuzumab as single agent. There is limited options available for subjects with PS 3 so we studied this population Objectives Analysis of Nimotuzumab as single palliative therapy in PS 3 and above EGFR expressing tumors for safety and efficacy Methods 38 subjects with pretreated advanced refractory or progressive tumors having PS of more than 2 were evaluated. Nimotuzumab was administered weekly at 200 mg/m2 single agent for 4 weeks and patients were stratified into those with improved PS and those without. The subjects without PS improvement were continued on the single agent and those with improvement were offered additional chemotherapy Results 18 had improvement in the PS and were offered chemotherapy. 16 patients had stable PS and disease. The median number of nimotuzumab applications was 6 in the induction phase and the median chemotherapy cycles were 3. No toxicity occurred during induction phases (single agent) and during chemotherapy the Grade II/IV toxicities were observed in 6 (33%) cases (cytopeneas, neuropathy and diarrhea). The median PFS was 142 days and the median improvement in QOL was 6 points on a scale of 30. Conclusions Nimotuzumab is well tolerated and may have a role in the treatment of advanced cancers as a single agent in patients with poor performance status. 47% of the patients who are otherwise not eligible for chemo became eligible and had better QOL and longer PFS

eP380 FACTORS AND CORRELATES OF DEPRESSION IN ADVANCED CANCER PATIENTS: A SCOPING REVIEW

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M. Puopolo1, E. Bain1, A. Agarwal1, M. Lam1, A. Wan1, E. Chow1, B. Henry1 1 Sunnybrook Health Sciences Centre, Department of Radiation Oncology, Toronto, Canada Introduction Depression is common in cancer patients, particularly those in advanced or end stages of their disease. Objectives To identify factors and correlates of depression in advanced cancer patients. Methods A comprehensive search was conducted using four databases (OVID MEDLINE, Embase, PsychInfo, and Cinahl). Articles were considered eligible if they discussed factors associated with depression in adult patients with advanced cancer diagnoses, or if they compared prevalence rates of depression between the palliative setting and other care settings for cancer patients. Two reviewers screened identified hits, and extracted data for articles deemed eligible. Results Nineteen eligible articles were identified (see Figure 1). There appeared to be a consensus that having a worse prognosis, poor spiritual health, metastatic disease, cognitive impairment, less control over the course of illness, fatigue, sleep disorders, longer duration of illness and being female were positively correlated with the presence of depression. There was no such consensus found for differences based on age or care settings.

Conclusions Depression in the advanced cancer population appears to be influenced by a number of comorbidities, personal and disease correlates. There are a number of factors which contribute to depression in this patient population. Further research should be undertaken to explore the role of comorbid disorders and other identified factors and their role in optimal management to prioritize overall quality of life for advanced cancer patients.

eP381 EVALUATION OF THE QUALITY OF CARE OF ONCOLOGIC PATIENTS WITH PAIN, IN PALLIATIVE AND PAIN UNITS: ACHIEVABLE BENCHMARKS OF CARE (ABC™). PROJECT 25Q. F. Villegas-Estévez1, M.D. López-Alarcón2, A.J. Jiménez-López3, A. SanzYagüe4, B. Soler-López5 1 Consorcio Hospitalario Provincial de Castellón, Pain Unit, Castellón, Spain 2 Consorcio Hospital General Universitario de Valencia, Pain Unit, Valencia, Spain 3 Kyowa Kirin Farmaceútica- S.L.U., Medical Department, Madrid, Spain 4 Kyowa Kirin Farmacéutica- S.L.U., Medical Department, Madrid, Spain 5 E-C-BIO- S.L., Medical Department, las Rozas, Spain

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Introduction Although there are numerous guidelines for assessing and treating cancer-related pain, symptom control continues to be deficient. In addition to pain control, it is necessary to comply with other aspects of patient care that ensure adequate quality of care. Recommendations for the integral management of the patient are described, but it is necessary to evaluate whether the recommendations are applicable in clinical practice, and to what degree they can be fulfilled in real world. Objectives The aim of the study was to quantify the quality of patient care with pain associated with cancer. Methods A retrospective observational study was designed and completed in 107 centers: 81 pain units and 26 palliative care units. The coordinating committee selected 25 quality indicators, 12 structure and 13 process indicators based on the recommendations of different clinical practice guidelines. Process indicators were evaluated by collecting information from 15 selected medical records retrospectively until March 31, 2016, obtaining pooled information from 1,605 patients. The degree of compliance with the recommendations was evaluated using the Achievable Benchmarks of Care ™ (University of Alabama, Birmingham, USA).

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Conclusions The selected indicators are applicable to clinical practice, can be met (ABC ™ 100%), and allow controlling the quality of care of patients, with a quantitative and reproducible measure.

eP382 USE OF SEDATIVES IN DYING PATIENTS: A MULTICENTER STUDY

Results The average compliance of all indicators was 82.4% (95% CI 70.4-94.4). The ABC ™ of the 13 process indicators was 100%. There were no significant differences in the degree of compliance with quality indicators between geographical areas.

H.N. Song1, J.S. Ahn2, S.J. Koh3, Y.S. Kim4, J. Jun Ho5, I.G. Hwang6, J. Yun7, J.H. Kang1 1 Gyeongsang National University Hospital, Department of Internal Medicine, Jinju, Republic of Korea 2 Samsung Medical Center- Sungkyunkwan University School of Medicine, Division of Hematology‑Oncology- Department of Medicine, Seoul, Republic of Korea 3 Ulsan University Hospital, Division of Hematology-OncologyDepartment of Internal Medicine, Ulsan, Republic of Korea 4 Gachon University Gil Medical Center, Division of Hematology and Oncology- Department of Internal Medicine, Incheon, Republic of Korea 5 Samsung Changwon Hospital- Sungkyunkwan University School of Medicine, Division of Hematology‑Oncology- Department of Internal Medicine, Changwon, Republic of Korea 6 Chung‑Ang University Hospital- Chung-Ang University College of Medicine, Division of Hematology/Oncology- Department of Internal Medicine, Seoul, Republic of Korea 7 Soonchunhyang University Bucheon Hospital, Division of Hematology/ Oncology- Department of Internal Medicine, Bucheon, Republic of Korea Introduction Terminal cancer patients usually suffered from refractory symptoms, such as pain, insomnia, delirium. Palliative sedation usually used for relieving refractory symptoms using sedative drugs. Objectives The need for sedation is tend to increase, however, little is known about this practice at palliative care in Korea. Methods Patients who died between January 2010 and December 2015 were identified. A predefined group of patients were received palliative sedation before two weeks from the date of death, and data were collected by chart review. We analyzed clinical characteristics of patients, used sedative drug, sedation type, and duration of palliative sedation. Results During 5 years, total 8311 patients were died in 7 centers of Korea. Among these patients, 1389 cases (16.7%) were received palliative sedation from delirium (550/1389, 39.6%), dyspnea (315/1389, 22.7%) and intractable

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pain (296/1389, 21.3%). Two most common origin of primary cancer were gastrointestinal and lung (590/1389 (42.5%) and 379/1389 (27.3%), respectively). Midazolam was the most frequently used sedative drug (441/1389, 31.7%) and followed by lorazepam (427/1389, 30.7%) and diazepam (252/ 1389, 18.1%). The sedative drugs were given more often intermittently (844/1389, 60.8%) than continuous infusion (545/1389, 39.2%) and median duration of palliative sedation was 3 days (1~369 days). Conclusions This study showed the current status of clinical practice for palliative sedation in Korea. Also, these data could serve insights of safety and efficacy of palliative sedation to medical oncologists.

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Introduction Quality of life (QOL) in patients with metastatic breast cancer can be compromised due to fatigue, decreased fitness and impaired functional mobility. In cancer survivors, exercise has been demonstrated to improve these outcomes. Exercise might be equally beneficial for patients with advanced disease, but likely requires a more client-centered approach. Objectives To develop and evaluate an exercise-based, client-centered and goal directed program for patients with metastatic breast cancer. Methods This project comprises three phases: 1) patient survey, focus groups and literature review, 2) program development, and 3) feasibility study (See table).

eP383 ESAS WITH PATIENTS’ PRIORITIES, A WAY TO IMPROVE TREATMENT AND CARE? M. Staerk1, M.N. Svendsen1, S.S. Ottesen1 1 Zealand University Hospital, Department of Oncology, Roskilde, Denmark Introduction The Edmonton Symptom Assessment System (ESAS) is used for symptom screening and monitoring within palliative care and oncology. A high score of a given symptom does not always align with the patients’ need to be relieved from that symptom. Objectives We aimed to elucidate the symptom burden and pattern in patients admitted at the oncology ward. We wished to characterize differences between symptom pattern and the patients’ priorities of symptoms they wanted the health professionals to focus on. Methods We used an ESAS chart with the possibility for the patient to mark up to three symptoms they mostly wanted relieved (patients’ priorities). 306 ESAS charts registered upon patient admission from 01.01.16 to 01.10.16 were retrospectively included. 34 lacked a score for one or more symptoms (interpreted as score 0). 147 included the patient priorities. Results The most common severe symptom (score >= 7) was fatigue (n= 164, 54%). The least common severe symptoms were nausea (n=49, 16%), depression (n=45, 15%) and anxiety (n=39, 13%). In the charts with priorities, 46% (n=67) had one or more priorities that were not among the three highest scoring symptoms. The symptoms that the patients chose to prioritize were: pain (n=14, 21%), shortness of breath (n=14, 21%) and nausea (n=11, 16%). Conclusions We found that ESAS is a relevant tool within oncology. When patients prioritize their symptoms, they often choose differently than expected based on the symptom scores. Knowing patients priorities may help achieve better patient treatment and care.

eP384 FITTING THE INTERVENTION TO THE PATIENT: FIRST PHASE OF A PROJECT TO DEVELOP A TAILORED, GOAL DIRECTED EXERCISE INTERVENTION FOR PATIENTS WITH METASTATIC BREAST CANCER M.R. ten Tusscher1, W.G. Groen1, E. Geleijn2, N. Aaronson1, M.M. Stuiver3 1 The Netherlands Cancer Institute, Division of Psychosocial Research and Epidemiology, Amsterdam, The Netherlands 2 VU University Medical Center, Department of Physical Therapy, Amsterdam, The Netherlands 3 The Netherlands Cancer Institute, Department of Physical Therapy, Amsterdam, The Netherlands

Results Current evidence from the literature suggests that (modified) exercise programs are safe for patients with advanced cancer, and that they may contribute to improved functional mobility and QOL. The results of the survey (N=114, response rate of 70%) indicated that patients had limitations in sports activities (64%), maintaining an upright position while sitting and/or standing for longer periods of time (63%), lifting (35%) and carrying objects (24%) and domestic work (32%). Patients expressed a preference for guidance by a physical therapist (82%) and also exercising in their own environment (41%). Based on these results, we developed an intervention program that includes eHealth support. Fifteen physical therapists have been trained in the use of the program. Conclusions Patients with metastatic breast cancer experience functional limitations that may be improved through tailored exercise interventions. We have developed a client-centered, goal-directed program based on best available evidence and taking patients’ preferences into account. A pilot feasibility study is currently underway.

eP385 BARRIERS TO ADVANCE CARE PLANNING BY PRIMARY CARE PHYSICIANS: A NARRATIVE REVIEW B. Hannon1, H. Toor2 1 Princess Margaret Hospital, Palliative Care, Toronto, Canada 2 University of Toronto, Department of Family and Community Medicine, Toronto, Canada Introduction Although primary care settings and general practitioners are ideally placed to discuss goals of care and advance care planning with their patients with a life-limiting illness, these conversations are often neglected, even in the terminal stages of both malignant and nonmalignant disease. Instead, discussion of code status and preferred place of death are often initiated in acute care settings where lack of rapport with the physician or patient incapacity can limit conversations. Objectives This narrative review aims to examine the barriers faced by primary care physicians in engaging in these conversations.

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Methods Embase and Medline were searched from 1976-2016 using search terms including primary care physicians, advance care planning, terminally ill, and living wills. Reference lists of relevant studies were examined to identify additional studies. Studies were reviewed and analyzed independently by two authors. Studies solely examining advance care planning done by palliative physicians were excluded, as were facilitators of advance care planning among primary care physicians. Results Fourteen studies were included for analysis. Several barriers to early goals of care discussions were identified. These included physician uncertainty regarding the appropriate timing of discussions; and difficulty allocating sufficient time with patients and families for discussion. Discomfort with prognostication, uncertain disease trajectories, and fears around potential physician-patient conflict were also highlighted. Conclusions Programs and policies that promote advance care planning as part of usual care, as well as education around disease trajectories and prognosis, particularly for non-malignant disease, may provide increased incentives, confidence and competence for primary care physicians to broach these conversations with patients.

eP386 PERCUTANEOUS TRANSESOPHAGEAL GASTROTUBING FOR PATIENTS WITH MALIGNANT GASTROINTESTINAL OBSTRUCTION F. Soichi1, S. Ueda1, O. Takafumi1, H. Atsushi1, Y. Akashi1 1 Nara Hospital Kindai University School of Medicine, Medical Oncology, Ichoma city -Nara, Japan Introduction Peritonitis is a common symptom in terminal cancer, reportedly occurring in 5%–42% of patients. Vomiting caused by a malignant gastrointestinal tract obstruction is typically treated with a nasogastric tube (NGT) or small-bowel intubation. However, this condition has a bad prognosis, and transnasal decompression can add to the patient’s distress and reduce quality of life. Objectives We tried 12 patients to percutaneous transesophageal gastrotubing (PTEG) as an esophagostomy procedure for bowel decompression in patients with malignant bowel obstruction. Methods After receiving PTEG, efficacy evaluations were conducted, with NGT designated as the control state. The procedure was considered effective only when discomfort in the nasopharynx was improved for at least 2 weeks. PTEG was created as Ohishi et al and Mackey et al described with the use of a PTEG kit and the following procedures. Results From December 2006 to July 2016, 12 patients were tried. The technical success rate was 100%. Median procedure time was 35 minutes (range, 20–60 min). Median follow-up duration for PTEG was 43 days (10-602 days). The procedure was considered effective in all patients. The one patient in which the procedure was ineffective could not be evaluated as a result of deterioration of early death. 12 patients had given an evaluation of “more comfortable than NGT”. One patient was a Grade 4 for postoperative hemorrhage. No other severe complications were observed during the procedure. Conclusions PTEG is an effective technique to relieve discomfort in the nasopharynx caused by NGT in patients with terminal malignant tumors.

eP387 LATE PALLIATIVE CARE REFERRALS OF HOSPITALIZED PATIENTS AT A NATIONAL CANCER CENTER IN MEXICO

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E. VERASTEGUI-AVILES1, S. ALLENDE PEREZ2, G. DOMINGUEZ OCADIO2, E. MONREAL2, C. PEÑA2 1 InstitutoNacional de Cancerologia, Cuidados Paliativos, Mexico City, Mexico 2 Instituto Nacional de Cancerologia, Cuidados Paliativos, Mexico City, Mexico Introduction Early referral to palliative care (PC) of advanced cancer patients has been a provisional recommendation of the American Society of Clinical Oncology (ASCO). However, several factors not related to the disease stage have influenced the implementation of the recommendation in some countries. At the Instituto Nacional de Cancerologia (INCAN), as in many middle income countries, cancer is diagnosed in advanced stages, patients often have high symptoms burden and low survival rates. PC referrals of hospitalized patients at INCAN has been a major challenge, and has provide the PC team the opportunity to have a close interaction with the oncologist that has had a positive impact in early consultations and better quality of care of patients with advanced cancer. Objectives To study the characteristics of hospitalized patients seen by the PC team. Methods Retrospective review of electronic charts of hospitalized patients seen by the PC team from 2013 to 2016 Results During this period, 1076 patients were evaluated. Breast cancer and cervical cancer patients are the most frequent oncologic diagnosis seen; average age 54±2 years. Those patients with social insurance plan (breast, cervix, prostate, colon) had received at least three lines of chemotherapy, and radiation therapy, 80% had PPI-C. Although pain control was the principal reason for referral (57%), spiritual distress was also common. Hospital mortality was high. Conclusions Hospice Services are not available in Mexico; therefore, oncologist and PC teams should work in an integrated model to provide PC to cancer patients alongside with the disease and avoid late referrals of hospitalized patients.

eP388 FINANCIAL BURDEN AND THERAPEUTIC ADHERENCE OF PALLIATIVE CARE CANCER PATIENTS IN MEXICO E. VERASTEGUI-AVILES1, S. ALLENDE-PEREZ1 1 instituto nacional de cancerologia, cuidados paliativos, mexico city, Mexico Introduction Mexico as other Middle Income countries is facing a double burden of diseases; cancer has become a public health problem that requires a significant infrastructure with important expenses for the health system. In the country, access to health care is a Constitutional Right; therefore, major health care reforms have been implemented to warranty affordable care to the population. Regardless of these actions, there are important inequalities in the access and quality of health services, and out-of pocket expenses are significant. Objectives The purpose of this study was establish the economic burden that travel to the INCAN may represent to advanced cancer patients and its impact in adherence. Methods Patients with advanced cancer were invited to participate in a 28 questions survey. Descriptive statistics were used in the case of the variables associated with the cost.

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Results Four hundred and nine patients participated in the survey. Median age was 53 years, most patients had an average total income between $150.00 to $300.00 USD (67%); 42% had less than 6 years of formal education. Severe pain for more than a month was present in 50%, only 25% had received strong opioids. Most patients have to travel at least 5 hours to arrive to the hospital, with an average cost of $20.00 USD. The average out of pocket expenditure per hospital visit was $150.00 USD. A high percentage of patients were lost on follow-up after 2 visits. Conclusions Financial burden in advanced cancer patients may impact the therapeutic adherence and the relief of suffering.

eP389 CLINICAL AND SOCIODEMOGRAPHIC CHARACTERISTICS O F E L D E R LY PAT I E N T S W I T H B R E A S T C A N C E R REFERRED TO PALLIATIVE CARE E. VERASTEGUI-AVILES1, S. ALLENDE PEREZ1, N. SANCHEZ DAVILA1, P. CABRERA2, E. MONREAL1 1 instituto nacional de cancerologia, cuidados paliativos, mexico city, Mexico 2 instituto nacional de cancerologia, Servicio de Tumores Mamarios, mexico city, Mexico Introduction In Mexico every year 23,000 cases of breast cancer (BC) are diagnosed and six thousand deaths are reported each year. In 2013, 63 out of 100,000 women aged 80 and over die. Age is a risk factor for developing BC There are few studies that describe the profile and prognostic factors of older adult patients sent to palliative care (PC). Objectives To define the clinical, sociodemographic, histopathological, prognostic and treatment characteristics in patients with BC over 65 years of age referred to PC. Methods We reviewed the elctronic charts of BC 65 y/o and older from 2010 to 2016 Results Mean age was 75 years, median overall survival was 42.5 months. The median overall survival after PC admission was 2 months. The 40% (71/178) were widows, 29% (29/178) were illiterate, 33% (59/ 178) had more than 3 comorbidities. The 84% (150/178) had metastases, 43% had polypharmacy and 59% (105/178) had ECOG 2 and 3. The 36% were referred in clinical stage IV and the most frequent phenotype was the hormone receptor positive with 62% (69/178). In the correlation between quantitative variables and overall survival, Karnofsky (p = 0.01) and the clinical stage (p = 001) showed significance Conclusions Elderly patients with BC require a unique and specialized approach. Timely referral and comprehensive geriatric assessment should be the strategy to improve the care of this group of patients.

eP390 IMPROVEMENT F THE QUALITY OF LIFE IN PATIENTS WITH GYNECOLOGICAL TERMINAL CANCERS ACCORDING TO ESAS S. ALLENDE PEREZ1, E. MONREAL1, M. GALLARDO DE LAS PEÑAS1, G. DOMINGUEZ OCADIO1 1 instituto nacional de cancerologia, cuidados paliativos, mexico city, Mexico

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Introduction Prevalence of gynecological cancer (GC) in Mexico is high, regarless of prevention and early detection methods, a high percentage of patients are diagnosed with advanced disese, which cause suffering and poor quality of life i(QoL). Objectives To evaluate trhe most prevalent symptoms in women with gynecological cancer referred to palliative care(PC) Methods ESAS from patients with GC referred to PC were evaluated during the initial visit and after 8 days of treatment Results 155 patients were included. Average age of 54 ± 4 years old, cervical cancer was the most frequent diagnosis. An statistical significant decrease of pain, fatigue, depression, anxiety and nausea iaccording to the Wilcoxon test was documented after 8 days of palliative treatment. Conclusions PC intervention in GC patients, within the first consultation, improves pain, fatigue, depression and anxiety, which may have a significant impact on QoL. Improving the ESAS experience can predict response to treatment from the first consultation.

eP391 A NEW ERA FOR PALLIATIVE CARE PROGRESS IN RUSSIA E. Vvedenskaia1, A. Palekhov2 1 , Nizhny Novgorod, Russia 2 Stavropol State Medical University- Regional Center for Palliative Care in Cancer, Cancer and Palliative Care Department, Stavropol, Russia Introduction Palliative Care in Russia started in late 1980s with the first pain clinics in Moscow, Saint Petersburg and Rostov. In November 2011 Russia's president ratified the New Health Bill "On the Basis of Healthcare Provision in the Russian Federation". Objectives For the first time it provides a definition of palliative care: "palliative care is a set of interventions aimed to relieve pain and other severe manifestations of the disease in order to improve the quality of life of terminally ill people ". Methods Palliative care for the first time has been included in the list of medical care forms guaranteed for the citizens by the government. The law says that palliative care "... can be provided by health professionals who have been trained to provide such care". Palliative care will be funded through the Program of the state guarantees of rendering free medical care to the citizens of the Russian Federation“. Palliative care issues are included in the Health Care Strategy of the Russian Federation to 2020. Results The Orders for palliative medical care delivering for adults and children in Russia has been approved. According to the Order palliative care should be delivered both in clinics and at home, and in specialized medical institutions, such as hospices, palliative care departments.Specialist palliative care centers will be establishes and physicians will have the opportunity to study specialist palliative care on a regular basis. Conclusions New legislation opens a new era for palliative care progress in the country.

eP392 RADIOFREQUENCY ASSISTED VERTEBROPLASTY AND OSTEOPLASTY USING A BIPOLAR DEVICE IN THE PALLIATION OF BONE METASTASES: AN INITIAL SINGLECENTER EXPERIENCE

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E. David1, A. Yee2, E. Chow3, A. Saghal3, S. Chan3, A. Wan3, A. Agarwal3, S. Kaduri1 1 Sunnybrook Health Sciences Centre- University of Toronto, Medical Imaging, Toronto, Canada 2 Sunnybrook Health Sciences Centre- University of Toronto, Orthopedic Surgery, Toronto, Canada 3 Rapid Response Radiotherapy Program- Odette Cancer CentreSunnybrook Health Sciences Centre- University of Toronto, Radiation Oncology, Toronto, Canada Introduction Radiologically guided vertebral and pelvic augmentation via vertebroplasty (VP) and osteoplasty (OP) are considered safe and effective in the palliation of bone metastases. Objectives To assess the clinical effectiveness and safety of bipolar radiofrequency ablation (RFA) assisted VP and OP in pathological and insufficiency fractures. Methods Patients referred for symptomatic fractures for VP or OP from January 2011 to May 2015 were retrospectively reviewed. Bipolar RFA was performed (Osteocool RF ablation system, Baylis Medical), reaching a constant temperature of 70°C over 7 to 15 minutes, followed by cement injection. Clinical outcomes were evaluated based on electronic medical chart data. Radiological outcomes were assessed based on computed tomography. Pre- and post-procedural pain scores were documented for the RFA subset. Results Twenty-six patients were treated with the RFA assisted technique. These contributed to 4 OPs and 35 VP levels, of which 4 VP levels were insufficiency fractures. All were technically successful without morbidity or mortality. Fifty-six patients were treated with a non RFA assisted technique. All these were VPs and 142 levels were treated in total. Two levels were insufficiency fractures. All were technically successful without morbidity. There was a significantly reduced rate of posterior and venous cement leaks when RFA was used prior to VP. Pain scores in the RFA assisted group decreased post-procedure with no neuropathic events.

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Conclusions RFA assisted VP and OP using a bipolar device is safe and allows for controlled injection of cement into a thermal cavity with a decrease in venous and posterior cement leaks.

eP393 GENETIC BIOMARKERS ASSOCIATED WITH RESPONSE TO PALLIATIVE RADIOTHERAPY IN PATIENTS WITH PAINFUL BONE METASTASES A. Furfari1, A. Wan1, A. Wong2, K. Ding3, A. Bezjak4, R. Meyer5, R. Wong4, C. Wilson3, C. DeAngelis6, A. Azad2, E. Chow1, G. Charames2 1 Odette Cancer Centre - Sunnybrook Health Sciences Centre - University of Toronto, Radiation Oncology, Toronto, Canada 2 Mount Sinai Hospital, Pathology and Laboratory Medicine, Toronto, Canada 3 Queen’s University, Canadian Cancer Trials Group- Cancer Research Institute, Kingston, Canada 4 Princess Margaret Cancer Centre, Radiation Medicine Program, Toronto, Canada 5 Juravinski Hospital and Cancer Centre, Oncology, Hamilton, Canada 6 Odette Cancer Centre - Sunnybrook Health Sciences Centre - University of Toronto, Pharmacy, Toronto, Canada Introduction Palliative radiotherapy (RT) is a method of pain control for patients with painful bone metastases. Differences between individuals that cause variations in RT response may be due to underlying genetic factors. Singlenucleotide variants (SNVs) are inter-individual genetic differences that occur at a single nucleotide, and are the most common type of genetic variation. Objectives To identify DNA biomarkers associated with response to palliative RT. Methods 79 patients who received a single 8 Gy RT for painful bone metastases were categorised into responders (n=36) and non-responders (n=43). Saliva samples were sequenced to identify SNVs in 4813 genes with known disease-causing variants. Uncommon (ExAC population frequency < 0.30), non-synonymous exonic variants significantly associated with RT response (p<0.05, Cochran-Armitage trend test) were identified. Results Fifty-six significant SNVs produced 33 variants associated with good radiation response, including GIGYF2 rs527464858 CAG repeat (p=0.004), NSUN7 rs4861066 A/G (p=0.004), POLG rs3087374 C/A (p=0.004), and ADCY10 rs16859886 G/A (p=0.01). 23 variants were associated with non-response, including GBGT1 rs75765336 C/T (p=0.006), GJB4 rs3738346 A/C (p=0.01), and TMC6 rs1799950 G/A (p=0.01). SNVs with existing clinical associations include ADCY10 rs16859886 G/A, BRCA1 rs1799950 T/C, CACNA1S rs12406479 A/G and KCNE1L rs1700395 G/A. Conclusions Ten SNVs involved in mechanisms, including DNA maintenance, signaling, muscle contractions, and membrane transport, have significant associations with radiation response. SNVs with predictive power may stratify patient populations according to likelihood of responding to treatment, therefore enabling more efficient identification of beneficial strategies for pain management and improved resource utilisation.

eP394 PATIENTS WITH ESTABLISHED CANCER CACHEXIA LACK THE MOTIVATION AND SELF-EFFICACY TO UNDERTAKE REGULAR STRUCTURED EXERCISE

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D. Wasley1, N. Gale2, S. Roberts2, K. Backx1, A. Nelson3, R. Van Deursen2, A. Byrne3 1 Cardiff Metropolitan University, Cardiff School of Sport, Cardiff, United Kingdom 2 Cardiff University, School of Medicine, Cardiff, United Kingdom 3 Marie Curie Research, Wales Cancer Trials Unit, Cardiff, United Kingdom Introduction Patients with advanced cancer frequently suffer a decline in daily activities associated with involuntary loss of weight and muscle mass (cachexia). This has profound effects on function and quality of life. Although exercise participation can maintain physical and psychological function in patients with cancer, uptake is low in cachectic patients who are largely underrepresented in exercise studies. Objectives To address gaps in understanding of how patient experiences influence exercise participation, this study investigated exercise history, self-confidence, and attitudes to exercise in patients with established cancer cachexia. Methods Outpatients with established cancer cachexia, who were independent and self-caring (lung =103 and gastrointestinal [GI] =93), completed a questionnaire set exploring key constructs of the Theory of Planned Behaviour to examine perceived control, psychological adjustment, motivational attitudes, exercise history and preferences. Results Patients reported low physical activity levels and few undertook regular structured exercise. Exercise self-efficacy was very low with concerns it could worsen symptoms and do harm. Patients showed poor perceived control and a strong need for approval but received little advice from healthcare professionals. Preferences were for low intensity activities, on their own, in the home setting. Conclusions Frequently employed higher intensity, group exercise models do not address the motivational and behavioural concerns of patients with established cancer cachexia. Development of exercise interventions which match their skills and perceived abilities are required to specifically address challenges of self-efficacy and perceived control identified here. Greater engagement of health professionals in promoting the potential benefits of exercise with this group is required.

eP395 THE UTILITY OF THE QUAL-EC IN THE CLINICAL CARE OF PATIENTS WITH ADVANCED CANCER A. Wilkinson1, S. Slatyer2, A. Nowak3, C. Pienaar4, A. Tandon5 1 Edith Cowan University, School of Nursing and Midwifery, Joondalup, Australia 2 Sir Charles Gairdner Hospital, Centre for Nursing Research, Perth, Australia 3 Sir Charles Gairdner Hospital, School of Medicine and Pharmacology, Perth, Australia 4 Perth Children's Hospital, Child and Adolescent Health Service, Perth, Australia 5 Sir Charles Gairdner Hospital, Palliative Care Service, Perth, Australia Introduction We piloted the Quality of Life at the End of Life (QUAL-E) in Australian palliative care in-patients (N=52) and demonstrated feasibility, acceptability and face validity, indicating opportunities for enhanced support. Objectives We compared the 17-item QUAL-E-Cancer (QUAL-EC) to the Distress Thermometer Screening Tool (DT) with the QUAL-EC conducted as an interview.

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Methods A cross-sectional, mixed methods design was used. Convenience sampling recruited patients (N=50) with advanced cancer and a prognosis of less than 12 months from a tertiary hospital. Participants completed the DT, followed by the QUAL-EC interview which was digitally recorded. Results Correlational and thematic analysis found that 39.6% of participants reported severe distress (score ≥7) while 40% reported moderate distress (score 4-6) on the DT. Levels of distress significantly correlated with two QUAL-EC domains: symptom control (r=0.52, p<0.001) and preparation for end of life (r=0.32, p<0.05). Qualitative analysis identified six themes: the health care team; family issues; approaching death; worry; coping and QUAL-EC experience. Acceptability: Participants overwhelmingly found the questions to be clear and did not find the questions hard to understand, hard to answer or stressful. Ninety per cent of participants agreed or strongly agreed that they were glad they took part. Conclusions Patient psycho-social distress was associated with either symptom burden or concerns about their family/loved ones. When distress is identified on screening, the QUAL-EC offers good potential for nuanced, versus vague, assessment of globalised distress (e.g., DT) as an aid in targeting patient-centered clinical/psycho-social interventions.

eP396 PERCEPTION OF CURABILITY IN ADVANCED CANCER PATIENTS, AND ITS ASSOCIATION WITH END OF LIFE QUALITY CARE OUTCOMES Y. Sriram1, Z. Lu1, J.L. Williams1, K.H. Lim1, E. Bruera1 1 UT MD Anderson Cancer Center, Palliative Care Rehabilitation and Integrative Medicine, Houston, USA Introduction Better understanding of their illness and treatment, especially patients’ perception of curability would facilitate better patient-clinician communication. Objectives To determine the association between inaccurate perception of curability and patient characteristics, decisional control preferences (DCP), symptoms, and end of life quality care outcomes in advanced cancer patients. Methods This is a secondary analysis of a study to determine the DCP among advance cancer patients receiving palliative care. We analyzed the association between inaccurate perception of curability as assessed by the Understanding of Illness questionnaire item and patient characteristics, symptoms, DCP, and end of life quality care outcomes (i.e., overall survival, hospice referral, time between hospice referral and death, chemotherapy, radiotherapy, immunotherapy and/or hormonal therapy in the last 14 days of life, ICU deaths, ICU admissions, length of stay, advanced care discussions, DNR documentation, ER visits, hospitalizations/length of hospital stay in last month of life) in the cohort of 121 consecutive patients seen as supportive care consults at a Comprehensive Cancer Center. Results 104/121 (86%) were evaluable. 39 (38%) inaccurately reported that their cancer is curable. In univariate analysis, older age (>60: OR 2.59, P=0.08; 50-60: OR 1.55, P=.043), passive DCP (OR 10.2, P=.032), shared DCP (OR 8.966, P=.042), early palliativecare referrals (OR .94, P=.048) were associated inaccurate perception of curability. The logistic regression analysis showed only passive DCP was significantly associated inaccurate perception of curability (OR 15.1, P=.042). Conclusions Frequency of inaccurate perception of curability was 38%. Passive DCP was significantly associated with inaccurate perception of curability in advanced cancer patients. Further studies are needed.

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eP397 THE PATIENT AND FAMILY MEETING PROGRAM: ENHANCING PALLIATIVE CARE INTEGRATION F. Zachariah1, S. Mooney1, R. Sidhu1, D. Ramchandani1, D. Mitani1, D. Horak2, S. Buga1, M.J. Loscalzo1 1 City of Hope National Medical Center, Supportive Care Medicine, Duarte, USA 2 City of Hope National Medical Center, Medical Specialties, Duarte, USA Introduction Studies demonstrate benefits of early palliative care. It is unclear how to best provide scalable, integrated supportive care alongside disease directed treatment in a way that expands primary palliative and effectively leverages specialty palliative care. Family meetings are frequently used to communicate medical information, but patients and families often have difficulty understanding the information provided. Objectives Design a scalable, mixed model palliative program centered around family meetings. Methods At City of Hope National Medical Center, we developed a 10-step model alongside provider specific training to facilitate shared medical decision making that aligns a patient’s goals and values with provider medical recommendations. This program allows staff to work at the top of their license, improves efficiency, and leverages relevant palliative disciplines. We developed screening tools, palliative consult triggers, and patientcentric educational material. An electronic family meeting summary form was designed to highlight patient values, facilitate information retention, improve medical decision making, and ease documentation burden. Results Early iterations of the program in the ICU have demonstrated successful screening of patients and caregivers, increased provider efficiency and satisfaction, and correlated length of stay reductions. We will formally evaluate the model in its entirety in the coming months. Conclusions Family meetings are important forums to communicate complex medical information and are a ubiquitous focal point to integrate relevant components of palliative medicine allowing for enhanced patient and familycentric care. The Department of Supportive Care Medicine will offer the model, educational sheets, consult triggers, and samples of the electronic family meeting summary form as free downloadable resources.

eP398 PSYCHONEUROLOGIC COMORBIDITY SCREENING IN PATIENTS WITH FAR-ADVANCED CANCER B. Zaydiner1, V. Fedunenko2, S. Savina3, I. Baranovsky4 1 Regional Cancer Hospital, Out-Patient Care, Rostov-on-Don, Russia 2 State Medical University, Surgery, Rostov-on-Don, Russia 3 Medical Center "Hyppocrates", out-patient care, Rostov-on-Don, Russia 4 Medical Center "Zdorov'e", Psychiatric, Rostov-on-Don, Russia Introduction Mental disorders in cancer patients are under-recognized by both GPs and oncologists, such situation burdens patients’ state especially in supportive care settings Objectives to assess prevalence of neuropsychiatric disorders in patients with generalized malignancies Methods Observational survey was undertaken. Patients were consulted at home; they were cIassified as having mental comorbidity based on clinical

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judgment which was added with routine tests if necessary. While detecting such comorbidity patients were prescribed with standard treatment Results 3589 patients (men 1769 women 1820, mean age 64.8 ± 5.6 years) were examined for variety of malignancies, the commonest being breast, lung, colorectal & skin cancers. Psychiatric disorders were detected in 1547 (43.1 % of total cohort), in this group nosologic prevalence was as follows: depression & other mood disturbances 544 cases (35.2%), cognitive impairment 332 (21.5%), delirium (hyperactive, hypoactive & mixed) 648 (41.9%), other disorders 23 (1,5%). During final days of life the delirium prevalence increased Conclusions screening and adequate treatment of mental disorders in patients with generalized cancer contribute to improve their quality of life

eP399 THE UNMET SUPPORTIVE CARE NEEDS OF CANCER SURVIVORS I. Alananzeh1, J. Levsque2, C. Kwok3, B. Everett1 1 Ingham Institute for Applied Medical Research, Centre for Applied Nursing Research, Liverpool, Australia 2 Monash University, Faculty of Medicine- Nursing and Health SciencesSchool of Psychological Sciences Centre for Oncology Education and Research Translation CONCERT, NSW, Australia 3 Western Sydney University, School of Nursing and Midwifery, parramatta, Australia Introduction Unmet supportive care needs can be negatively impact on the quality of life of people affected by cancer. Minority groups, including immigrants have been reported to experience significantly higher unmet needs and worse quality of life than the majority population. One such group is Arab immigrants who are more likely to have unmet information and physical needs. Objectives Examine the prevalence, severity and predictors of unmet supportive care needs in a sample of Arab Australian and Arab Jordanian cancer survivors. Methods This paper presents findings from a larger mixed methods study conducted in Australia and Jordan. Arab people diagnosed with cancer within the last five years were invited to complete a questionnaire which measured unmet supportive care needs, social support, quality of life, depression, and language acculturation. Results 77 Arab Jordanian and 66 Arab Australian cancer survivors were recruited. Australian participants were significantly older than their Jordanian counterparts (61.5 vs. 52.3 years; p < 0.001), and reported higher levels of overall unmet needs (44.9 vs. 36.1; p = 0.012) including higher physical (57.4 vs. 42.3; p = 0.001) and psychological (55.9 vs. 35.3; p < 0.001) needs. Accounting for age group difference, higher levels of depression (beta: 0.34) and living in Australia (beta: 0.26) were significant predictors of unmet needs explaining 16 % of the variance. Conclusions These findings have extended our understanding of the unmet supportive care needs of Arab cancer survivors. The finding that Arab Australians had worse outcomes than their Jordanian counterparts confirms disparities in outcomes in minority versus majority populations.

eP400 I N C R E A S E D D I S T R E S S A S S O C I AT E D W I T H PA I N CATASTROPHIZATION IN PATIENT WITH CANCER EXPRESSING DEPRESSIVE SYMPTOMATOLOGY

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P. Naylor1, S. Kuhlman1, T. Butler2, M. Floore1, E. Eversole1, P. Smith1, E. Labbe1 1 University of South Alabama, Psychology, Mobile, USA 2 Mitchell Cancer Institute, Medical Oncology, Mobile, USA Introduction Introduction: Depression, pain, and general distress are prominent healthrelated issues patients experience (ACS, 2016). Providers are encouraged to treat patients’ depression and other stress-related symptoms, as these issues can influence physical functioning. Although it has also been suggested that reducing pain catastrophizing will also reduce the symptoms of depression (e.g., Badr & Shen, 2014), it is unclear which therapeutic approach would foster improved physical functioning. Objectives Objectives: The current study investigated how distress may influence pain catastrophization through depressive symptoms. It was hypothesized that depression would significantly mediate the relationship between distress and pain catastrophization such that higher levels of distress would increase pain catastrophizing through increases in depression. Methods Methods: After consenting, patients (n=136; M age = 57.6; SD = 12.3) at a southeastern United States cancer institute completed questionnaires during their routine treatment/follow up appointments. The majority of patients identified as Caucasian (66.2%) and as female (57%). Patients completed the NCCN Distress Thermometer to assess distress, Patient Health Questionnaire-9 to assess depression and the Pain Catastrophizing scale. Hayes (2016) Process Modeling for Mediation was utilized to test the proposed mediation model. Results Results: Results supported the hypothesis. The indirect effects model was significant, while the direct effect of distress on pain catastrophization was not. Conclusions Conclusions: Distress does not appear directly associated with pain catastrophizing. However, depression symptoms resulting from higher levels of distress may increase one’s propensity for pain catastrophization. Therefore, addressing depression symptoms prior to cognitive/behavioral techniques for pain may be beneficial.

eP401 PREDICTORS OF PSYCHOLOGICAL DISTRESS AND ITS’ IMPACT ON SURVIVAL IN HEAD AND NECK CANCER PATIENTS Y.J. Chen1, Y.H. Lai2 1 Da-Yeh University, Department of Nursing, Changhua, Taiwan R.O.C. 2 National Taiwan University, School of Nursing, Taipei, Taiwan R.O.C. Introduction Head and neck cancer (HNC) is the fourth rank of top ten common cancer of male in Taiwan. Cancer patients suffer from great stress and impact physically and psychologically as cancer diagnosis. After HNC patients receive active cancer treatment, they may experience functional changes. Previous studies proved the HNC patients' psychological distress was significantly correlated to physical symptoms, and also negatively impacted on quality of life. However, there were limited research on psychological distress and survival in HNC patients. Objectives Therefore, the purposes of the study are to explore: (1) the predictors of psychological distress; (2) the impacts of psychological distress on survival. Methods The study is a prospective cohort study from July 2010 to December 2015. Patients were assessed by structured questionnaires, including

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Hospital Anxiety and Depression Scale (HADS), Symptom Severity Scale (SSS), and background information at six month after treatment. We linked the subjective patient' self-report data to survival status in cancer register databank in medical records room. Data analyzed by logistic regression and survival analysis. Results The results found that (1) in a total of 120 patients, 28.1% were dead; (2) gender, marital status, tumor stage, continued alcohol, tobacco, and betel nut used after treatment, and symptom severity were significantly predicted to psychological distress; (3) lymph stage, symptom severity, marital status, recurrence, and depression predicted to survival. Conclusions According to the results, HNC survivors still suffered from psychological distress after treatment. Health care provides should assess psychological distress routinely and provide mental support or referral service to improve their disease prognosis.

eP402 EFFECT OF ACCEPTANCE AND COMMITMENT THERAPY IN COGNITIVE FUNCTION AMONG BREAST CANCER PATIENTS IN EASTERN COUNTRY A. Datta1, P. Guha Choudhuri2, A. Mukhapadhyay3 1 Netaji Subhas Chandra Bose Cancer Research Institute, Psychooncology, Kolkata, India 2 Institute of Psychiatry, Psychiatry, Kolkata, India 3 Netaji Subhas Chandra Bose Cancer Research Institute, Hematology, Kolkata, India Introduction Acceptance and commitment therapy (ACT) is one of the newer form (third wave) therapy. This therapy helps a cancer patient to increase acceptance level about their disease as well as their present situation. Breast cancer patients are known to suffer from depression and mild cognitive impairment; both affect their quality of life. Objectives The present study had assessed effect of structured ACT intervention on cognitive function and acceptance level among breast cancer patients who were undergoing chemotherapy. Methods Data was collected from 123 breast cancer patients those who were undergoing chemotherapy were willing to undergo psychological treatment. Their baseline of cognitive function and acceptance levels were assessed using validated tools and the effect of demographic and clinical factors on cognitive function was determined too. The participants were randomly divided into two groups: experimental (ACT, 4 sessions over 2 months) and control group. Cognitive function and acceptance level were measured during post intervention. Appropriate statistical analyses were performed to determine the effect on cognitive function and acceptance level in two groups. Results At baseline, the factors that significantly influenced slower speed of task performance was different biological factors were related with that. Sociodemographic characteristics did not show any significant difference between slow and fast performance. Per and post intervention analysis showed that ACT intervention resulted in significant difference both in terms of speed of cognitive performance and acceptance level. Conclusions ACT is an effective therapeutic option for treating mild cognitive impairment and improve acceptance level among breast cancer patients undergoing chemotherapy.

eP403 SLEEP QUALITY IN PATIENTS WITH CANCER; FINDINGS FROM A NIGERIAN SAMPLE

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B. Fadipe1, A. Olagunju1,2 , M. Habeebu3,4, A. Adegboyega1 , O. Fatiregun1, A. Ojeyinka1, A. Sowunmi3,4 1 Lagos University Teaching Hospital- Lagos- Nigeria, Psychiatry, Lagos, Nigeria 2 College of Medicine- University of Lagos, Psychiatry, Lagos, Nigeria 3 Lagos University Teaching Hospital- Lagos- Nigeria, Oncology, Lagos, Nigeria 4 College of Medicine- University of Lagos, Oncology, Lagos, Nigeria Introduction Sleep is essential to human health, serving restorative functions with enormous physical and emotional benefits. In cancer, illness symptoms, treatment side-effects and psychological or physical co-morbidity may prevent patients from enjoying qualitative sleep. However, till date, there has been no study examining sleep quality among people with cancer from this environment. Objectives This study is set out to determine the quality of sleep and associated factors among patients with cancer in a Nigerian oncology clinic. Methods A total of 115 consenting adults with cancer were recruited into the study. Participants were administered a designed questionnaire to profile their clinico-demographic characteristics and Pittsburgh Sleep Quality Index (PSQI) to measure quality and patterns of sleep. Data was analyzed using SPSS-20. Results The mean age of participants was 47.33(±12.86) years, majority of them were female (86.1%) and had breast cancer (67.8%) with slightly above half presenting with advanced stages. The average duration of sleep of was 6.35(±1.85) hours. Eighty (69.6%) participants reported poor sleep quality. Nineteen (16.5%) reported having to use sleep medication three or more times a week. Participants who experienced pain in the month prior to the study (X2= 13.117,p=<0.001), used over the counter sleep medications (X2= 25.191,p=<0.001) and advanced stages of cancer (X2= 8.864,p=0.003) were more likely to report poor sleep quality. Conclusions Findings in this study suggest the experience of poor sleep quality in association with pain, use of sleep medication and advanced cancers. These should be considered in managing patients as means to improving overall care and outcome.

eP404 AN ATTENTIVE EVALUATION OF PATIENTS’ NEEDS BY A DMI N I ST R AT I ON OF N E Q ( NE E DS E VA LU ATI O N QUESTIONNAIRE) IN OUR CLINICAL PRACTICE A. Farnesi1, N. Virgili1, F. Paolieri1, A. Sbrana1, G. Musettini1, E. Biasco1, M.P. Zuccarone1, I. Brunetti1, E. Pfanner1, E. Vasile1, F. Bonci1, G. Miccinesi2, S. Ricci1, A. Antonuzzo1 1 Azienda Ospedaliero-Universitaria Pisana, Oncologia Medica, Pisa, Italy 2 Istituto per lo Studio e la Prevenzione Oncologia ISPO, Epidemiologia Clinica e descrittiva, Florence, Italy Introduction Cancer and its treatment modify the type of needs of men and women. NEQ (Needs Evaluation Questionnaire) is a validated tool to assess the informative, psychological, social, and practical needs of cancer patients. Objectives Our aim was to evaluate our patients’otherwise unexpressed needs through the administration of NEQ. Methods We administered NEQ (shown in Figure 1) to patients that accessed our Supportive Care Service, for unplanned visits, from August 2016 to January 2017.

We categorized the explored needs into five groups, as proposed by Annunziata et al*. Results We collected data from 137 patients. Results are shown in Table 1.

Our patients expressed major informative needs (42.3%); in particular, they asked for more information about their future condition and their diagnosis. Secondly, they also express concerns about their relational condition (22.5%), in particular they are worried about their usefulness within their families. Thirdly, they express material needs (22.2%), in particular they are concerned with economical issues. Fourthly, they have psychoemotional needs (20.7%), in particolar they would like to speak with people who had similar experiences. Lastly, they express needs about assistance and care (11.7%): a particolar concern about the respect of their intimacy is expressed. Conclusions The administration of NEQ is a useful tool to under stand our patients’ desires and needs. It allowed us to investigate about some needs that otherwise would not have been cared for. We then suggest an attentive evaluation of the patients’ needs at baseline and during treatment in order to have an holistic clinical approach.

eP405 FEATURES OF CARE BURDEN AMONG CAREGIVERS OF PATIENTS WITH LYMPHOMA: A LATENT CLASS ANALYSIS Y. Feng1, C. Chen2 1 1st affiliated hospital of Zhengzhou University, oncology department, Zhengzhou, China 2 Zhengzhou University, College of Nursing, Zhengzhou, China Introduction With the progress of medical science and technology and the extension of cancer patients survival time, the cancer patients' families undertake the main care, generally exist a certain amount of care burden. Always the study mainly take the caregivers as a whole ignoring the heterogeneity between groups. This study explore the features of care burden among caregivers of patients with lymphoma using latent class analysis and and provide a basis for making targeted intervention measures according to different features. Objectives To explore the features of care burden among caregivers of patients with lymphoma using latent class analysis and and provide a basis for making targeted intervention measures according to different features.

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Methods Totally 234 caregivers of patients with lymphoma were investigated with Caregiver Burden Inventory (CBI). Latent class analysis (Mplus 7.0) was used to discuss the features of care burden. Results The results indicated that there were three latent classes of care burden among caregivers of patients with lymphoma, namely“low burden group”(59%)、“social burden group”(31%)and “physiological burden group”(10%). Further analysis found that care burden was associated with female gender, higher age. Model 1 2 3 4

Log(L) -1844.57 -1499.25 -1388.50 -1327.42

AIC 3820.06 3265.82 3180.69 3194.92

BIC 3737.13 3096.50 2924.99 2852.84

Entropy

LMR

BLRT

0.93 0.91 0.89

<0.001 0.01 0.13

<0.001 <0.001 <0.001

Conclusions There were three latent classes of care burden among caregivers of patients with lymphoma. Each category has different proportion of gender and age, so targeted intervention measure should be taken to reduce the burden according to different classes and influence factors.

eP406 GOOD TRAINING NOT GOOD LUCK: WHAT HAEMATOLOGISTS AND ONCOLOGISTS BELIEVE WOULD MAKE IT EASIER FOR THEM TO REFER THEIR CANCER PATIENTS TO PSYCHOSOCIAL CARE K. Fennell1,2,3, L. Bamford4, I. Olver1, C. Wilson2,3 1 University of South Australia, Sansom Institute for Health Research, Adelaide, Australia 2 Flinders University, Flinders Centre for Innovation in Cancer- School of Medicine, Adelaide, Australia 3 Cancer Council SA, Behavioural Research and Evaluation Unit, Australia, Australia 4 The University of Adelaide, School of Psychology, Adelaide, Australia Introduction Rates of referral to psychosocial services are low in most cancer treatment centres, while rates of distress among patients are high. Objectives To determine why some oncologists and haematologists find it difficult to refer their cancer patients to psychosocial services, and to identify interventions through which enablers may be promoted and barriers may be surmounted, that clinicians would be willing and able to participate in. Methods A purposive sampling method ensured data were gathered from 7 oncologists and 5 haematologists, 36.36 % female, with varying levels of experience, who worked in two large public teaching hospitals. Qualitative data were collected using semi-structured interviews guided by the COM-B framework (Michie et al., 2014), to help understand influences on the target behaviour (i.e. referral). Data were analysed using Thematic Analysis (Braun and Clarke, 2006). Results Barriers relating to capability, opportunity and motivation to refer to psychosocial services were identified; for example a lack of knowledge on available psychosocial services, how to refer to them and the types of patients that would benefit, lack of time to discuss and refer, convoluted referral pathways and patient reluctance due to stigma. Barriers will be discussed with reference to specific, acceptable methods of overcoming them, identified by participants (e.g. short face-to-face instruction sessions, role plays and printed service summaries with contact details).

Conclusions Findings will inform the development of acceptable behaviour-changetheory-based interventions to improve rates of referral to psychosocial services by oncologists and haematologists, so that cancer patients do not continue to suffer unnecessarily from high levels of distress.

eP407 ‘SOCIAL NETWORK SUPPORT AND CANCER’ – A RCT STUDY ON OPTIMIZING SOCIAL NETWORK SUPPORT FOR FAMILIES LIVING WITH PARENTAL CANCER M. Hauken1, M. Senneseth1 1 Center for Crisis Psychology Bergen, Research, Bergen, Norway Introduction Social support is widely documented as essential to human health, especially in various stressful life events. However, families living with parental cancer report lack of social support in order to uphold a ordinary everyday life. Aiming to increase social support, The Cancer PEPSONE Program (CPP) was developed. Objectives To build competence to help children living with parental cancer. Specifically, we investigated the effects of the CPP on the healthy parents' and the children's quality of life (QOL) and mental health. Methods The effect of the CCP - a three hour psychoeducational program for the families and their social network - was evaluated using a RCT design. The children and their well parents completed questionnaires measuring QOL, mental health and social support at baseline and after three and six months. Results 35 families were enrolled (18 intervention (IV), 17 controls (C)). Both healthy parents and children reported significant impairment in mental health and QOL at baseline. The healthy parents reported significant intervention effects on social support, but no effects on mental health or QOL. An indirect effect was found on QOL and mental health through improved of social support. No effects were found on the children's mental health and quality of life, except for a significant effect on 'family function' Conclusions A family -oriented perspective is needed to safeguard the children’s needs. Actions should be initiated to increase the well parents’ social support, QOL and psychological distress, which may also benefit the children.

eP408 THE EFFECT OF PSYCHODRAMA GROUP THERAPY ON SELF COMPASSION IN BREAST CANCER PATIENTS D. IREN AKBIYIK1, B. ARAPASLAN2 1 Diskapi Research and Training Hospital Ankara, Family MedicinePsychosocial Support for Cancer, Ankara, Turkey 2 Ankara Psychodrama Association-, Psychiatrist- Psychodramatist, Ankara, Turkey Introduction The adaptation to the change in psychosocial needs and social networks as well as a new body image can cause a serious stress which puts breast cancer patients under a strain which is hard to cope with. The ability to be kind to oneself (self compassion), might have an effect on the stress the patients experience and illness adjustment. Objectives Psychodrama group therapy might support the breast cancer patients by increasing their selfcompassion to cope with the illness burden and the stress they experience during the treatment period

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Methods Breast cancer patients (n:10) were invited to attend psychodrama group sessions once in a week for a 10 week period. Before the groups, they filled Self Compassion Scale and Stress Thermometer developed specificly for cancer patients. The procedure repeated after completing 10 week group therapy focused on self compassion and awareness of the patients for the illness burdens and opportunities. During this period, the patients were also informed about dietary issues, physical activity principles against lymphedema and breast cancer. Results Although the self compassion scale scores differed among the patients regarding the age and the illness stage, the scores obviously increased at the end of the group sessions as well as the stress thermometer levels. Conclusions This study showed that self compassion might be increased by psychodrama techniques and the stress levels might decrease. The presentation will include the impacts of the sessions one by one. Psychodrama might be recommended for the interventions against the stress and the burden of the illness.

eP409 PSYCHOSOCIAL NEEDS OF BREAST CANCER PATIENTS; A QUALITATIVE STUDY D. IREN AKBIYIK1, O. SUVAK2, C. AYPAK3, S. GORPELIOGLU2 1 Diskapi Research and Training Hospital Ankara, Family Medicine/ Psychosocial Support for Cancer, Ankara, Turkey 2 Diskapi Research and training Hospital, Family medicine, Ankara, Turkey 3 Diskapi Research and Training Hospital Ankara, Family Medicine, ankara, Turkey Introduction Unmet psychosocial needs of breast cancer patients might cause serious psychiatric conditions later. There is a huge amount of data defining implementation experiences of an intervention or support program. However, the psychosocial needs, base elements of those efforts, were evaluated mostly regarding estimates of caregivers or health care professionals. Objectives The definition of "unmet psychosocial needs" might differ from the health professionals and caregiver family members and the patients. Any program intending to serve to the cancer patients should evaluate the patiens subjective ideas. Methods Breast cancer patients (N:6) were invited for a focus group interview which would last about 2 hours. During the focus group study, they were asked a semistructured list of basic psychosocial needs. The interactive interviews were recorded by the permission of the patients and analysed by two researchers regarding the cumulation of repeated phrases, underlined sentences etc. Results Most of the patients mentioned that finding no address who can support them psychologically at the very begining of the illness. They were also unhappy being not informed about the procedure after the diagnosis. The behaviours trying to hide the real diagnosis were the leading problem of safety. Conclusions To give reliable information about the illness period and to provide appropriate psychosocial support sources at the very begining of the illness seemed important for the patients' coping and adjustment abilities.

eP410 WERNICKE ENCEPHALOPATHY PRESENTED IN THE FORM OF POSTOPERATIVE DELIRIUM IN A PATIENT WITH CARCINOMA OF GINGIVA

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H. Onishi1, T. Takahashi2, M. Ishida1 1 International Medical Center - Saitama Medical University, Psychooncology, Hidaka, Japan 2 International Medical Center - Saitama Medical University, Palliative Care, Hidaka, Japan Introduction Postoperative delirium, which is defined as an acute change in cognitive status characterized by fluctuating consciousness and inattention occurring within 30 days postoperatively (Dyer et al., 1995), is common in cancer patients, however, the etiology is not well understood. Objectives A 63-year-old female diagnosed as carcinoma of gingiva of upper jaw and received chemotherapy (CDDP, 5-FU, Taxotere) followed by partial maxillectomy. She developed psychomotor excitement, disorientation and disturbance in cognition soon after the operation and was referred for psychiatric consultation. Methods Her psychiatric features fulfilled the Diagnostic and Statistical Manual of Mental Disorders, 5th edition for delirium and also fulfilled Dyer’s criteria for postoperative delirium. Neurological and laboratory findings were unremarkable. Detailed examination revealed that she developed appetite loss for about three weeks. Results She was suspected wernicke encephalopathy (WE) because ingested thiamine is stored in the body for about 18 days. She was administered 100mg of thiamine for four days. Symptoms of delirium resolved in three days. Serum thiamine level using high-performance liquid chromatography was proved to be 23ng/ml (reference range: 24-66ng/ml). From these findings, she was diagnosed as WE. Conclusions WE should be considered as a underlying pathology of postoperative delirium. Decreased absorption due to appetite loss and direct effect of 5-FU might be associated with development of thiamine deficiency.

eP411 RESILIENCE AND POST-TRAUMATIC GROWTH AMONG CANCER PATIENTS IN TURKEY S. Kav1, A. Karaaslan Eser1, E. Citak1, B. Cevik1, H. Ozencakir2, B. Erten2, U. Turkay2 1 Baskent University Faculty of Health Sciences, Nursing, Ankara, Turkey 2 Baskent University Ankara Hospital, Nursing Directorate, Ankara, Turkey Introduction Psychological resilience refers to individual's capacity to overcome adverse situations and ability to adapt into new condition. Post traumatic growth defined as positive changes as a results of the struggle with highly challenging life events. Cancer diagnosis and disease process can cause intensive stress in person since it is perceived as life threatening illness. Objectives The aim of this study was to determine the status of resilience and posttraumatic growth among cancer patients in Turkey. Methods The study has been conducted at a university hospital ambulatory treatment center of medical oncology department. Sample included the patients with cancer over 18 years, has received at least one course of chemotherapy and volunteer to participate. We have reached 58 responses until now and aimed to complete with 200 patients. In data collection Turkish version of the Resilience Scale for Adults and Post-Traumatic Growth Inventory were used. Results Majority of them were women (79.3%), married (65.5%), primary school graduates with diagnosis of ovarian (40%) and breast (24.1%) cancers. Resilience scale means were 129.57 ±19.87 and

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62.58±19.07 for Post-Traumatic Growth Inventory. They were no statistically significant associations between demographics and scale scores. Conclusions Compared to the current literature, our preliminary results showed that patient reported resilience and post-traumatic growth were high among this sample. Future studies are needed to better understand the associations of resilience and post-traumatic growth.

eP412 CANCER-SURVIVORS IN LONG-TERM ALL-CAUSE MORTALITY AMONG KOREAN CANCER PATIENTS WITH A N D W I T H O U T D E P R E S S I O N : A N AT I O N W I D E RETROSPECTIVE COHORT STUDY A.R. Ko1 1 Seoul, Republic Of Korea Introduction Psychologic and behavioral variables can have profound effects on health Objectives This study aimed to determine whether cancer patients with depression predict survival with regard to short-term and long-term all-cause mortality in Korea. Methods This study is a population-based prospective cohort study based on NHIS-NSC. We identified 120,562 cancer patients who were diagnosed as cancer according to ICD-10 and who underwent treatment between 2002 and 2013. To distinguish between short-term and long-term survivorship outcomes, we performed survival analysis of short-term (<5 years) and long term all-cause mortality for cancer patients with depression before cancer diagnosis. Results Short-term all-cause mortality in female (HR, 1.11; 95% CI, 1.02–1.24) patients with depression had higher mortality than non-depressed group, whereas among male patients the statistics were not significant. Both male (HR,1.43; 95% CI, 1.06–1.92) and female (HR, 1.77; 95% CI, 1.14–2.73) patients with GU cancers had higher short-term all-cause mortality. Male (HR, 1.30; 95% CI, 1.07–1.58) cancer patients had higher long-term allcause mortality than those in the non-depressed group. Long-term all-cause mortality was not significantly higher for female patients (HR, 1.05; 95% CI, 0.86-1.27). Male patients with GI cancers (HR, 1.70; 95% CI, 1.26– 2.30) and with GU cancers (HR, 3.29; 95% CI, 1.89–5.54) had higher longterm all-cause mortality than those without depression. Among female (HR, 2.36; 95% CI, 1.02–5.45) 5-year cancer survivors, only lung cancer showed a significant association with a higher long-term mortality. Conclusions These prospective data provide a new quantitative insight on gender differences and the long-term public health significance of depression among the cancer survivors.

eP413 CAREGIVER BURDEN PATTERNS AND RELATED FACTORS IN FAMILY CAREGIVERS OF PATIENTS WITH NEWLY DIAGNOSED ADVANCED LUNG CANCER: A LONGITUDINAL STUDY Y.H. Lee1, Y.H. Lai2, C.T. Hung1, M.Y. Hong3, S.Y. Jhang3 1 Mackay Medical College, Departmet of Nursing, New Taipei City, Taiwan R.O.C. 2 College of Medicine- National Taiwan University, School of Nursing-, Taipei, Taiwan R.O.C. 3 College of Medicine- National Taiwan University Hospital, Department of Nursing, Taipei, Taiwan R.O.C.

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Introduction Family caregivers (FCs) caring for patients with life-threatening advanced lung cancer may have burden experience. However, limited studies have explored FCs’ burden longitudinally to determine if there is a change in FCs burden and if there are patterns of change. Objectives To (i) examine changes in and patterns of overall caregiver burden, and (ii) determine factors predicting these changes and patterns over 6 months after lung cancer diagnosis in patients cared for by family caregivers (FCs). Methods For this longitudinal study, we recruited newly diagnosed lung cancer patient-FC dyads (N=150) from a medical center in Taiwan. Four measurement times were taken: before treatment, and 1, 3, and 6 months after treatment. The number of patterns of overall caregiver burden was determined by latent class growth analysis, and factors related to changes in and patterns of overall caregiver burden were identified by generalized estimating equations. Results We identified three patterns of overall caregiver burden over time (% caregivers): (i) higher burden (34.7%), moderate burden (56.0%), and lower burden (9.3%). The first pattern showed consistently higher burden over time, the second pattern showed a steadily moderate burden over time, and the third pattern showed relatively lower burden that dropped slightly 3 months post-treatment. The only patient or FC factor predicting changes in overall burden was FCs’ self-efficacy, but other factors predicted each pattern. Conclusions Our findings can help healthcare professionals identify FCs at relatively high risk of burden and provide them with specific care and to design timely and comprehensive interventions to reduce FCs’ burden.

eP414 THE INFLUENCE OF RESILIENCE ON THE COPING STRATEGIES IN PATIENTS WITH PRIMARY BRAIN TUMORS S.Y. Liang1 National Taipei University of Nursing and Health Sciences NTUNHS, Taipei, Taiwan R.O.C. 1

Introduction Understanding the strategies that patients adopt to cope with primary brain tumors is important in order to allow clinicians to help these patients deal with the complexities of this disease and its treatment. Currently, little is understood regarding the contribution of resilience to the coping strategies of patients with brain tumors. Objectives The purpose of the present study was to assess the degree to which resilience accounts for the variance in the coping strategies of patients with brain tumors. Methods A total of 95 participants completed the cross-sectional survey. These patients had all undergone surgical, chemotherapy, or radiotherapy treatments for their brain tumors at least one month prior to data collection. The instruments that were used in data collection included: the Ways of Coping Checklist-Revised (WCC-R) and Resilience Scale (RS). Results A significantly positive association was identified between resilience and the variables of problem-focused coping (r = .65, p < .001) and total coping (r = .49, p < .001). Furthermore, resilience accounted for 27% (R2inc= .27, p< 0.05) and 16% (R2inc= .16, p< 0.05) of the respective variances in predicting problem-focused coping and total coping.

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Conclusions As resilience plays a significant role in patient coping with brain tumors, health professionals should develop and implement relevant strategies to enhance the resilience of their patients with brain tumors.

eP415 LACK OF MEANS FOR COUNSELING BREAST CANCER PATIENTS HARBOURING BRCA 1/2 MUTATIONS IS ASSOCIATED WITH SOMETIMES UNNECESSARY SURGERY R. MATEI1, A. ENIU1, T. TOROK2 1 "ION CHIRICUTA " INSTITUTE OF ONCOLOGY, DAY HOSPITAL UNIT, CLUJ NAPOCA, Romania 2 "ION CHIRICUTA " INSTITUTE OF ONCOLOGY, HEMATOLOGY UNIT, CLUJ NAPOCA, Romania Introduction About 3% of breast cancer patients under the age of 50 harbour a BRCA 1/2 mutation. Contralateral prophylactic mastectomy (CPM) for patients already diagnosed and treated for unilateral early breast cancer was associated with reduced risk of contralateral recurrence and reduction in the risk of breast cancer-related death. However, data about improvement of overall survival is still scarce. Objectives To assess the procent of already treated BRCA carriers breast cancer that choose to perform CPM versus close follow up with clinical exam and breast imaging. Methods In 2016, 6 early breast cancer pacients treated between 2009 and 2015 were diagnosed with BRCA 1/2 mutation. They were explained both advantages and disadvantages of CPM versus clinical and imagistical follow up of the contralateral breast. Unfortunately we do not have multidisciplinary teams specialised in dealing with BRCA mutation carriers. We also lack the financial power to perform high resolution imaging for those patients (breast MRI) as requested by guidelines. The decision of weather to perform CPM was taken by patient after consulting with medical oncologist. Results All 6 BRCA positive patients chose to perform CPM. Conclusions Being a BRCA carrier is a great burden. Until now, all our patients choose to perform CPM, even if data about OS benefit is limited and surgery can have its serious physical and phisiological side effects. We need specialised teams to support BRCA carriers to live with this burden and in order to avoid sometimes unnecessary major surgery.

eP416 DOES EARLY INITIATION OF PALLIATIVE CARE INFLUENCE THE COPING MECHANISMS IN CAREGIVERS OF CANCER PATIENTS? R. MIRIYALA1, M. ARORA1, B. PARMAR1, P. NAGAR1, S. GHOSHAL1 1 Post Graduate Institute of Medical Education and Research, RADIOTHERAPY, Chandigarh, India Introduction Coping with cancer is a stressful challenge for patients as well as their caregivers. Similar to cancer patients, their caregivers also adopt different strategies for coping with the stress of care giving. Though multiple studies have reported the impact of palliative care on coping mechanisms in cancer patients, its impact on caregivers has seldom been reported. Objectives To evaluate the impact of palliative care on the coping mechanisms in caregivers of cancer patients

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Methods Primary caregivers of 100 patients undergoing curative treatment were prospectively recruited and the 28-point ‘brief cope’ questionnaire was used for recording their coping mechanisms. The intervention group consisted of caregivers of 50 patients who had at least 2 comprehensive palliative care consultations, and was compared with 50 non-random matched controls that did not receive specialist palliative care. Coping mechanisms were categorized into active and avoidant strategies, and descriptive statistics were obtained. Mann-Whitney’s test was employed to evaluate the differences in coping strategies between the two groups. Results Both the groups were homogenous with respect to age, sex, education, disease site and stage (ANOVA, p>0.05). Significant differences were observed among most of the coping mechanisms, with more positive scores in the intervention group (Table 1). No significant correlation was found between demographic variables and coping strategies (Spearman’s correlation, p>0.05).

Conclusions Early initiation of palliative care had a significant positive impact on the coping strategies adopted by cancer caregivers. This study reinforces the importance of palliative care in improving the quality of life of cancer caregivers, apart from that of the patients.

eP417 CORRELATION BETWEEN ESAS (EDMONTON SYMPTOM ASSESSMENT SCALE) SCORES ASSESSED BY PATIENTS AND NURSES G. Musettini1, A. Sbrana1, A. Farnesi1, E. Biasco1, F. Paolieri1, N. Virgili1, Z. Maria Pia1, L. Galli1, I.M. Brunetti1, E. Pfanner1, E. Vasile1, S. Ricci1, A. Falcone1, G. Miccinesi2, F. Bonci1, A. Antonuzzo1 1 Azienda Ospedaliero-Universitaria Pisana, Oncologia Medica, Pisa, Italy 2 Istituto per lo studio e la prevenzione oncologica, UO Epidemiologia Clinica e Descrittiva, Florence, Italy Introduction ESAS is a validated tool used to assess nine symptoms common in cancer patients and their severity. Such questionnaire should give clinicians a better idea of the severity of principal patients’symptoms. Objectives We wanted to evaluate the concordance of the ESAS assessed by the patients and by the clinical figures caring for them. Methods We administered ESAS questionnaire to our patients during an unscheduled visit in our Supportive Care Service. At the same time ESAS was completed by the nurse who was caring for him or her. We analysed ESAS scores obtained from both evaluations and, by using Spearman’s rank correlation coefficient (rho, ρ), we estimated the agreement between the two assessments. Results We collected data from 137 patients. Figure 1 shows the values of Spearman’s ρs for the nine considered symptoms, without considering the “other” item. We observe a general good concordance (ρ values approaching the unit) for all considered symptoms, with the only exception for well-being and shortness of breath.

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eP419 A SCOPING REVIEW ON THE USE OF BIOMARKERS IN RESEARCH ON CANCER CAREGIVERS' HEALTH J. Park1, A. Ross1, S. Klagholz1, M. Bevans1 1 National Institutes of Health, Clinical Center, Bethesda, USA Conclusions We want to underline that a third evaluation by the treating physician would have been useful and of interest. Nonetheless, we can affirm that the evaluation made by the nurse is usually concordant with the patients’ real perception of their clinical condition. We that strongly suggest to take into high consideration the nurse evaluation when assessing the severity of the patients’issues, especially in outpatients during unplanned visits. Such evaluation could then be implemented even in other steps of our patients’ clinical path.

eP418 IMPACT OF PSYCHO-ONCOLOGICAL INTERVENTION THROUGH COUNSELING IN PATIENTS WITH THYROID CANCER TREATED WITH RADIOYODINE N. Javaloyes1, L. Botella1, S. Manuel1, C. Aurora1, R. MªCarmen1, B. Antonio1 1 Hospital Quironsalud Torrevieja. Catedra Oncologia MultidisciplinarUCAM, Platform of Oncology, Torrevieja, Spain Introduction Radioyodine therapy and thyroidectomy affects significantly in the psychological aspects of well-differentiated thyroid cancer patients. Psycho-oncological interventions decrease symptoms of depression/ anxiety in short-term and improve adherence to treatment in these patients. Objectives The aim of this study is to quantify the adverse impact of thiroidectomy, hormonal deprivation and radioyodine treatment, and otherwise the benefit of psycho-oncological assessment, in well-differentiated thyroid cancer patients. Methods A total of 75 thyroid cancer patients were randomized assigned into two groups. The experimental one was constituted by patients that underwent psychological intervention (n=37) and the control one without any specific intervention (n=38). Baseline and post-intervention assessment was analyzed, including anxiety/depression (HADS), quality of life (SF-36), and wellness (PGWBI). Results A statistical significantly worsening in the control group in their baseline status of anxiety (basal-final difference=0,76), depression scores (basal-final difference=1,57), well-being (basal-final difference=-8,13) and in all measured dimensions of quality of life after radioiodine treatment was observed (p<0,001). Otherwise, in the experimental group and statistically significant improvement on the basal state of anxiety (basal-final difference=-4), depression (basal-final difference=-2,29), well-being (basal-final difference=16,29) and evaluated dimensions of quality of life were observed. Statistically significant differences (p<0,001) for all the variables analyzed after intervention in this group were observed. Conclusions We have founded a global improvement greater in emotional and adaptive factors analyzed caused the psycho-oncological intervention through counseling. These results encourage us to incorporate routinely this psycho-oncological assessment in a multidisciplinary environment and to explore its role in other indications of high psychological impact in cancer.

Introduction Our understanding of biomarkers of health in caregivers of cancer patients is limited. Biomarkers can be used as prognostic, predictive, or monitoring indicators of an associated outcome. Objectives The purposes of this review were to provide a comprehensive summary regarding the research examining biomarkers as surrogate endpoints for clinical outcomes in family caregivers of patients with cancer and to make recommendations for future research. Methods A scoping review, described as a process of mapping the existing literature or evidence based literature, was conducted to identify studies on biomarkers in caregivers of patients with cancer. We reviewed studies comparing biomarkers in caregivers and controls, and the relationships between biomarkers and behavioral and psychological health. Results We identified 34 studies in caregivers of adult patients suffering from cancer. These studies used biomarkers to predict outcomes (n=28) and monitor interventions (n=7). We further divided biomarkers into four broad categories: (1) Neuroendocrine function [sympathetic adrenal-medullary (SAM) axis activity, hypothalamicpituitary-adrenal (HPA) axis activity]; (2) Immune function; (3) Cardiovascular function; and (4) Cognitive function. Predictive biomarkers were sensitive to differences between the conditions of caregivers and controls. The biomarkers evaluated outcomes that are frequently associated with stress, depression, anxiety, and sleep disturbance. Cortisol was the most commonly measured to monitor the efficacy of caregiving interventions. Conclusions The review provides recommendations for future research: appropriate and accurate biomarker collection, biomarkers to monitor caregiving interventions, biomarkers for cardiovascular risk, and biomarkers with multisystem indicators (e.g., allostatic load). Expanding the scientific study for biomarkers will contribute to improving caregiver performance and health.

eP420 CORRELATION BETWEEN HADS (HOSPITAL ANXIETY AND DEPRESSION SCALE) AND ESAS (EDMONTON SYMPTOM ASSESSMENT SYSTEM) SCALE IN ONCOLOGICAL PATIENTS: OUR EXPERIENCE A. Sbrana1, A. Farnesi1, G. Musettini1, E. Biasco1, F. Paolieri1, N. Virgili1, M.P. Zuccarone1, L. Galli1, I.M. Brunetti1, E. Pfanner1, E. Vasile1, S. Ricci1, A. Falcone1, G. Miccinesi2, F. Bonci1, A. Antonuzzo1 1 Azienda Ospedaliero-Universitaria Pisana, Oncologia Medica, Pisa, Italy 2 Istituto per lo Studio e la Prevenzione Oncologica ISPO, UO Epidemiologia Clinica e Descrittiva, Florence, Italy Introduction Anxiety (A) and Depression (D) are frequent comorbidities of oncological patients, but they are often underestimated by medical oncologists. Objectives Our aim was to evaluate the incidence rates of A and D, assessed by the administration of HADS questionnaire, and to correlate such results to each item evaluated in the ESAS scale.

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Methods We administered both HADS and ESAS questionnaires in patients that accessed to our Supportive Care Service. Results We collected data from 137 patients. Results of their HADS scales are shown in Figure 1.

Patients with a total score of 8 or higher in either scale (66, 48.2 %) were offered a psychological visit: 19 (28.8%) accepted, whereas 40 (60.6%) refused this evaluation. 7 (5.2%) were already on psychological or psychiatric treatment. We then made an evaluation of the correlation between HADS and ESAS of the patients with clinically-relevant A or D. Results are shown in Figure 2.

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stability of patients’ DC controlling for their allies’ DC from baseline to follow-up (and vice versa for allies). Results All subscale scores declined from baseline to follow-up (ps<.03). Between patients and allies, baseline uncertainty scores were positively related (p=.01); follow-up information scores were positively related (p=.05); and although not statistically significant, follow-up support scores tended to be positively related (ps=.09). SI-APIM revealed that, for information, value clarity, and support subscales, baseline scores positively related to follow-up scores (ps<.003). For uncertainty, baseline scores positively related to follow-up scores for allies only (p=.004). Higher ally baseline uncertainty also, though not statistically significant, tended to be related to higher patient follow-up uncertainty (p=.07). Conclusions Although DC declines across the early post-diagnosis period, high DC at diagnosis predicts continued high DC months later among men with lowgrade prostate cancer and their allies. Moreover, allies’ early uncertainty may affect men’s uncertainty months later. Findings suggest attention to DC is warranted for both men and their allies.

eP422 IDENTIFYING THE UNMET NEEDS OF PATIENTS WITH A PREVIOUSLY TREATED PRIMARY UVEAL MELANOMA, THAT ARE UNDERGOING REGULAR LIVER SURVEILLANCE

Patients with clinically-relevant A or D have statistically-significant higher ESAS scores with the exception of the items 3 and 9 in the A group and of the item 9 in the D group. Conclusions Oncological patients affected by either A or D have a worse perception of the severity of the most common cancer- or treatment-related symptoms. We then suggest an attentive basal evaluation and monitoring of A or D in order to give the patients a better quality of life and to make them face cancer and related treatments in a better way.

eP421 EXAMINING DECISIONAL CONFLICT IN MEN WITH LOWGRADE PROSTATE CANCER ELIGIBLE FOR ACTIVE SURVEILLANCE AND THEIR CLOSE ALLIES: AN UPDATED ANALYSIS K. Shaffer1, E. Schofield1, M. Diefenbach2, C. Nelson1 1 Memorial Sloan Kettering Cancer Center, Psychiatry and Behavioral Sciences, New York, USA 2 Northwell Health, Department of Medicine & Urology, Manhasset, USA Introduction Men diagnosed with low-grade prostate cancer and their close allies report significant uncertainty when deciding between pursuing treatment or active surveillance (AS). Objectives This study explored if decisional conflict (DC) resolved following diagnosis and if DC was related between patients and allies. Methods Men with prostate cancer eligible for AS (N=124) and their allies (N=60, 96% spouses; complete dyads N=55) completed the Decisional Conflict Scale at baseline and again three months later. Correlations and paired-samples t-tests compared four subscale scores of patients and allies. Stability-influence modeling using actor-partner interdependence modeling (SI-APIM) examined the

J. UPTON1, E. MARSHALL2, J. SACCO3 1 THE CLATTERBRIDGE CANCER CENTRE, INTEGRATED CARE, MERSEYSIDE, United Kingdom 2 THE CLATTERBRIDGE CANCER CENTRE, MEDICAL ONCOLOGY, MERSEYSIDE, United Kingdom 3 THE CLATTERRBRIDGE CANCER CENTRE, RESEARCH AND INNOVATION, MERSEYSIDE, United Kingdom Introduction Cancer survivorship is aimed at ensuring that those living with and beyond cancer are able to access care and support so that they can lead healthy lives. Although there is an abundance of work with the larger cancer groups such as breast, lung and prostate, there is little understood about the issues faced by patients with uveal melanoma. Objectives • Identify trends in unmet needs Ascertain if there is any correlation between unmet needs and time-points within the patient’s surveillance trajectory • Explore if unmet needs decrease/increase throughout the surveillance programme trajectory Methods A retrospective audit will quantitatively report the unmet needs of patients inducted into the uveal melanoma, liver surveillance programme. As the Holistic Needs Assessment questionnaire (developed by the National Cancer Survivorship Initiative) is used routinely to identify concerns/ needs, this data will be captured over a one year period and the results reported. The data will be stratified into cross-sections of cohorts to generate trends in time-points or identify patterns in age groups where high levels of needs are unmet. Results Analysis demonstrates a baseline of anxiety scored at a mean of 6/10 for 68% of patients inducted on to the surveillance programme, this reduces gradually, but then increases at 24 months (mean score 5/10) and then again at 5 years (mean score 5/10). Conclusions Liver surveillance in patients with high risk, uveal melanoma is associated with high levels of anxiety, that is compounded by prognostic scoring with transient increases in anxiety levels at 2 and 5 years.

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eP423 INTEGRATED PSYCHO- ONCOLOGY PROGRAM: A MODEL OF COLLABORATIVE CARE T. weitzman1, J. Fann- MD- MPH2 1 Seattle cancer Care Alliance /Fred Hutchinson Cancer research Center, Supportive Care, Seattle, USA 2 Seattle cancer Care Alliance /Fred Hutchinson Cancer research Center, Director Psychiatry and Psychology Service, Seattle, USA Introduction Despite the high prevalence of psychosocial problems in cancer populations and the availability of evidence based approaches to these problems, many patients still do not receive adequate psychosocial care. Practice guidelines and quality measures call for universal screening for distress during cancer treatment; however, no standard approach exists ensuring patients identified as distressed receive adequate treatment and follow up. A framework for an integrated model for psychosocial care was presented at The Institute of Medicine in 2008. The report emphasized five components: (1) identification of patients with psychosocial health needs (2) plan to address needs (3) linkages for patients to psychosocial health services (4) support of illness self-management, and (5) follow up on care delivery. Objectives Numerous patient, providers, organizational and economic challenges exist to implement a psychosocial care model integrated with patient’s cancer care. Collaborative Care is an evidence based, practical way of addressing these challenges. This model comprises systemic identification of need, integrated delivery of care, appropriate supervision, and the stepping of care based on systematic measurement of outcomes. This presentation will focus on applying the Collaborative Care model to provide a population based approach to integrated psychosocial oncology care. We will focus on key components and concepts utilizing principles of Collaborative Care and draw upon our clinical and research experience with Collaborative Care to lay the foundation of implementing this this model, as well as practical lessons learned from applying this model across a variety of ambulatory oncology settings. Methods Didactic Results n/a Conclusions n/a

eP424 DISTRESS EXPERIENCED BY PATIENTS WITH ACUTE MYELOID LEUKEMIA (AML) AND MYELODYSPLASTIC SYNDROME (MDS) L.A. Williams1, P. Ault1, J.E. Cortes2, G. Garcia-Manero2, C.S. Cleeland1 1 The University of Texas MD Anderson Cancer Center, Symptom Research, Houston, USA 2 The University of Texas MD Anderson Cancer Center, Leukemia, Houston, USA Introduction Investigation of psychological distress experienced by patients with the related diseases of acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) are scarce. Lack of recognition of distress and its causes may result in failure to address distress appropriately. Objectives The purpose of this study was to describe the experience of distress during AML and MDS in the words of patients.

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Methods This was a secondary analysis of qualitative interviews of patients with AML or MDS, conducted originally to describe AML/MDS symptom burden. Patients described their disease experiences in single qualitative interviews. Content analysis was used to identify themes of distress experiences. Results Thirty patients participated in individual interviews. Nineteen of 25 patients with AML and 4 of 5 patients with MDS described experiencing distress. Content analysis found themes including unexpectedness, lack of information, fear and uncertainty, severe symptoms, change in appearance, life disruptions, fear of abandonment, insurance and financial concerns, and family needs. Patients with AML reported all themes, while patients with MDS had concerns related to unexpectedness, fear and uncertainty, life disruptions, and family needs. Conclusions Most patients with AML and MDS experience distress. While patients may require immediate and intensive disease treatment, it is also important that they have distressing issues identified and addressed. Support needs can include information about the disease and treatments, help in coping, support to maintain daily activities, and assistance in meeting personal and family needs including financial and health insurance-related. Additional research assessing the effectiveness of interventions is needed to build an evidence base for directing care.

eP425 EGFR AND PD-L1 IN MOOD DISORDERS AMONG METASTATIC NON-SMALL CELL LUNG CANCER R. Zheng1, Y. Chunhua1, L. Junying1 West China Hospital of Sichuan University, Cancer center, Chengdu, China 1

Introduction Little is known whether or not expressed products of tumor cells are associated with mood disorders in metastatic non-small cell lung cancer (NSCLC). Objectives The aim of the present study was to explore the association between expressed product of tumor cells and anxiety and depression among newly diagnosed patients with Metastatic NSCLC. Methods Of 687 consecutive newly diagnosed NSCLC patients admitted to cancer center, 508 (73.9%) were recruited into our study. We obtained demographics, and clinical data, including tumor stage, performance status, anxiety and depression severity, and expressed product of tumor cells from the electronic medical records. Stage IV and performance status 01 NSCLC patients were chose to analyze. Huaxi Emotional Index (HEI) is used in routine to assess cancer patients’ anxiety and depression severity in our hospital. Results 127 patients (31.1%) tested positive for EGFR mutations, and 27 patients (52.9%) tested positive for PD-L1 expression. No EGFR mutation–positive cases were diagnosed with anxiety or depression, in comparison with 3.6% of patients with wild-type EGFR (p=0.035). The multiple linear regression analyses found that mutations of EGFR and PD-L1 positive expression were associated with lower HEI scores than with wild-type EGFR and PD-L1 negative expression respectively, independent of age, gender, marital status, education, performance status, chronic diseases (F=2.89, p=0.006; and F=2.70, p=0.021, respectively). Conclusions This study indicates that EGFR mutations and PD-L1 positive expression are protective factors of mood disorders in patients with stage IV and performance status 0-1 NSCLC..

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eP426 CANCER AND QUALITY OF LIFE V. Aguti1 1 Hospice Africa Uganda, Research, Kampala, Uganda Introduction Cancer can produce many different symptoms, some subtle and some not at all subtle. According to WHO Publication in 2009., Uganda has registered a number of cancer related cases which affects the quality of life. Objectives The aim of this study is to assess the quality of life among Cancer patients especially in Uganda in the last 10 years. Methods This was a cohort study. A total of 10 cancer patients and their families on the Hospice Africa Uganda Patient program (a palliative care unit in Uganda which was founded in 1993 by Dr. Anne Merriman) were observed. Results The study indicated that there was a significant relationship between Cancer and the quality of life especially right from diagnosis to end of life. It further indicated that most families with Cancer patients live below the poverty line and therefore their quality of life is antagonized with. Also the quality of life of a cancer patient reduces as the disease progresses to the different stages. More so, the study indicated that the Quality of Life is categorized into psycho-social, social, financial, physical, spiritual and emotional. The patients are so disturbed by the disease right from prognosis or diagnosis to end of life as it is believed that cancer is an end of life signal without any cure and proper treatment. Conclusions Cancer is an important health issue influencing and affecting Quality of Life of many people in Uganda today and therefore, there is need to conduct more research on how best cancer can be handled and treated.

eP427 LONG-TERM COMPLICATIONS AND SEXUAL DYSFUNCTION IN LOCALLY ADVANCED CERVICAL CANCER PATIENTS A F T E R D E F I N I T I V E C H E M O R A D I AT I O N A N D BRACHYTHERAPY. K. Akbarov1, I. Isayev1, E. Guliyev1, N. Aliyeva1 1 National Center of Oncology, Radiotherapy, Baku, Azerbaijan Introduction Cervical cancer is one of the most spread gynecological tumors in the world. Women treated for cervical cancer with chemoradiotherapy have reported serious vaginal dryness and pain, and sexual late effects like less interest in sex. Objectives The purpose of this study was to describe late adverse effects of newly diagnosed women with locally advanced cervical cancer (stages IIB IVA) in order to describe rehabilitation needs Methods In 78 consecutive patients, who received concurrent chemoradiotherapy in 2012 – 2014 long-term complications were prospectively assessed by EORTC QLQC30 and EORTC QLQCX24 (sexual activity, sexual enjoyment, and sexual worry) and Female Sexual Function Index (desire, arousal, lubrication, orgasm, satisfaction, and pain) questionnaires after 6 months, 1 year and 2 years of treatment. Results The mean age was 48 ± 9.8 years. Overall, vaginal dryness and pain during sexual intercourse were reported in 68% of cases. The results confirmed that sexual function was impaired in accordance with sexual satisfaction. After therapy, the frequency of sexual activity was decreased. The functional quality of life was significantly correlated with sexual function.

Conclusions Pelvic radiotherapy has a persistent adverse effect on the vaginal mucosa impacting negatively on the sexual functioning in female cancer patients. Health care professionals are encouraged to use water-based (not hormone-based) lubricants during intercourse and try a vaginal moisturizer, which can help the vaginal walls stay moisturized.

eP428 HEAD AND NECK CANCER (HNC) PATIENTS BEYOND 2 YEARS OF DISEASE CONTROL: PRELIMINARY ANALYSIS OF ILEA (INTENSITY MODULATED RADIOTHERAPY LATE EFFECT ASSESSMENT) SCALE. T. Basu1 1 , Gurgaon, India Introduction Intensity modulated radiotherapy (IMRT) has been instrumental in the head and neck cancer (HNC) management owing to its clinical and safe toxicity profile. Patient’s controlled on their disease for more than 2 years has several unmet concerns. Objectives This study aims at assessing these concerns through an indigenous ILEA scale combining quality of life and organs at risk (OAR) specific late toxicities together. Methods Single institution study over 6 months with HNC patient’s disease free for at least 2 years after IMRT. Indigenous ILEA questionnaire with 10 major topics and sub topics highlighting OAR specific late toxicities and quality of life issues as perceived from day to day patient assessment. The most bothersome response was selected. Main topics were skin over the irradiated region, oral cavity, dental status including jaws, swallowing, speech, nutrition, general physical aspects, and questions on personal life, professional life and any other specific aspects. Results Various sites combined there were 18 patients (Nasopharynx-oral cavityoro-laryngo-hypopharynx). ILEA scale major responses from different topics were sub cutaneous edema (skin), dryness of mouth and sticky saliva (oral cavity), dental sensitivity (dental status including jaws), increased time to swallow (swallowing), change in voice quality (speech), dietary modifications (nutrition) and fatigue (personal life). The most troublesome was still the questions related to oral cavity either dryness or sticky saliva resulting diet modifications, swallowing and speech disabilities. Conclusions ILEA scale could indicate concerns related to long term squeal. Future prospective documentation would highlight more on quality of life issues.

eP429 HEALTH-RELATED QUALITY OF LIFE OF POSTMENOPAUSAL WOMEN WITH HORMONE RECEPTOR–POSITIVE, HER2− ADVANCED BREAST CANCER TREATED WITH RIBOCICLIB + LETROZOLE: RESULTS FROM MONALEESA-2 S. Verma1, J. O’Shaughnessy2, H. Burris3, M. Campone4, E. Alba5, D. Chandiwana6, S. Manson6, S. Sutradhar6, M. Monaco6, W. Janni7 1 Tom Baker Cancer Centre, Calgary, Canada 2 Texas Oncology-Baylor Charles A. Sammons Cancer Center and The US Oncology Network, Dallas, TX 3 Sarah Cannon Research Institute, Nashville, TN 4 Institut de Cancérologie de l’Ouest/Centre René Gauducheau, SaintHerblain, France 5 Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain 6 Novartis Pharmaceuticals Corporation, East Hanover, NJ 7 Universitätsklinikum Ulm, Ulm, Germany

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Introduction In the MONALEESA-2 trial, ribociclib + letrozole significantly improved progression-free survival and showed higher overall response rates vs placebo + letrozole in hormone receptor–positive, HER2– advanced breast cancer. Objectives Here, we present key patient-reported outcomes including health-related quality of life (HRQoL). Methods Six hundred sixty-eight patients were randomized (n=334 for each treatment group). Patient-reported outcomes were evaluated during treatment and at progression using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQBR23. Changes from baseline in all subscales were analyzed using a linear mixed-effects model, and time to 10% deterioration was compared between treatment arms using the stratified log-rank test. Results Questionnaire adherence rates were high (≥90%). During treatment, HRQoL (global health status/QoL score) was maintained and similar in both treatment arms. At progression/end of treatment, HRQoL worsened numerically in both arms. Time to definitive 10% deterioration of HRQoL was similar between treatment groups, slightly favoring the ribociclib + letrozole arm (hazard ratio, 0.89; 95% confidence interval, 0.67–1.18). No statistically or clinically relevant differences were observed for key symptoms using EORTC QLQ-C30 including fatigue, nausea, and vomiting. There was clinically relevant improvement (>5 points) in pain from baseline to post baseline (through cycle 15) in the ribociclib + letrozole arm, but only mild improvement (<5 points) in the placebo + letrozole arm. Conclusions Ribociclib + letrozole maintained HRQoL, and a numerical trend favoring ribociclib + letrozole was observed for pain reduction and delay.

eP430 I MPROV ED PAT IE NT S AT I SFA CT ION A ND E ARLY DISCHARGE AFTER VENTING PEG PLACEMENT FOR MALIGNANT BOWEL OBSTRUCTION R. Boparai1 1 North Shore University Hospital/Northwell Health, Hospital Medicine, Manhasset, USA Introduction Malignant bowel obstruction is a common complication of advanced Gastrointestinal and Gynecological cancers. It can cause significant distress to the patient, lead to prolonged hospitalizations and increase morbidity and mortality. Few therapeutic interventions are available to relieve the obstruction. Laparotomy and intestinal resection are seldom advised and if done usually lead to more complications and morbidity. Objectives We attempted to look at the benefit of a Venting PEG to improve patient symptoms and quality of life in malignant bowel obstruction. Methods A 69 year old female with advanced metastatic endometrial cancer presented with progressive severe nausea and vomiting. CT revealed malignant bowel obstruction secondary to peritoneal metastases. Had two prior admissions with similar symptoms. Started on iv fluids, octreotide and decadron. Seen by surgery and deemed not a candidate for surgery. Continued to have vomiting. NG tube subsequently placed with copious output. Symptoms improved. Placement of a Venting PEG discussed to allow patient to go home.

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Results Patient agreed, Venting PEG placed successfully. Patient able to tolerate liquids without vomiting. Able to ambulate. Patient discharged home with instructions to eat liquids and semisolids as tolerated. Home hospice arranged for supportive care. Conclusions Early placement of a Venting Gastrostomy should be considered in patients with intractable malignant bowel obstruction. This allows the patient to be mobile and eat liquids and semisolids without vomiting. It facilitates discharge to home and improves quality of life, with the potential to improve survival.

eP431 H E A LT H R E L AT E D Q U A L I T Y O F L I F E D U R I N G CHEMOTHERAPY TREATMENT: PREDICTIVE FACTORS IN A SAMPLE OF WOMEN WITH GYNECOLOGICAL CANCER V.E. Di Mattei1,2, L. Carnelli1,2, P. Taranto1, M. Mazzetti1, M. Bernardi1, P.M.V. Rancoita3, E. Rabaiotti1, L. Sarno1,2, M. Candiani1,4 1 San Raffaele Hospital, Clinical and Health Psychology UnitDepartment of Clinical Neurosciences, Milano, Italy 2 Vita-Salute San Raffaele University, Faculty of Psychology, Milano, Italy 3 Vita-Salute San Raffaele University, Centre of Statistics in the Biomedical Sciences CUSSB, Milano, Italy 4 Vita-Salute San Raffaele University, Faculty of Medicine, Milano, Italy Introduction Patients with gynecological cancer often undergo aggressive chemotherapy treatment regimens. Cytotoxic drugs lead to a wide variety of side effects that adversely impact women’s quality of life. Objectives This study aimed to identify the variables that could be predictive of variations of quality of life during chemotherapy treatment, in order to properly address these patient issues. Methods Eighty-seven patients treated for gynecological cancer at the San Raffaele Hospital completed the EORTC QLQ-C30 before their first and third chemotherapy infusion. A self-report questionnaire was used to collect socio-demographic characteristics, while treatment-related information was gathered from their medical records. Results The age range of the sample was 27-84 years (mean=59.01; SD=13.33). Global quality of life and physical functioning significantly (p<.05) worsened over time in patients who experienced anticipatory nausea (23%) before their third infusion, while it improved for those who were treated with only carboplatin (10%) and received treatment with medium or high emetogenic potential (87%). Physical functioning also worsened in patients undergoing a weekly regimen (26%). Emotional and role functioning improved more over time in patients who maintained a full-time job during treatment (34%). Conclusions The findings suggest that medical and personal factors contribute to differences in quality of life over time during chemotherapy treatment of gynecological cancer. Both of these should be taken into consideration by the multidisciplinary treating team.

eP432 SCREENIT: IMPLEMENTATION ANALYSIS OF A CONSUMERCENTRED SCREENING TOOL TO GUIDE SUPPORTIVE CARE DURING CHEMORADIATION FOR HEAD AND NECK CANCER B. Cartmill1, L. Wall1, E. Ward2, A. Hutchison2, A. Hill3, E. Isenring4, J. Nixon1, S. Porceddu5

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S220 1 Centre for Functioning and Health Research and Princess Alexandra Hospital, Radiation Oncology Department, Woolloongabba, Australia 2 Centre for Functioning and Health Research and The University of Queensland, Metro South Hospital and Health Service, Brisbane, Australia 3 The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Australia 4 Bond University, Facutly of Health Sciences and Medicine, Gold Coast, Australia 5 Princess Alexandra Hospital and The University of Queensland, Radiation Oncology Department and School of Medicine, Brisbane, Australia

Methods Principal component analysis (PCA), exploratory factor analysis (EFA), and hierarchical cluster analysis (HCA) were used to identify symptom clusters among the 9 ESAS symptoms using ESAS scores from each patient’s first visit. Results PCA identified 3 symptom clusters (cluster 1: depression, anxiety, well-being; cluster 2: pain, tiredness, drowsiness, cluster 3: nausea, dyspnea, loss of appetite). EFA identified 2 clusters (cluster 1: tiredness, drowsiness, loss of appetite, wellbeing, pain, nausea, dyspnea; cluster 2: depression, anxiety). HCA identified 3 clusters identical to those from PCA except for loss of appetite from cluster 1.

Introduction ScreenIT is consumer-centred, validated, web based screening tool which connects patients with head and neck cancer, and their carers, to supportive care professionals (ie. speech-language pathology, dietetics, occupational therapy, physiotherapy, social work and psychology) during chemoradiotherapy for head and neck cancer. Patients and carers complete ScreenIT on a weekly basis and the results guide referrals to the appropriate supportive care professional, at the right time. Objectives The aim of this project was to assess the success of implementing ScreenIT into the clinical setting, in terms of efficiency, accuracy, and cost-savings. Methods Using the Consolidated Framework for Implementation Research (CFIR), ScreenIT was implemented into the Radiation Oncology Department of a large, quaternary hospital in Brisbane, Australia. Demographic data, accuracy and efficiency of ScreenIT to guide referrals, and cost-efficiency analysis was performed. Results Fifty-two patients and 24 carers used ScreenIT to guide their care (aged 22-92). The majority had oropharyngeal primary tumours, were treated with chemoradiation, and scheduled for 247 routine multidisciplinary appointments. ScreenIT accurately identified 23% of appointments as “cancellable”. ScreenIT was 100% efficient - all patients were seen within 4 clinical days as per published safety algorithms. These results realised cost-efficiencies AUD$386,460/ year per discipline. Conclusions Service implementation is complex and requires systematic planning and prospective use of an implementation framework. During implementation, ScreenIT was found to be sensitive, cost-efficient and feasible, and now is the standard care in our centre. ScreenIT will be expanded to other cancer subtypes.

eP433 SYMPTOM CLUSTERS IN A PALLIATIVE RADIOTHERAPY CLINIC FROM THE EDMONTON SYMPTOM ASSESSMENT SYSTEM (ESAS) S. Chan1, B.A. Wan1, L. Zhang1, M. Tsao1, C. Danjoux1, E. Barnes1, R. McDonald1, L. Rowbottom1, P. Zaki1, R. Chow1, M. Hwang1, A. Agarwal1, E. Chow1 1 Odette Cancer Centre - Sunnybrook Health Sciences Centre - University of Toronto, Radiation Oncology, Toronto, Canada Introduction Symptom clusters are a group of related symptoms that occur concurrently and are often seen in cancer patients. Objectives To identify symptom clusters in advanced cancer patients attending a palliative radiotherapy clinic using the Edmonton Symptom Assessment System (ESAS).

Conclusions Two to three symptom clusters were identified using three analytical methods. Depression and anxiety were always in the same clusters. This was seen for nausea and dyspnea, as well as pain, tiredness and drowsiness. Clinicians should be aware of these clusters to aid in treating patients rather than focusing on individual symptoms.

eP434 SEVERITY OF ESAS SYMPTOMS IN PATIENTS ATTENDING AN OUTPATIENT PALLIATIVE RADIATION CLINIC

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S. Chan1, P. Zaki1, B.A. Wan1, L. Zhang1, M. Tsao1, C. Danjoux1, E. Barnes1, R. McDonald1, L. Rowbottom1, R. Chow1, M. Hwang1, A. Agarwal1, E. Chow1 1 Odette Cancer Centre - Sunnybrook Health Sciences Centre - University of Toronto, Radiation Oncology, Toronto, Canada Introduction Cancer patients experience a multitude of symptoms that reduce their quality of life. Objectives To identify the frequency of severe symptoms as reported with the Edmonton Symptom Assessment System (ESAS) by advanced cancer patients who presented to an outpatient radiation clinic. Methods A prospective study was conducted including patient demographics and the Edmonton Symptom Assessment System (ESAS) score at first visit. ESAS assessed pain, tiredness, nausea, depression, anxiety, drowsiness, loss of appetite, general well-being, dyspnea, and the additional symptom of constipation from a score of 0 to 10. Symptom scores from 7-10 were considered severe. Results 182 patients with 263 visits were included (median age 70.5 years, 58% male). The most common cancers were prostate (24.7%), lung (24.7%), and breast (13.7%). The median KPS score was 70.0 and ranged from 30100. 84.4% of patients had bone metastases, 25.8% had lymph metastases, 23.6% had lung metastases, and 21.4% had brain metastases. Symptoms were reported as being severe for constipation (46.7% of patients), tiredness (30.2%), pain (28.2%), general well-being (22.8%), loss of appetite (16.6%), anxiety (15.0%), drowsiness (13.8%), depression (12.1%), dyspnea (7.2%), and nausea (2.8%). Conclusions Patients presenting to a palliative radiotherapy clinic had a multitude of symptoms, with constipation, tiredness and pain being the most common severe symptoms. Healthcare professionals should be aware of these symptoms when prescribing treatment.

eP435 P R E L I M I N A R Y S T U D Y O N T H E M E L AT O N I N CONCENTRATIONS, LIFE RESILIENCE, AND SLEEP QUALITY OF BLADDER CANCER PATIENTS Y.P. Chang1, T.C. Cheng2 1 DA-Yeh University, Department of Nursing, Changhua, Taiwan R.O.C. 2 Chi Mei Medical Center- Liouying, Vice Superintendent Office, Tainan, Taiwan R.O.C. Introduction Bladder cancer has an important role in urinary cancers with an occurring frequency next to the prostate cancers. Promoting the metal adjustment and sleeping quality of patients has been thought to be an important indicator in preventing cancers and deterioration of cancers, and also an important result index of disease therapy and patient care. Confirming the status of post- diagnosis melatonin, recovery of routine chores in life, and sleeping quality are the focuses of this research. Objectives The purpose of this study is to understand the important patient care indicators such as melatonin concentration in urine, life resilience, and sleeping quality before and after surgery and their interrelationship. Methods Thirteen confirmed bladder cancer patients who had undergone surgery and chemotherapy for data analysis. The average age of participants are 66 (from39-83), sleeping duration pre- and post-surgery is averaged 7-8 hrs. Of those, 91% indicated relatively good quality of sleeping in the past month.

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Results Of those 13 patients who had the concentrations of melatonin checked, 10 had higher and 3 had lower melatonin concentrations relative to those of average people of comparable ages. The average life resilience score is 4.79 (SD =1.09), the highest factor of the life resilience based on “family resources” was 5.26 (SD =1.32). There was a good correlation between the concentration of melatonin and the level of life resilience (p< .05). Conclusions Our study collected interesting information on patient sleeping quality and life resilience, which could serve as important guidance for proper treatment and care of cancer patients.

eP436 PRELIMINARY STUDY OF CANCER-RELATED FATIGUE, FEAR OF RECURRENCE AND QUALITY OF LIFE OF CANCER SURVIVORS Y.P. Chang1, Y.H. Lee2 1 DA-Yeh University, Department of Nursing, Changhua, Taiwan R.O.C. 2 The National Health Research Institutes NGRI, Department of Administration, Miaoli County, Taiwan R.O.C. Introduction Cancer is among the leading causes of incidental death worldwide. Cancer-related fatigue and fear of recurrence are two most distressing symptoms which significantly disrupt normal functioning and quality of life of cancer survivors. Objectives The purpose of this preliminary study is to assess the level of cancerrelated fatigue (C-FR), fear of recurrence, and quality of life for of cancer survivors. Methods A cross-sectional research design with self-administrated questionnaires was used. Eighty-five volunteers from an NPO cancer foundation in Taiwan participated in this study. The evaluation included socialdemographic inventory and three questionnaires on cancer-related fatigue, fears of recurrence, and quality of life. Results Most participants (70%) are breast cancer survivors, the remainders are ovarian and lung cancer survivors. Among the survivors, 36.5% indicated they had cancer-related fatigue, while 29.4% expressed fear of recurrence. There is no significant correlation between types or stages of cancers and cancer-related fatigue, fear of recurrence, or quality of life of survivors. Self-awareness symptoms of anxiety, pain, and fatigues are significantly parameters predicting cancer survivors’ quality of life (R2=.398, p=.003) Conclusions The result of this study reveals the cancer survivors perceptions on cancer-related fatigue, fear of recurrence, and quality of life. It suggests that developing an effective intervention for improving cancer-related fatigue, fear of recurrence, and quality of life is critical for survivors, irrespective of the types or stages of their cancers.

eP437 QUALITY OF LIFE AND SATISFACTION WITH CARE IN A CONTEMPORARY COHORT OF PANCREATIC CANCER PATIENTS O. Abdel-Rahman1, W. Cheung1 1 Tom Baker Cancer Center, Oncology, Calgary, Canada Introduction Pancreatic cancer patients face significant morbidity.

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Objectives An understanding of these patients’ quality of life (QOL) and their satisfaction with their care is essential to inform future healthcare delivery models. Methods Pancreas Centre BC was established in British Columbia in 2012 to optimize triage processes, access to multidisciplinary care, and involvement of palliative care. Pancreatic cancer patients referred to and seen at Pancreas Centre BC completed EORTC-QLQ C30 and PAN26 questionnaires pre/post surgery as well as surveys focused on levels of satisfaction with their care. Results We included 167 patients: median age 63 years, 45% men, and 70% ECOG 0/1. The majority had early stage disease (78%), pancreatic head tumors (53%), adenocarcinoma histology (68%), and adjuvant gemcitabine (75%). Baseline mean QOL scores were 63, 90, 83, 58 and 92 (out of 100) in the overall, physical, emotional, cognitive and social domains, respectively. Advanced age (>70 years), weight loss (>10 kg), and poor ECOG were associated with lower overall QOL rating (all p>0.05). Surgery had a positive impact on all functional domains where we observed a mean improvement in QOL scores ranging from 8 to 17 points (all p>0.05). In terms of satisfaction, 94% rated their overall care as good/excellent. Likewise, 80% were very/mostly satisfied with the amount of information they received and 84% rated the healthcare information they received as very/mostly helpful. Conclusions Patients treated at a tertiary pancreatic cancer center reported good QOL and satisfaction, suggesting that centralization of pancreatic cancer care is an effective model to address the needs of this population.

eP438 LINGUISTIC VALIDATION OF THE KOREAN VERSION OF THE U.S. NATIONAL CANCER INSTITUTE’S PATIENTREPORTED OUTCOMES VERSION OF THE COMMON TERMINOLOGY CRITERIA FOR ADVERSE EVENTS (PROCTCAE) J. Cho1, J. Yoon2, D. Oh3, J. Ahn4, S.J. Nam5, S. Mitchell6 1 Sungkyunkwan University, Clinical Research Design and Evaluation, Seoul, Republic of Korea 2 Sungkyunkwan University, Digital Health, Seoul, Republic of Korea 3 Sungkyunkwan University, Radio-oncology, Seoul, Republic of Korea 4 Sungkyunkwan University, Medicine, Seoul, Republic of Korea 5 Sungkyunkwan University, Sugery, Seoul, Republic of Korea 6 National Cancer Institute, Outcomes Research Branch, Rockville, USA Introduction PRO-CTCAE is a new patient-reported outcome measure developed to capture symptomatic adverse events during cancer treatment. Objectives The aim of this study was to translate and linguistically validate a Korean language version of PRO-CTCAE. Methods The PRO-CTCAE item library (124 items) was translated into Korean, and linguistically validated in a sample of 120 cancer patients (diverse tumor types; 48% low educational attainment) in three rounds of interviews conducted at a Korean cancer center. Participants completed 50 PRO-CTCAE items, and were cognitively debriefed. Item-level analysis identified difficulties in comprehending the symptom term (e.g. fatigue), attribute (e.g. severity)), or response frame (e.g. past 7 days, symptom at its worst). Items experienced as difficult to comprehend by ≥20% of respondents were rephrased and retested in subsequent rounds. Results A majority of symptom terms (71/78) were well comprehended. Four symptom terms (urinary frequency, body odor, skin ulceration, and vaginal dryness), and 3 symptom terms (depression, watery eyes and

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injection site reaction) presented difficulties in ≥20% and ≥60% of participants respectively. Phrasing was revised and retested in Round 2 (n=40). Phrasing for depression still presented comprehension difficulties in 30% of participants, and was revised and rested in Round 3. After Round 3, no items presented difficulties in ≥20% of participants. Four terms posed remaining difficulties for <20%, but were not revised due to lack of suitable alternative phrasing. Conclusions PRO-CTCAE has been linguistically validated for use in Korean populations, with high levels of comprehension and acceptability. Quantitative evaluation of the measurement properties of PRO-CTCAE-Korean is warranted.

eP439 QUALITY OF LIFE AND SYMPTOM BURDEN IN PATIENTS WITH BREAST CANCER TREATED WITH MASTECTOMY AND LUMPECTOMY R. Chow1, N. Pulenzas1, L. Zhang1, C. Ecclestone1, A. Leahey1, J. Hamer1, C. DeAngelis1, G. Bedard1, R. McDonald1, A. Bhatia1, J. Ellis1, E. Rakovitch1, S. Vuong1, E. Chow1, S. Verma2 1 Odette Cancer Centre - Sunnybrook Health Sciences Centre - University of Toronto, Institute of Evaluative Clinical Sciences, Toronto, Canada 2 Tom Baker Cancer Centre - University of Calgary, Department of Oncology, Calgary, Canada Introduction Mastectomy (MAS) and lumpectomy (LUMP) are the two common local surgical treatments for early breast cancer. There has been a debate whether MAS or LUMP results in better quality of life (QOL). Objectives The purpose of this study was to examine the symptom burden (SB) and QOL of both MAS and LUMP patients. Methods Patients at the Louise Temerty Breast Cancer Centre in Toronto, Canada, were approached to complete two self-administered questionnaires, the Edmonton Symptom Assessment Score (ESAS) and the Functional Assessment of Cancer Therapy—Breast (FACT-B) cancer edition. Additionally, patient demographics were recorded from medical records. Patients were divided into two cohorts depending on their surgical treatment: MAS and LUMP. The QOL and SB, assessed by FACT-B and ESAS, respectively, of MAS and LUMP patients were compared. The analysis was repeated excluding patients with metastases. Results From January to August 2014, 614 MAS and 801 LUMP patients were accrued. The MAS patients reported a lower QOL in all categories, except social well-being. There was however no statistical difference in ESAS scores for MAS and LUMP patients with non-metastatic breast cancer. Conclusions This study supports existing literature that SB of MAS and LUMP patients without metastases are similar. QOL of MAS patients including those with metastases was lower than that of LUMP patients.

eP440 DO PATIENTS WITH BRAIN METASTASES SELECTED FOR WHOLE BRAIN RADIOTHERAPY HAVE WORSE BASELINE QUALITY OF LIFE AS COMPARED TO THOSE FOR RADIOSURGERY OR NEUROSURGERY? R. Chow1, M. Tsao1, N. Pulenzas1, L. Zhang1, A. Sahgal1, D. Cella2, H. Soliman1, C. Danjoux1, C. DeAngelis1, S. Vuong1, E. Chow1 1 Odette Cancer Centre - Sunnybrook Health Sciences Centre - University of Toronto, Institute of Evaluative Clinical Sciences, Toronto, Canada 2 Northwestern University Feinberg School of Medicine, Department of Medical Social Sciences, Chicago, USA

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Introduction Patients with brain metastases often experience psychological, emotional, social and physical difficulties which can all affect QOL. QOL is most commonly assessed through self-administered questionnaires. Objectives The purpose was to examine the baseline characteristics, symptoms and quality of life (QOL) in patients who receive different treatments for brain metastases. Methods Eligible patients were divided and analysed based on their treatment: whole brain radiotherapy (WBRT) alone versus stereotactic radiosurgery (SRS) or neurosurgery with or without WBRT. The Functional Assessment of Cancer Therapy-Brain (FACT-Br) items were grouped according to different domains for summary scores. The domains used for summary scores were physical, social/family, emotional, functional well-being (FWB) and additional concerns. Results A total of 120 patients were enrolled, with 37 treated with WBRT alone and 83 with SRS or neurosurgery with or without WBRT. Of the 50 baseline FACT-Br items, only five items (I feel ill; I get support from my friends; I worry about dying; I have difficulty expressing my thoughts, I am able to put my thoughts into action) were statistically worse in patients treated with WBRT alone (P<0.05). Patients who received SRS or surgery with or without WBRT had statistically (P<0.05) higher scores for the FWB domain, additional concerns domain, and FACT-G total scores, indicating better QOL. Conclusions Patients selected for WBRT alone reported statistically different baseline QOL as compared to patients who were treated with SRS or neurosurgery (with or without WBRT).

eP441 QUALITY OF LIFE WITH BRAIN SYMPTOM AND IMPACT QUESTIONNAIRE IN PATIENTS WITH BRAIN METASTASES R. Chow1, S. Ray2, M. Tsao1, N. Pulenzas1, L. Zhang1, A. Sahgal1, D. Cella3, H. Soliman1, C. Danjoux1, C. DeAngelis1, S. Vuong1, R. McDonald1, E. Chow1 1 Odette Cancer Centre - Sunnybrook Health Sciences Centre - University of Toronto, Institute of Evaluative Clinical Sciences, Toronto, Canada 2 AbbVie, Oncology AbbVie, Abbott Park, USA 3 Northwestern University Feinberg School of Medicine, Department of Medical Social Sciences, Chicago, USA Introduction The Brain Symptom and Impact Questionnaire (BASIQ) was developed as a novel brief QOL assessment tool for brain metastases patients. This instrument consists of 18 items that measures symptom severity and impact on daily functional activities. The questionnaire is scored from 0–10, with higher scores denoting worse symptom severity and lower QOL and covers 12 domains relevant to patients with brain metastases. The relative brevity of this questionnaire reduces patient burden while also maintaining the breadth of coverage. Objectives To examine the baseline characteristics of patients who underwent different treatments for brain metastases. Methods Allocated into group A [whole brain radiation therapy (WBRT) alone], or group B [stereotactic radiosurgery (SRS) or neurosurgery with or without WBRT], brain metastases patients with assigned treatment completed the Brain Symptom and Impact Questionnaire (BASIQ). Items of BASIQ were arranged as a symptom score or function score. Results Lung, breast, melanoma and renal cancer were the most prevalent primary cancer site among the study population, with 91 (53%), 25 (15%), 17

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(10%) and 15 (9%) patients, respectively. Baseline BASIQ results were obtained before patients were treated with WBRT, neurosurgery, or SRS. Seventy-six (44%) and 96 patients (56%) were grouped to A and B, respectively. Group A reported lower quality of life (QOL) in all function scores (P<0.0001) and all symptom scores (P values from <0.0001 to 0.005) with the exception of energy (P=0.1). Conclusions Baseline QOL in patients assigned WBRT alone was statistically worse as compared to patients assigned SRS, neurosurgery with or without WBRT.

eP442 EFFICACY OF DIFFERENT VARIETIES OF MEDICAL CANNABIS IN RELIEVING SYMPTOMS IN PTSD PATIENTS L. Drost1, B.A. Wan1, S. O'Hearn2, S. Chan1, V. Ganesh1, A. Wolt2, L. Zhang1, M. Slaven3, E. Shaw3, C. DeAngelis1, H. Lam1, P. Zaki1, E. Chow1, A. Blake2 1 Sunnybrook Health Sciences Centre, Odette Cancer Centre, Toronto, Canada 2 MedReleaf, Research, Markham, Canada 3 Hamilton Health Sciences Centre, Juravinski Cancer Centre, Hamilton, Canada Introduction Post-traumatic stress disorder (PTSD) is a crippling condition that affects some people who have experienced severe traumatic event(s). The physiological effects of cannabis are thought to be dependent on the strain’s particular cannabinoid and terpene profile. Therefore, different strains may be strategically selected to alleviate certain symptoms of PTSD. Objectives To determine which varieties of cannabis PTSD patients perceive to be most effective for relieving their symptoms. Methods PTSD patients using medical cannabis from a Canadian licensed provider voluntarily completed an online survey at baseline, 4 and 10 months, which collected information pertaining to their medical conditions, symptoms, and use of medical cannabis. Descriptive and inferential statistical analyses on the data were performed. Results PTSD patients (n=647) consumed approximately 8.0-10.0g or more cannabis daily than non-PTSD patients (n=2429) (21.03% vs. 1.77%, respectively). The varieties SedamenMR, AlaskaMR, and LuminariumMR were reported to be the most effective in managing the symptoms of PTSD at 4 months. At 10 months, SedamenMR and Luminarium MR were still preferred, with many reporting MidnightMR to be effective as well. SedamenMR and MidnightMR were reported to be most beneficial for managing the four symptoms most commonly reported by PTSD patients (depression, anxiety, sleep problems, and pain). AlaskaMR and LuminariumMR were reported effective for all four symptoms except pain and sleep problems, respectively.

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eP444 FOSTERING RESILIENCY IN INFORMAL CAREGIVERS OF PATIENTS WITH ADVANCED CANCER: THE CARING FOR CAREGIVERS PROGRAM A. Driga1, E. Boileau2, O. Hughes2, M. Keenleyside2, C. Kenmuir2, K. Richards2, A. Fairchild3 1 Cross Cancer Institute, Occupational Therapy, Edmonton, Canada 2 University of Alberta, Occupational Therapy, Edmonton, Canada 3 Department of Radiation Oncology, Cross Cancer Institute 11560 University Avenue, Edmonton, AB, Canada, T6G 1Z2

Conclusions PTSD patients perceived differences in the effectiveness of cannabis varieties to improve their symptoms. Further research in a controlled clinical setting to determine which varieties manage PTSD symptoms more effectively will help clinicians make better recommendations to patients.

eP443 SYMPTOM CLUSTERS USING THE BRIEF PAIN INVENTORY IN PATIENTS WITH BREAST CANCER V. Ganesh1, L. Drost1, N. Chiu1, L. Zhang2, L. Chiu1, R. Chow1, N. Lao1, B.A. Wan1, J. Lee1, E. Chow1, C. DeAngelis3 1 Sunnybrook Health Sciences Centre, Radiation Oncology, Toronto, Canada 2 Sunnybrook Health Sciences Centre, Statistics, Toronto, Canada 3 Sunnybrook Health Sciences Centre, Pharmacy, Toronto, Canada Introduction Symptom clusters (SC) are groups of a minimum of two symptoms that co-occur in patients. Due to their implications on management of patient quality of life, they are of great clinical interest. SCs in breast cancer (BC) patients undergoing chemotherapy have been understudied. Objectives The purpose of this study was to assess SC in functional interference using the Brief Pain Index (BPI) in patients with BC. Methods A principal component analysis with varimax rotation was conducted on data from 228 patients with non-metastatic BC undergoing taxane chemotherapy. Average BPI scores from acute (during treatment) and delayed (after treatment) phases were used. Number of significant clusters was selected for with an Eigenvalue higher than 0.6, and all clusters accounted for at least 10% of the variance. Robust relationships and correlations among symptoms were displayed using a biplot graphic. Results The average age was 52 years, with most patients receiving docetaxel. Physical (general activity, normal work, walking ability) and psychosocial (mood, relationships, sleep, enjoyment of life) interference clusters were present at baseline. The SCs at baseline are visible in the biplot (Figure 1). No SCs in the acute phase were identified. Clusters were observed at 1-month (cluster 1: general activity, normal work, enjoyment of life; cluster 2: relationships, sleep) and 3-months (cluster 1: general activity, normal work, relationships; cluster 2: sleep, enjoyment of life) in the delayed phase. All SCs demonstrated good internal consistencies. Conclusions Results from our study suggest dynamic SCs in this patient population, and encourage continued symptom management following completion of treatment.

Introduction An evolution towards increased home-based care for patients with advanced cancer places increased demands on informal caregivers (IC). IC may be inadequately prepared to manage complex caregiving tasks, and balancing this role with other responsibilities can lead to burnout. Objectives To design a program which improves resilience of IC through knowledge acquisition around caregiving skills and available resources. Methods Using the Model of Human Occupation, potential challenges related to the interaction between IC, their tasks, and the caregiving environment were tabulated to prioritize informational needs, supplemented by a literature search, IC survey and clinician consultations. Ways to determine IC needs and provide educational support were evaluated, aiming for integration within the patient’s treatment schedule. As ¾ of palliative radiotherapy (RT) clinic patients are accompanied by an IC, the 20 minutes required for RT presents an opportunity to intervene. Results The most essential IC needs were identified as: medication management; mobility assistance; self-care; and accessing community resources eg respite. IC will be offered the opportunity to view evidence-based instructive modules via convenient tablet videos while patients receive RT. Modules will be supplemented by pamphlets, referrals to supportive care services and phone follow-up. Modules will be designed by the team if a suitable pre-existing resource cannot be identified. Conclusions By providing strategies to help IC adapt to the complex demands of caring for a palliative patient, the Caring for Caregivers Program aims to foster resiliency without imposing additional time or financial burdens. Acknowledgments. Jaima Sheldon & Jackqueline Geller Award (Alberta Cancer Foundation).

eP445 LIFESTYLE AND BREAST CANCER A. Fatima1, S.S.A. Zaidi2 1 , Lahore, Pakistan 2 WeCare, Research, Lahore, Pakistan Introduction Pakistan is an under developing country. Breast cancer is the leading cause of death in this country. The incidence of breast cancer in Pakistani women is higher than in women from neighboring countries. Objectives To evaluate the knowledge, screening and pre disposition of breast cancer risk factors among undergraduate students. Methods A cross sectional study was carried out at Punjab University from March 2015 to July 2105. About 500 female students between 20-24 years of age were requested to fill a questionnaire. The questionnaire was divided into parts. The first compromise the qualification of the respondent. The second part contained the questions which depicts the knowledge of respondent about risk factors, symptomology, screening

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tools and treatment modalities. The third part of the questionnaire was directed towards female respondent’s own practices regarding screening, specifically BSE. Results More than 250 students had good knowledge about self-breast examination, risk factors associated with breast cancer. More than 100 students agreed that breast cancer can be easily cured if it is detected in its early stage and about 150 students thought that a surgeon rather than an oncologist should be consulted first if lump is palpable. Almost 175 students had a knowledge of mammography screening. Conclusions This study reveals that students are not fully aware about the risk factors, signs, symptoms associated with breast cancer. There were very few students who had the knowledge of mammography screening and self-breast examination method. Education and awareness programs are required to educate people about the morbidity and mortality of breast cancer.

eP446 IDENTIFYING PATIENT REPORTED OUTCOMES OF A TELEPHONE PEER SUPPORT SERVICE M. Fitch1 University of Toronto, Bloomberg Faculty of Nursing, Toronto, Canada

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Introduction Interest in measuring patient reported outcomes has been growing within cancer care facilities. In particular, community-based support agencies now want to identify appropriate patient reported outcomes to use in evaluating their programs. Objectives Willow Breast Cancer Support Canada established a project to identify the most relevant patient reported outcomes for their telephone peer support service and identify indicators that would be feasible to measure on a routine basis. Methods In-depth interviews were held with staff members (n-6), volunteer peer support counsellors (n=4), and individuals who called the service (n=20). Verbatim transcripts were subjected to a descriptive qualitative analysis where the participant experiences provided a foundation to identify relevant indicators. Results Structure, process, and outcome variables were identified as relevant for future measurement. Patients can report on both process and outcome indicators as the approach used during the call by the counselor was seen as critically important in achieving the intended service outcomes. Process indicators cited by patients included feelings of comfort, being listened to, and not judged. Patient reported outcome indicators identified included: reduction in anxiety, heightened insight regarding their situation, increase in information, and feeling connected and supported. Conclusions A range of indicators were identified as relevant for measurement of a telephone peer support service. Some could be captured at the point of service while others would require follow-up inquiry. This work could serve as a model for similar organizations to implement.

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Sunnybrook Health Sciences Centre, Radiation Oncology, Toronto, Canada 2 Feinberg School of Medicine, Medical Social Sciences, Chicago, USA 3 University of Toronto, Leslie Dan Faculty of Pharmacy, Toronto, Canada 4 European Organisation for Research and Treatment of Cancer, Quality of Life, Brussels, Belgium Introduction Given advances in diagnosis and management, and the symptoms commonly accompanying colorectal cancer, quality of life (QoL) has become an increasingly important patient outcome. A number of tools exist for the assessment of patient-reported QoL. Objectives To compare the development, characteristics, validity and reliability of three QoL assessment tools in colorectal cancer patients: the Functional Assessment of Cancer Therapy – Colorectal (FACT-C), and European Organisation for Research and Treatment of Cancer (EORTC) QoL Questionnaire Colorectal Cancer Modules QLQCR38 and QLQ-CR29. Methods A literature search was conducted using Ovid MEDLINE, Embase and the Cochrane Central Register of Controlled Trials to identify studies addressing the FACT-C, EORTC QLQ-CR38, and QLQ-CR29 regarding development, characteristics, validity and reliability. Screening and data extraction was conducted by paired reviewers. Results The FACT-C consists of 36 items (5-point Likert scale), in four domains of wellbeing (physical, emotional, social, and functional) and the Colorectal Cancer Subscale (CCS). Physical and social well-being scales showed reasonable internal consistency across all studied populations. FACT-C also performed well for emotional QoL, and allows prorating of subscales and analysis of specific indices. The EORTC QLQ-CR38 (38 items) and QLQ-CR29 (29 items) are implemented in conjunction with the core QLQ-C30 (30 items) (all in 4-point Likert scales), with an emphasis on disease symptoms and treatment consequences. Seven scales in the QLQ-CR38 and three in the QLQ-CR29 demonstrated good internal consistency (Table 1).

Conclusions The FACT-C, QLQ-CR38 and QLQ-CR29 have been extensively validated; however, findings suggest differing suitability in assessing QOL across specific clinical situations.

eP447 COMPARISON OF THE FACT-C, EORTC QLQ-CR38, AND QLQ-CR29 QUALITY OF LIFE QUESTIONNAIRES FOR PATIENTS WITH COLORECTAL CANCER: A LITERATURE REVIEW

eP448 PRO EVALUATION USING THE LCSS 3-ITEM GLOBAL INDEX (3-IGI) TO REDUCE HOSPITALIZATION IN PATIENTS RECEIVING CHEMOTHERAPY: RESULTS OF A 164 PATIENT PROSPECTIVE TRIAL IN NSCLC

V. Ganesh1, A. Agarwal1, M. Popovic1, D. Cella2, R. McDonald1, S. Vuong 1 , H. Lam 1 , L. Rowbottom 1 , S. Chan 1 , T. Barakat 1 , C. DeAngelis3, M. Borean1, A. Wan1, E. Chow1, A. Bottomley4

N. Gaspe Mudiyanselage1, R. Gralla2, P. Hollen3, R. Hall3, R. Genzler3, H. Cordero1, H. Cheng2, J. Crawford4, J. Gildersleeve3, L. Rosen5, M. Lesser5

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Jacobi Medical Center, Internal Medicine, Bronx, USA Albert Einstein College of Medicine, Oncology, Bronx, USA 3 University of Virginia, Oncology, Charlottesville, USA 4 Duke University, Oncology, Durham, USA 5 Feinstein Institute for Medical Research, Biostatistics Unit, Manhasset, USA 2

Introduction Hospitalization is a leading element of cost in cancer care and contributes to multiple negative outcomes. Predicting risk of hospitalization may help in employing preventive interventions. No PRO, laboratory, imaging or other factor is routinely used for hospitalization prevention. Prior research demonstrated that the 3-IGI (quality of life, activities, distress) of the wellvalidated LCSS at baseline, predicts survival more accurately than performance status and requires only two minutes for administration. Objectives To determine if the 3-IGI accurately predicts cancer-related or treatment toxicity-related hospitalization risk. Methods We prospectively evaluated PROs in 164 patients starting chemotherapy for advanced NSCLC using the LCSS 3-IGI, with electronic assistance (eLCSS-QL) at baseline. Patients were followed for hospitalization over three months. Results Characteristics: 43% women, 92% Stage IV; 73% first-line therapy. Means: age–63, KPS-81. 77 hospitalizations occurred among 53 patients (33%); 73% were cancer-related. Mean 3-IGI was 188 (0=worst/300=best); the 33rd percentile was <162 and 67th percentile > 239. Baseline 3-IGI significantly predicted risk of cancer-related hospitalization (but not for treatment-related hospitalization) whether analyzed as a continuous variable (p=0.024) or by tertile (p<0.0001). High 3-IGI baseline scores had decreased hospitalization risk compared with medium (HR 0.37) and low (HR 0.22) 3-IGI groups; hospitalization rates at 90 days were 12%, 27%, and 41% by 3-IGI risk group. Conclusions The 3-IGI of the LCSS significantly identifies risk of hospitalization in patients receiving chemotherapy for NSCLC. Interventions (including enhanced monitoring) focused on identifiable high risk groups is warranted to reduce hospitalization. This could improve cancer care and reduce unnecessary costs. Support: NIH/NCI-R01-CA157409.

eP449 TRANSFUSION PRACTICE PATTERNS IN PATIENTS RECEIVING MYELOSUPPRESSIVE CHEMOTHERAPY FOR NONMYELOID CANCER: RESULTS FROM A PROSPECTIVE OBSERVATIONALSTUDY J. Granfortuna1, K. Shoffner2, S.E. DePasquale3, X. Sui4, S. Badre5, C. Bohac6, C. De Oliveira Brandao6 1 Cone Health, Internal Medicine Teaching Program, Greensboro, USA 2 Cone Health, Alamance Regional Cancer Center Research, Burlington, USA 3 University of Tennessee College of Medicine, Division of Gynecologic Oncology, Chattanooga, USA 4 Providence Regional Cancer System, Oncology, Lacey, USA 5 Amgen Inc, Global Biostatistical Sciences, Thousand Oaks, USA 6 Amgen Inc, Clinical Development, Thousand Oaks, USA Introduction The decision to prescribe a packed red blood cell (PRBC) transfusion in patients with chemotherapy-induced anemia (CIA) includes assessment of clinical features such as the patient’s cancer type and treatment regimen, severity of anemia symptoms, and presence of comorbidities.

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Objectives To examine contemporary transfusion practices in patients with nonmyeloid cancer and CIA. Methods Key inclusion criteria were: ≥18 years of age with nonmyeloid cancer, receiving first/second-line myelosuppressive chemotherapy, baseline hemoglobin (Hb) ≤10.0g/dL, and planned to receive ≥1 PRBC transfusions. Key exclusion criteria were receipt of an erythropoiesis-stimulating agent within 8 weeks prior to screening and/or chronic renal insufficiency. Data were collected from patients’ medical records, laboratory values, and physician/provider questionnaires. The proportion of patients for each primary clinical consideration leading to a PRBC transfusion and 95% exact binomial confidence intervals were determined. Results The study enrolled 154 patients at 18 sites; 147 (95.5%) received a PRBC transfusion (Table 1). Fatigue was the most common symptom affecting the decision to prescribe a PRBC transfusion (101 [69.2%] patients) (Table 2). The most frequently reported primary clinical consideration for prescribing a PRBC transfusion was anemia symptoms (106 [72.1%] patients), followed by Hb value (37 [25.2%] patients) and medical history (4 [2.7%] patients).

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Conclusions In this study, the primary clinical consideration for prescribing a PRBC transfusion was anemia symptoms in 72.1% of patients, with only 25.2% of patients prescribed a transfusion based on Hb value. Results indicate that multiple clinical factors, not just Hb value, were used in the decision to prescribe PRBC transfusions.

St. Jude Children's Research Hospital, Oncology, Memphis, USA St. Jude Children's Research Hospital, Epiemiology and Cancer Control, Memphis, USA 4 Children’s Hospital of Philadelphia, Pediatrics, Philadelphia, USA 5 St. Jude Children's Research Hospital, Pediatric Medicine, Memphis, USA 6 St. Jude Children's Research Hospital, Biostatistics, Memphis, USA

eP450 END OF LIFE CARE FOR HAEMATOLOGIC MALIGNANCIES: A RETROSPECTIVE COHORT STUDY FROM THE STATE OF QATAR

Introduction Although clinicians and parents judge HRQOL of childhood cancer survivors differently than survivors themselves, their individual perspectives of HRQOL at the item level has been understudied. Objectives We compared the importance ratings of HRQOL items among these three groups. The ratings were mapped to item difficulty parameters of the underlying HRQOL traits. Methods We recruited 101 childhood cancer survivors, 101 parents of survivors, and 36 clinicians from St. Jude Children’s Research Hospital survivorship clinic to identify 8 items per HRQOL domain they deemed important for survivorship care. Five PROMIS Pediatric item banks were evaluated: pain (20 items), fatigue (23 items), stress (19 items), meaning and purpose (43 items), and positive affect (37 items). Agreement among survivors, parents, and clinicians was analyzed using X2 tests. Discrepancies were mapped to item difficulty parameters of the underlying HRQOL traits. Results Among survivors, the mean age was 13.9 years [range=8-17.9], 50% were male, 46% had a solid tumor, 30% had leukemia, 16% had brain tumors, and 9% had lymphoma. Across five HRQOL domains, items with significant discrepancies in ratings (p <0.05) ranged from 16% (stress) to 40% (pain) between clinicians and survivors and from 5% (pain) to 22% (positive affect) between parents and survivors. Discrepancies, either underreporting or overreporting, were related to the levels of HRQOL traits. For example, items denoting a lower level of positive affect trait were underreported by clinicians. Conclusions Clinicians disagree with survivors more than parents on important HRQOL items. When selecting items for HRQOL measures, these different views should be carefully considered.

A. Hassan1,2,3, S. Elazzazy4, P. Haddad2 1 National Center for Cancer Care & Research- Hamad Medical Corporation, Medical Oncology, Doha, Qatar 2 Weill Cornell Medical College - Qatar, Clinical & Faculty Affairs, Doha, Qatar 3 Medical Research Institute- Alexandria University, Cancer Management & Research, Alexandria, Egypt 4 National Center for Cancer Care & Research- Hamad Medical Corporation, Pharmacy, Doha, Qatar Introduction It is well known that patients with hematologic malignancies are exposed to a higher percentage of aggressive care near EOL compared to those with solid tumors. Objectives The aim of the present study is to report on the quality of EOL care for patients with hematologic malignancies treated at the National Center for Cancer Care & Research (NCCCR) in the state of Qatar and to compare it to those with solid tumors over the same period of time. Methods This retrospective cohort study included 97 patients diagnosed with hematologic malignancies at NCCCR who died as a result of their disease over the period from 1-1-2009 till 31-12-2013. Their EOL care was compared to 687 patients diagnosed with solid tumors who died during the same period. Indicators for aggressiveness of care were compared in the 2 groups. A p value <0.05 was considered statistically significant Results Hematologic malignancies constituted 12% of all malignancies. Patients with hematologic malignancies had significantly more ER visits compared to those with solid tumors (p <0.024); more ICU admissions (p <0.001) and were less likely referred to palliative care (p <0.001). Conclusions Patients with hematologic malignancies have significantly more ER visits and ICU admissions compared to patients with solid tumors. They are also less likely to be referred to palliative care. Earlier engagement with palliative is warranted for those patients in order to improve the quality of their EOL care.

eP451 DISAGREEMENT WITH IMPORTANCE RATINGS ON HEALTH-RELATED QUALITY OF LIFE (HRQOL) ITEMS AMONG CHILDHOOD CANCER SURVIVORS, PARENTS, AND CLINICIANS: THE PEPR CHILDHOOD CANCER SURVIVORSHIP STUDY C. Jones1, J. Baker2, R. Keesey3, R. Eliason3, J. Lanctot3, J. Clegg4, B. Mandrell5, K. Ness3, K. Krull3, K. Srivastava6, C. Forrest4, M. Hudson2, L. Robison3, I.C. Huang3 1 St. Jude Children's Research Hospital, Epidemiology and Cancer Control, Memphis, USA

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eP452 FUNCTIONAL STATUS AND THE EFFECT ON HEALTHRELATED QUALITY OF LIFE IN LUNG CANCER PATIENTS ABOVE THE AGE OF 50: A DESCRIPTIVE CORRELATIONAL STUDY Z. Huang1, K.F.K. Cheng2, S.Y. Loh3, C.K. Toh4 1 National Cancer Centre Singapore, Ambulatory Treatment Unit, Singapore, Singapore 2 National University of Singapore, ALICE LEE CENTRE FOR NURSING STUDIES, Singapore, Singapore 3 National Cancer Centre Singapore, Nurse Clinician Department, Singapore, Singapore 4 National Cancer Centre Singapore, Medical Oncology, Singapore, Singapore Introduction The majority of lung cancer patients are diagnosed at advanced stage with poor prognosis. Lung cancer patients report higher level of unmet needs, and poorer level of health related quality of life (HR-QoL) as compared with patients with other types of cancer. Objectives The study aims to describe the relationship between functional status and HR-QoL, and the relationship between unmet supportive care needs and HR-QoL of lung cancer patients above the age of 50.

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Methods This is a descriptive, cross-sectional, correlational study.103 patients were recruited. EORTC-C30 and EORTC-Lung Cancer specific module (QLQ-LC13), Lawton IADL scale and Supportive Care Needs Survey Short-Form were administered during data collection. Spearman Correlation Coefficient were used for analysis. Results Patients who were Instrumental Activities of Daily Living (IADL) dependent had statistically significant lower levels of HR-QoL in all of the functional scales and global health status (GHS) than those who were IADL independent (p < 0.01). Physical and daily living (38.0±20.9) and psychological needs (34.6±20.7) were the most common domains of unmet needs. There were statistically significant negative relationships between psychological needs and all of the functional scales and GHS (r =-0.351to-0.661, p < 0.001), and physical and daily living needs and all of the functional scales and GHS (r = -0.376to-0.645, p < 0.001). Conclusions This study highlights the relationships between demographic and clinical variables, functional status, unmet needs and HR-QOL of lung cancer patients. Comprehensive understanding of these relationships is vital in providing holistic nursing care, and directing tailored educational and support interventions to improve patient’s HR-QOL.

eP453 I MPA C T O F M AJ O R PA LL I AT I V E S U R GE R I E S O N QUALITY OF LIFE IN PATIENTS WITH ADVANCED MALIGNANCY: A PROSPECTIVE STUDY FROM DEVELOPING COUNTRY V.K. JR1, S. Deo1, S. Bhatnagar2 1 All India Institute of Medical SciencesAIIMS, Surgical oncology and palliative care, New Delhi, India 2 All India Institute of Medical SciencesAIIMS, palliative care and OncoAnaesthesia, New Delhi, India Introduction We prospectively evaluated the effectiveness of palliative surgery in treating symptoms of advanced malignancies. Objectives To determine the impact of palliative surgeries on symptoms relief and QOL in patients with advanced malignancies by using validated tools of outcome measurements. Methods Patients requiring major palliative surgery intended for palliation of symptoms caused by an advanced malignancy were prospectively enrolled from June 2015 to May 2016. Impact of palliative surgery was assessed by validated tools; QOL by FACT-G tool, symptoms response assessment by Symptom distress score. Follow-up assessment was performed at 1 and 3 months post-surgery Results 95 patients were enrolled in this study. Spectrum of common symptoms and palliative procedures performed are tabulated (Table 1). 16.8% of patient’s required readmission. At 3 months follow up, 17 patients were died, 15 patients lost to follow up and 63 patients were alive. Symptoms distress score significantly decreased after palliative surgery both at 1 month and 3 months of post-surgery. Even though new symptoms were appeared due to disease progression, symptoms for which palliative surgery was done were controlled up to 3 months of post-operative period (Fig 2).Overall QOL significantly (p<0.01) improved after 4 weeks of palliative surgery. Even though there was no significant improvement from 1 month to 3 months, there was no decline in QOL. Greatest improvement was seen in physical well being score (Fig 1).

Conclusions Most patients with advanced malignancies undergoing major operations attained excellent symptom relief and improvement of QOL. Although follow-up QOL evaluation is challenging, patient reported outcome measurement is feasible in developing country.

eP454 DOSE-DENSE PACLITAXEL AND CARBOPLATIN FOR O VA R I A N C A R C I N O M A I N C O M M U N I T Y B A S E D UNIVERSITY HOSPITAL IN KOREA M.K. Kim1, M.J. Yun2, M.J. Kwon2 1 Samsung Changwon Hospital, Obstetrics and Gynecology, ChangwonSi, Republic of Korea 2 Samsung Medical Center, Obstetrics and Gynecology, Seoul, Republic of Korea Introduction After JGOG 3016 trial, several studies have been done to evaluate effectiveness of dose dense paclitaxel and carboplatin among advanced ovarian carcinoma. There are not much study about this among korean population Objectives We undertook this study to investigate the chemotherapy induced toxicity and quality of life during chemotherapy comparing dose dense paclitaxel and carboplatin (dd-TC) with conventional paclitaxel and carboplatin (c-TC) Methods A retrospective review of ovarian cancer patients who were treated in Dept.of Ob. & Gyn. Samsung Changwon Hospital was done. Patients with ovarian cancer who received six cycle of either c-TC and dd-TC (carboplatin AUC 6 mg/mL per min on day 1 and paclitaxel 80 mg/m² on days 1, 8, and 15) was found. We survey of patient’s QoL by using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30) version 3.0 and its ovarianspecific module QLQ-OV28. We check Clinical information was extracted from the medical record. Results Total patient was 17. Of these, 8 patients were c-TC group and 9 were dd-TC group. There were two refusal cases during chemotherapy not related with chemotherapy associated toxicity. The dd-TC

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regimen was associated with a higher frequency of gastrointestinal toxicity than the c-TC regimen. But other chemo induced toxicity or patient’s QoL are not statistically significantly different between two treatment arms. Conclusions It shows that chemotherapy induced toxicity and quality of life in the ddTC regimen achieved comparable tolerability to the c-TC regimen. Long term and large scale study is needed in the future.

eP455 SELF-CARE AS A MEDIATOR BETWEEN SYMPTOMMANAGEMENT SELF-EFFICACY AND QUALITY OF LIFE IN WOMEN WITH BREAST CANCER S.Y. Liang1, W.W. Wu2 1 National Taipei University of Nursing and Health Sciences NTUNHS, Taipei, Taiwan R.O.C. 2 National Taipei University of Nursing and Health Sciences, College of Nursing, Taipei, Taiwan R.O.C. Introduction The important role of self-efficacy in facilitating health behavior and, in turn, promoting health outcomes has been widely presumed in the theoretical literature. However, little research has focused on the mechanism by which self-care mediates the relationship between symptom-management self-efficacy and quality of life (QOL) in breast cancer patients. Objectives The purpose of this study was to examine the relationship between symptom-management self-efficacy and quality of life in Taiwanese oncology outpatients with breast cancer and then proposes self-care as a mediator between these two factors. Methods This cross-sectional study enrolled 201 oncology outpatients at one teaching hospital in metropolitan Taipei City, Taiwan. The research instruments included the Symptom-Management Self-Efficacy Scale - Cancer (SMSES-Breast Ca.), the Self-Care Scale, and the European Organization for Research & Treatment of Cancer Quality of Life Group Questionnaire (EORTC-QLQ-C30). Results Symptom-management self-efficacy (SMSE) was directly associated with the QOL of the participants (β = 5.94, p < .001). Moreover, SMSE was indirectly associated with QOL through self-care. Self-care was found to mediate the relationship between symptom-management self-efficacy and global QOL (indirect effect=0.54, 95% CI 0.12 to 1.18). The level of 95% CI was significant. Conclusions The present study supports that self-efficacy beliefs and self-care both significantly and positively influence the quality of life of patients.

eP456 EFFECT OF EXERCISE ON CHEMOTHERAPY-INDUCED DIARRHEA IN 198 OLDER CANCER PATIENTS: A URCC NCORP NATIONWIDE RANDOMIZED CONTROLLED TRIAL K.P. Loh1, S. Mohile1, C. Cole2, R. Dunne1, C. Fung1, P.J. Lin2, J. Cho3, A. Conlin4, J. Giguere5, P. Reddy6, M. Karen2 1 University of Rochester, Hematology/Oncology, Rochester, USA 2 University of Rochester, Surgery- Cancer Control, Rochester, USA 3 Hawaii Minority Underserved NCORP, Hematology/Oncology, Hawaii, USA 4 Pacific Cancer Research Consortium NCORP, Hematology/Oncology, Portland, USA 5 NCORP of the Carolinas Greenville Health System NCORP, Hematology/Oncology, South Carolina, USA 6 Wichita NCORP, Hematology/Oncology, Kansas, USA

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Introduction Chemotherapy-induced diarrhea (CID) is a common toxicity and may partially be mediated by inflammatory cytokines. Older age is a risk factor for development of CID. Little is known if exercise improves CID in older cancer patients. Objectives We conducted a secondary analysis of a nationwide phase III RCT to assess the effect of exercise on CID in this population. Methods We included 198 older cancer patients (aged ≥60 years) who were randomized to receive chemotherapy alone (C) or with EXCAP (Exercise for Cancer Patients). EXCAP is a home–based progressive aerobic and resistance-training program. We used ANCOVA to evaluate the effect of EXCAP on CID, which was self-reported using a symptom inventory at baseline and 6 weeks post-intervention. Baseline values, gender and chemotherapy duration were adjusted. We assessed associations of changes in CID and in inflammatory cytokines. Results Median age was 66.7 ± 2.3 years, 92% were female, 77% had breast cancer; 72% and 28% received every 3-week and 2-week regimens, respectively. Both groups developed CID but compared to the C group, the EXCAP group reported less severe CID (0.8 ± 1.6 vs. 2.0 ± 2.8; P=0.008). In the C group, worsening CID was associated with elevated pro-inflammatory cytokine, IL-6 (r=0.39, p=0.03) but not in the EXCAP group. Conclusions Our analysis showed that exercise improves self-reported CID severity in older cancer patients. The up-regulation of inflammatory cytokine in CID may be mitigated by exercise. To our knowledge, this is the first study demonstrating the positive effect of exercise on CID older cancer patients.

eP457 IMPROVEMENTS IN QUALITY OF LIFE AS EARLY AS DAY 10 FOLLOWING RADIATION TREATMENT: A SECONDARY ANALYSIS OF THE NCIC CTG SYMPTOM CONTROL TRIAL SC.23 R. McDonald1, K. Ding2, M. Brundage3, R.M. Meyer4, A. Nabid5, P. Chabot6, G. Coloumbe7, S. Ahmed8, J. Kuk9, A.R. Dar10, A. Mahmud11, A. Fairchild12, C.F. Wilson2, J.S.Y. Wu13, K. Dennis14, C. DeAngelis15, R.K.S. Wong16, L. Zhu2, S. Chan1, E. Chow1 1 Odette Cancer Centre- Sunnybrook Health Sciences Centre, Department of Radiation Oncology, Toronto, Canada 2 Cancer Research Institute- Queen's University, Canadian Clinical Trials Group, Kingston, Canada 3 Queen's University, Department of Radiation Oncology, Kingston, Canada 4 Juravinski Hospital and Cancer Centre- McMaster University, Department of Oncology, Hamilton, Canada 5 Centre Hospitalier Universitaire de Sherbrooke, Department of Radiation Oncology, Sherbrooke, Canada 6 Hopital Maisonneuve-Rosemont, Department of Radiation Oncology, Montreal, Canada 7 CHUM-Hopital Notre-Dame, Department of Radiation Oncology, Montreal, Canada 8 CancerCare Manitoba, Department of Radiation Oncology, Winnipeg, Canada 9 Grand River Regional Cancer Centre- Grand River Hospital, Department of Radiation Oncology, Kitchener, Canada 10 London Regional Cancer Program, Department of Radiation Oncology, London, Canada 11 Cancer Centre of Southeastern Ontario- Kingston General Hospital, Department of Radiation Oncology, Kingston, Canada 12 Cross Cancer Institute, Department of Radiation Oncology, Edmonton, Canada

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Tom Baker Cancer Centre- University of Calgary, Department of Oncology, Calgary, Canada 14 The Ottawa Hospital and University of Ottawa, Department of Radiation Oncology, Ottawa, Canada 15 Odette Cancer Centre- Sunnybrook Health Sciences Centre, Department of Pharmacy, Toronto, Canada 16 Princess Margaret Cancer Centre- Radiation Medicine ProgramOntario Cancer Institute- University of Toronto, Department of Radiation Oncology, Toronto, Canada Introduction Studies that have demonstrated improved quality of life (QOL) following radiotherapy to painful bone metastases have small sample sizes or do not utilize questionnaires specific to bone metastases. Objectives To determine how soon after radiatiotherapy for painful bone metastases one can expect improvement in QOL, using the QLQ-C15-PAL and QLQ-BM22. Methods All patients were prescribed a single 8-Gy radiotherapy to 1 or 2 painful bone metastases and completed the QLQ-C15-PAL and QLQ-BM22 at baseline, and days 10 and 42 post treatment. Pain response was assessed per the International Bone Metastases Consensus Endpoint Definitions; patients with complete or partial response were responders whereas those with pain progression or stable pain were nonresponders. Clinically meaningful changes in QOL scores were interpreted according to previously described methods. Results A total of 298 patients were included, of which 122 (40.9%) and 116 (38.9%) had a pain response at days 10 and 42 post-treatment, respectively. At day 10, those with a pain response had a significantly greater reduction in pain (17.0 vs 1.8; p = 0.002), and pain characteristics (12.8 vs 1.1; p = 0.002) compared to nonresponders. Responders also had greater improvements in functional interference (11.6 vs 3.6; p= 0.01) and psychosocial aspects (1.2 vs decrease of 2.2; p = 0.04). Further improvements were seen in most domains of QOL at day 42. Conclusions QOL improves as early as day 10 following radiotherapy for those who experience a pain response, thus it should be offered to all patients with painful bone metastases, even those with very limited survival.

eP458 QUALITY OF LIFE AND PSYCHOSOCIAL NEEDS OF METASTATIC BREAST CANCER PATIENTS T. Mehmood1 1 Shaukat Khanum Memorial Cancer Hospital and Research Centre, Radiation Oncology, Lahore, Pakistan Introduction Metastatic breast cancer (MBC) patients holds severe psychosocial and emotional disturbances. Objectives Review prior literature and patient survey reports related to MBC patients’ quality of life (QoL) needs. Methods (1) Research findings of >150 published, peer-reviewed research articles including studies of MBC patients and their families, were summarized around the realities of living with MBC. (2) 13 surveys of ~8,000 MBC patients were examined for common concerns. (3) 16 Desk research analysis of leading nonprofits’ patient advocacy, research, education and support. Results MBC QoL issues was summarized into 6 categories: psychosocial distress; emotional support; information about the disease, its treatment, and

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resources; communication and decision making about care; relief of physical symptoms; and practical concerns. Sources of emotional support, individual and group psychotherapy, and counseling, as well as adequate information about the disease, its treatments, and methods to alleviate symptoms and side effects have been shown to be useful in helping patients cope with MBC. However, patients are typically not well informed in areas required for decision making about their care, and patient–clinician communication can be difficult. MBC symptoms and side effects of continuous treatment - fatigue, sleeping difficulties, and pain and emotional distress interfere with daily life. While the majority of the major local breast cancer advocate organizations focus on meeting the support needs of the breast cancer community, not enough attention is paid to the MBC patient population. Conclusions While QoL issues for MBC patients/caregivers are well understood, the resources and commitment to address these issues are still lacking.

eP459 CAN THE HEALTH CARE TEAM IN RESOURCED SCARCE SETTING, IMPACT QUALITY OF LIFE IN CHILDREN WITH CANCER ? J. Menang1, S. Njim2 1 CALMEF Practice, Paediatric Unit, Tiko, Cameroon 2 St Louis University Medicine, Clinical, Bamenda, Cameroon Introduction Enhancing the quality of lives of children with cancer; using basic tools and knowledge has proven to have a highly significant impact in overall wellness in our Burkitt lymphoma (BL) children’s unit. Objectives Maximizing available resources creatively while reviewing ongoing care/ support in order to explore multiple approaches in understanding the challenges especially psychological challenges and the impact in BL children. Methods Survey questionnaires, spending 30 minutes thrice a week with the children and family members involving the children in discussions where they express their feelings or telling them stories as well as interviewing the caretaker. Inclusions: 34 children; ages 3-15 years on the BL Unit (May 2014 – December 2015) were reviewed with the unit, divided into 2 separate rooms (unit A and B). Exclusions: Participants related to staff, children less than 3 years and more than 15. Results Unit ‘B’ kids appeared more relaxed, happier and friendlier just few days after initiation of discussion; meanwhile Unit ‘A’ where we maintained routine care remained largely indifferent. The children revealed vital information like unreported vomiting, strange feelings on some medication etc. It became also very evident that most kids on unit B became more friendly, less stressed and feeling of well-being just. Conclusions The art in care like maximizing available resources remains priority in resource scarce communities because ignored basics of maximizing available resources prove such can greatly enhance the quality of life in children with life limiting illnesses, it is very vital, incorporating this into paediatric palliative and supportive care in resource limited settings.

eP460 EVALUATION OF QOL FOR BREAST CANCER PATIENTS USING EORTC QLQ C 30 AND EORTC QLQ BR 23 A.N. Nagappa1, D. Augustine2

Support Care Cancer (2017) 25 (Suppl 2):S21–S266 1 SCS College of Pharmacy- RGUHS Bangalore, Pharmacy Practice, Harapapahalli, India 2 Kerala University of Health Sciences, Pharmacy Practice, Chertala, India

Introduction A total of 303 women with breast cancer, who were receiving treatment in Shirdi Sai Baba cancer Hospital and Research Centre, Manipal were invited to participate in the study after getting informed consent. The age of participants were 25-73 years, (mean age 47.23, SD=9.7).The patient reported humanistic outcomes were measured cross sectionally during or after chemotherapy, for each pharmacological group by using 6 EORTC QLQ C 30 and QLQ BR 23. Objectives To assess functional attributes physical, role, emotional, cognitive and social function, including body image, future perspectives and global health, pain, fatigue, nausea and vomiting, systemic therapy side effects, dyspnoea, diarrhea, constipation, appetite loss, upset by hair loss, loss of sleep, arm symptoms and breast symptoms. Methods The patient reported humanistic outcomes were measured cross sectionally during or after chemotherapy, for each pharmacological group by using 6 EORTC QLQ C 30 and QLQ BR 23. Results Statistical evaluation by ANOVA amongst the 3 treatment regimens were found to be significant (p=<0.05) for quality of life in physical function, role function, emotional function and global health (P=< 0.05). Similarly the statistical analysis by ANOVA for symptoms scores revealed insignificant p values except for pain, constipation and upset by hair loss (P=<0.05). Conclusions cancer is a disease, where there is a lot of scope for pharmaceutical care in order to improve the functional scales and global health and to reduce symptoms scales of breast cancer patients.

eP461 ASSESSMENT ON THE QUALITY OF LIFE OF BREAST CANCER PATIENTS UNDERGOING RADIOTHERAPY IN GHANA S. Opoku1 School of Biomedical and Allied Health Sciences, Radiography, Accra, Ghana 1

Introduction World Health Organization defines QoL as an individual’s perceptions of their position in life, in the context of the cultural and value systems in which they live and in relation to their goals, expectations, standards and concerns make up their QoL. Objectives The study was to assess factors that contribute to the quality of life of breast cancer patients undergoing treatment to determine the overall quality of life and to suggest ways and methods to improve the situation Methods Ninety breast cancer patients referred to the Oncology Unit were conveniently sampled within a three month period. Quality of life assessment was performed using the Functional Assessment of Cancer Therapy (FACT-B) Results The peak incidence age was between (56-65) years, 60% had triple modality treatment; thus had undergone surgery and were on chemotherapy and radiotherapy. Seventeen percent had surgery and were on chemotherapy only, 10% had surgery and were on radiotherapy only, 10% had surgery and only one patient was on chemotherapy and radiotherapy. The scores for the quality of life domains were General Emotional (GE) well-being (18.8±8.4), General Physical (GP) well-being (16.5±6.1),

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General Social (GS) well-being (14.3±7.0) and General Functional (GF) well-being (10.9±5.7). Seventy percent of the patient had stable quality of life, 10% had poor quality of life and 20% had good quality of life. Conclusions Considering the quality of life domains or subscale scores and the overall quality of life scores of the patients, it can be concluded that there is no significant difference (p>0.05) in the quality of life of breast cancer patients who receive treatment at the Unit

eP462 S A F E T Y, T O L E R A B I L I T Y, E F F I C A C Y, A N D IMMUNOGENICITY OF INACTIVATED VZV VACCINE (ZVIN) IN RECIPIENTS OF AUTOLOGOUS HEMATOPOIETIC STEM CELL TRANSPLANTS (AUTO-HSCTS) O. Cornely1, D. Winston2, K. Mullane3, M. Boeckh4, K. Hurtado5, S. Su5, L. Pang5, Y. Zhao5, I. Chan5, J. Stek5, S. Kaplan5, J. Parrino5, P. Annunziato5, Z. Popmihajlov5, A. Arvin6 1 University of Cologne, Research, Cologne, Germany 2 University of California, Medical Center, Los Angeles, USA 3 University of Chicago, Medical Center, Illinois, USA 4 University of Washington, School of Medicine, Seattle, USA 5 Merck & Co.- Inc., Research, Kenilworth- NJ, USA 6 Stanford University, School of Medicine, Stanford, USA Introduction Inactivated Varicella Zoster Virus (VZV) Vaccine (ZVIN) is being developed for the prevention and amelioration of Herpes Zoster (HZ) and HZrelated complications in patients undergoing Autologous Hematopoietic Stem Cell Transplants (auto-HSCT). Objectives Primary objectives to assess: (1) safety and tolerability of ZVIN; (2) impact of ZVIN on HZ following auto-HSCT. Secondary objectives to assess: (1) impact of ZVIN on moderate-to-severe HZ-associated pain; (2) impact of ZVIN on HZ complications; (3) impact of ZVIN on postherpetic neuralgia (PHN). Methods Adults (≥18 years old) randomly received either ZVIN (560 subjects), ZVIN high antigen lot (106 subjects), or placebo (564 subjects), administered in a 4-dose regimen. Dose 1 was administered ~30 days prior to HSCT. Doses 2 through 4 were administered ~30, ~60, and ~90 days post auto-HSCT. Results Confirmed HZ occurred in 42 vaccine (n=538) and 113 placebo (n=535) recipients. Estimated vaccine efficacy (VE) for HZ (VEHZ) was 63.8%; [95% CI: 48.4, 74.6]. Estimated VEPAIN was 69.5% (95% CI: 49.0%, 81.8%). Estimated VECOMPLICATIONS was 73.5% (95% CI: 49.8%, 86.0%). Estimated VEPHN was 83.7% (95% CI: 44.6%, 95.2%). Proportions of serious adverse events (SAEs) and vaccine-related SAEs were similar between vaccine and placebo groups (32.9% vs. 32.7% [risk difference 0.2% (95% CI: -5.1, 5.5)] and 0.8% vs. 0.9% [risk difference 0.1% (95% CI: -1.4, 1.1)]). None of the VZV rashes were PCR positive for vaccine strain. Conclusions These results of the pivotal Phase III study (V212-001; NCT01229267) demonstrate that ZVIN is efficacious and well-tolerated when administered to adult recipients of auto-HSCT.

eP463 SALVAGE TREATMENT TO HELPLESSLY NON-HODGKIN’S LYMPHOMA AND MUCINOUS BREAST CARCINOMA BY USING SPECIFIC HERBAL EXTRACT MEDICINE AND SUPPORTIVE CARE P. Rong1, L. Xianyong1, Z. Lingyan1, T. Ya2, Y. Weihua3, L. Xiaolu3, Y. Cui4, Z. Fen3

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1

Chengdu Fuxing Hospital, Oncology, Chengdu, China Chengdu Fuxing Hospital, Pharmacy, Chengdu, China 3 Chengdu Fuxing Hospital, Nursing, Chengdu, China 4 Chengdu Fuxing Hospital, Radiology, Chengdu, China 2

Introduction Although non-Hodgkin’s lymphoma (NHL) and mucinous breast carcinoma (BMC) present good prognosis, we pay much attention on the helplessly patients who need salvage treatments after previous treatment failure. Objectives Here, we reported terminal-stage NHL and BMC cases who used supportive care and herbal extract preparations as salvage treatment that contain ginseng, Herba Agrimonia, White Flower Patrinia Herb etc. Methods a NHL patient was diagnosed with multi-subcutaneous metastasis, esophagus invasion and skin ulcers. And, a bilateral pure BMC patient was diagnosed with metastasis on bilateral lung, bilateral chest wall etc. accompanied with skin ulcer (D=14 cm), bilateral pleural fluid, pericardial invasion and dyspnea and cachexia. Meanwhile, ECOG and NRS pain score were 3/5 and 4/6, respectively, and expected lifetime were three and less one month, respectively. Herbal extract preparations were given four times a day by oral, and nutrition medicine and hyperthermia once daily. Quality of Life (QOL) and survival time were assessed.

Results QOL has significantly improved and tumor-bearing living has achieved for 4 years and 5 months, respectively. Meanwhile, ECOG and NRS pain score decreased to 2/3 and 1/2, respectively. CT scan showed that primary tumor represented stable. Side effects which were greater than grade 1 according to the CTCAE 3.0 were not observed. Conclusions In summary, treatment, which can improve severe symptoms and keep tumor-bearing living time for helplessly patients, ought to be preferred. Specific and individual herbal extract medicine and supportive care do act on tumor itself as well as the whole body. Thus, such salvage treatment can make a difference.

eP464 ASSESSMENT OF MASTICATORY EFFICIENCY AND QUALITY OF LIFE AFTER TREATMENT FOR ORAL CANCER A. Singh1, K. Manikantan2 1 Tata Medical Center, Dental Services, Kolkata, India 2 Tata Medical Center, Head and Neck Services, Kolkata, India Introduction The clinical management of squamous cell carcinoma of the head and neck have sequelae like mouth dryness, difficulties in swallowing, eating, chewing and speech production which cause significant distress to the patients. In our study we evaluated the masticatory efficiency in patients treated for oral cancer and the treatment variables affecting masticatory efficiency in these patients. Objectives The primary objective of the study was to assess the chewing efficiency of patients treated for oral cancer. We also assessed their maximum bite force and their quality of life. Methods All patients who underwent curative intent treatment for oral cancer and completed six months or more post treatment were assessed using two colored chewing gums to assess chewing efficiency. Their bite force was measured with a transducer and quality of life assessed using the EORTC questionnaires. Results A total of 80 patients were assessed and the median follow up was 22.5 months. The mean mouth opening was 33.7mm and mean bite force was 13.3kgf. The bite force was significantly worse in advanced stage (p=0.009) disease. The mouth opening was significantly worse both on objective and subjective assessment in those who

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received adjuvant treatment (p=0.002), underwent marginal mandibulectomy (p=0.03) and free flap reconstruction (p=0.04). The mean chewing efficiency was 77.8(±15). Conclusions Treatment of oral cancer results in significant functional morbidity which depends on stage of disease, extent of resection and reconstruction. Proper treatment planning can reduce this morbidity.

eP465 ASSESSMENT OF QUALITY OF LIFE AND STRAIN BURDEN ON CANCER CAREGIVERS V. Talla1, Y. Surendra1, A. Kandagatla2 1 Talla Padmavathi College Of Pharmacy, Pharmaceutics, Warangal, India 2 Talla Padmavathi College Of Pharmacy, Clinical Pharmacy, Warangal, India Introduction Cancer is the most common condition associated with care giving. As cancer treatment progresses, the number of caregivers (CG) are likely to increase. Emotional well-being have a direct impact on overall prognosis of a cancer patient. Especially in countries like India, where the concept of nuclear family is highly followed and interpersonal sympathy plays major role Objectives Objective of the study is to assess the effects of cancer caregivers’ demographics on Quality Of Life (QOL) and Strain Burden (SB) and there inter-relation on overall wellbeing of cancer care givers Methods This is a prospective observational study, carried out at St. Ann’s cancer and general hospital, Warangal, Telangana, India involving 120 caregivers of patients undergoing cancer treatment irrespective of type of cancer. The CG Quality of Life-Cancer Scale (CQOLC) and the Modified CG Strain Index (CSI) were used to assess QOL and SB of CG respectively. Appropriate statistical tests were used to assess interrelation of QOL and SB. Results A significant correlation was found between CQOLC and CSI (R2=0.76). One way ANOVA revealed a significant difference in CQOLC and CSI of CG with respect to their relationship with the patient and their marital status (p<0.001). However, no such significant difference was found with respect to gender of the CG. Conclusions This study examined many causes of CG’s QOL and SB, like gender, relationship and marital status. As the cancer intensifies, the QOL of CG reduced and was found to be directly proportional to SB. Structured CG counselling is required to improve their QOL.

eP466 COPING WITH SIDE EFFECTS OF SYSTEMIC ANTI-CANCER TREATMENT – PATIENT-REPORTED MONITORING AND SUBSEQUENT INTERVENTIONS

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concurrent mild or moderate side effects will compromise Quality of Life (QoL) on the short and long term. The total symptom burden, it’s course, and outcomes of any interventions are mostly unknown. Objectives To garner experience from 3 European units on monitoring side effects to 1) enable (more timely) intervention, 2) enhance coping with side effects and self-management and 3) decrease short and long term side effects. Methods The Dutch ‘AlongsideCancer’, the UK ‘Health Buddy®’ and the Belgian ‘Symptom Diary’ studies utilised home-based devices to provide patient education and collect patient-reported data on side effects of systemic treatment and QoL. The Dutch and UK system also sent alerts to professionals when exceeding a threshold. Results In total 320 patients with a variety of malignancies participated in 3 studies. The ‘visual’ course of symptom burden was helpful for patients and professionals (figure 1). 1247 alerts were forwarded, with follow up through phone calls, emergency reviews and hospital admissions. Ontime symptom reporting led to higher numbers and severity of symptoms compared to reporting at the next hospital visit.

Conclusions Patient-reported side effects are informative alongside clinician-reported toxicity measures and ensure improved communication with patients. International standards are required to accelerate the knowledge transfer of real-time side effects, interventions and outcomes. Improving selfmanagement support requires active exploration of the symptom burden and coping styles. eP467 IDENTIFYING WOMEN AT RISK OF UNCERTAINTY AND POOR QUALITY OF LIFE WHEN UNDERGOING BREAST CANCER SURGERY: A SURVEY-BASED DESCRIPTIVE STUDY

C. van den Hurk1, M. van Eenbergen2, A. Coolbrandt3, A. Young4 1 Netherlands Comprehensive Cancer Organisation, Research, Utrecht, The Netherlands 2 Netherlands Comprehensive Cancer Organisation, Communication, Utrecht, The Netherlands 3 University Hospitals Leuven, Oncology, Leuven, Belgium 4 Warwick Medical School- University of Warwick, Reserach, Coventry, United Kingdom

S. Van Straten1, M. Xu2, S. Rayne1, C. Van Der Meer1, B. van der Linde1, N. Stephanou1, C. Smit1, R. Severaj1, E. Remwa1, T. Pillay1, L.A. Pepper1, M. Lelimo1, M. Fyffe1, M. Carides1 1 University of the Witwatersrand- Faculty of Health Science, Department of Surgery, Johannesburg, South Africa 2 University of Pennsylvania, Radiation Oncology, San Francisco, USA

Introduction Severe toxicities following systemic treatment are a risk for cancer patients and are well known by healthcare professionals. However,

Introduction Breast cancer is a leading cause of morbidity and mortality in South African women. In resource-limited settings emphasis for disease

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management is often concentrated on biological control and survival, however understanding the full biopsychosocial experience of breast cancer is essential in improving access and patient uptake of care. Objectives This study of women undergoing surgery for breast cancer aims to determine the presence of uncertainty, poor quality of life (QoL) and their relationships to demographics and social support in an urban uninsured South African population. Methods A quantitative cross-sectional study was carried out in patients prior to breast surgery. Each participant completed the survey including validated questionnaires of uncertainty, QoL index, social support scale and demographics. Results Of the 59 women approached, 53 (89.9%) participated. Uncertainty was found in 86.8% (28.3% severe uncertainty) with all newly-diagnosed patients experiencing uncertainty. Patients of age above 45 years made up 80% of all those who were severely uncertain. Good social support did not affect levels of uncertainty. Conversely QoL was improved in women with at least primary education, and in women above 45 years. Pre-surgical chemotherapy was unassociated with either uncertainty or QoL. Greatest uncertainty was reported about the roles of the treating staff and the presence of unanswered questions. Conclusions Older women and those with education more commonly experienced uncertainty, but reported better QoL. The areas of uncertainty can help direct clinicians in limited resources settings to better direct services to help support patients, instituting simple measures of education and orientation.

eP468 CHARACTERISTICS AND SYMPTOM MANAGEMENT OF PATIENTS UNDERGOING MEDICAL CANNABIS TREATMENT S. Chan1, A. Wan1, P. Zaki1, A. Blake2, A. Wolt2, L. Zhang1, M. Slaven3, E. Shaw3, C. DeAngelis1, H. Lam1, V. Ganesh1, E. Chow1, S. O'Hearn2 1 Odette Cancer Centre - Sunnybrook Health Sciences Centre - University of Toronto, Radiation Oncology, Toronto, Canada 2 MedReleaf, Research, Markham, Canada 3 Hamilton Health Sciences, Juravinski Cancer Centre, Hamilton, Canada Introduction Medical cannabis is prescribed by physicians to treat a variety of symptoms experienced by patients with cancer and other severe and chronic illnesses, including pain, anxiety, depression, and sleep disorders. Objectives To assess the characteristics of medical cannabis patients and evaluate its efficacy for the management of symptoms associated with cancer and other chronic illnesses. Methods Patients using medical cannabis from a single Canadian licensed producer voluntarily completed an online survey after registration (baseline), and at 4 and 10 month follow-up intervals (FU). Information pertaining to current condition and symptom severity was collected. Results A total of 2753 patients completed the baseline survey. Commonly reported conditions include anxiety disorder (31.7%), depression (31.6%), pain (29.5%), sleep disorder (25.5%), and cancer (7.1%). The most frequently reported symptoms by both cancer and non-cancer patients included pain (73.0%), anxiety (72.6%) and sleep problems (69.8%). At 4month FU, a majority of patients with the most common conditions demonstrated improvement: anxiety (77.5%, p=0.0006), depression (71.6%, p=0.2), sleep disorders (79.2%, p=0.0006). Reductions in symptom severity and pain, as well as QOL improvements were also demonstrated

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for patients with cancer and non-cancer conditions at 4-month FU, which remained stable from 4-month to 10-month FU. Conclusions Medical cannabis is an effective treatment option for managing a variety of symptoms commonly experienced by patients suffering from cancer and other chronic or severe illnesses. Understanding patient characteristics will be useful in informing the design of future clinical research initiatives and identifying the needs of patients, especially those suffering from cancer-associated symptoms.

eP469 GENETIC BIOMARKERS ASSOCIATED WITH CHANGES IN QUALITY OF LIFE AND CANCER SYMPTOMS FOLLOWING PALLIATIVE RADIOTHERAPY IN PATIENTS WITH BONE METASTASES A. Wan1, A. Furfari1, A. Wong2, K. Ding3, A. Bezjak4, R. Meyer5, R. Wong4, C. Wilson3, C. DeAngelis6, A. Azad2, E. Chow1, G. Charames2 1 Odette Cancer Centre - Sunnybrook Health Sciences Centre - University of Toronto, Radiation Oncology, Toronto, Canada 2 Mount Sinai Hospital, Pathology and Laboratory Medicine, Toronto, Canada 3 Cancer Research Institute- Queen’s University, Canadian Cancer Trials Group, Kingston, Canada 4 Princess Margaret Cancer Centre- Ontario Cancer Institute, Radiation Medicine Program, Toronto, Canada 5 Juravinski Hospital and Cancer Centre- McMaster University, Department of Oncology, Hamilton, Canada 6 Odette Cancer Centre - Sunnybrook Health Sciences Centre - University of Toronto, Pharmacy, Toronto, Canada Introduction Patients with bone metastases undergoing palliative radiation therapy (RT) may experience changes in both the functional and symptomatic aspects of quality of life (QOL). The EORTC QLQ-C15-PAL is a validated questionnaire employed to assess QOL specifically in palliative patients. Objectives To identify single-nucleotide variant (SNV) genetic biomarkers associated with changes in cancer symptoms and QOL. Methods 48 patients who received a single 8Gy RT for painful bone metastases completed the EORTC QOL-C15-PAL questionnaire prior to randomization and at 42-days post RT. Saliva samples obtained at day of RT were sequenced for genes with known clinical associations to identify SNVs. Analysis of SNVs by the Cochran Armitage trend test identified significant variants (p<0.05) associated with deterioration or improvement of global QOL, functional scale mean, and symptom scale mean. Results Global QOL improvement was associated with ABCA10 rs3842375 GA frameshift deletion, and rs10491178 G/A stop-gained, while deterioration was most significantly associated with CDC6 rs13706 G/A. Improvement and deterioration in overall function were respectively associated with SPAG17 rs17185492 T/A and GOLGA3 rs3741486 G/A. Overall improvement in symptoms was associated with AGXT2 rs37369 C/T and GDF3 rs12819884 C/T. These significant SNVs were found in genes involved in metabolism, membrane transport, cell cycle control, ciliary structure, and gene expression regulation. Conclusions SNVs were significantly associated with changes in QOL, functional, and symptom scales in patients with bone metastases. Identification of genetic biomarkers predictive of QOL items may allow patients and healthcare providers anticipate and better address functional impairment and symptoms to improve QOL in the palliative cancer patient population.

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eP470 SYMPTOM BURDEN AND DISTRESS IN PATIENTS WITH CANCER IN AFRICA J. Weru1 1 Aga Khan University Hospital, Medicine, NAIROBI, Kenya Introduction Cancer has become a significant public health problem in Africa but still most diagnoses are made late, Sitas et al (2006). The need for palliative care is significant due to the late contact with health care providers and the many symptoms they present with. No study has been undertaken to assess symptomatology for these patients in Africa Objectives To study the prevalence of symptoms in cancer patients in an African setting Methods Symptom studies from records of cancer patients referred to the Palliative Care Services at the Aga Khan University Hospital, Nairobi in 6 months. Symptoms charted on Edmonton Symptom Assessment Scale Results 42 patients were referred to the service in this period. All the patients reported >3 symptoms which cut across the physical, social, psychological and spiritual concerns. The most common symptoms were pain in the physical dimension (90%) as reported by the patient. Fatigue was reported by (93%).Family wellbeing was the main worry in psychological dimension (95%). 94 % reported social disconnect due to the diagnosis, job losses and huge cost of health care. 96% suffered from the existential question of why me and worry about the future Conclusions Cancer has become a major burden to patients, families, societies and nations in Africa. Patients suffering from this illness experience a myriad of symptoms which require holistic approach to care. Social wellbeing remains a major concern for patients with cancer in Africa

eP471 TRAJECTORIES OF MOOD DISTURBANCE ARE ASSOCIATED WITH CO-OCCURRING SYMPTOMS M. Whisenant1, S. Mitchell2, S. Beck1, B. Wong1, K. Mooney1 1 University of Utah, College of Nursing, Salt Lake City, USA 2 National Cancer Institute, Outcomes Research Branch, Rockville, USA Introduction Mood disturbance is reported to co-occur with other symptoms during treatment for breast cancer. We previously identified 2 patterns of depressed mood and anxiety in women undergoing chemotherapy for breast cancer using a Latent Growth Mixture Model. Objectives The purpose of this study was to explore whether membership in symptom classes of depressed mood and anxiety is associated with other symptoms. Methods Using data from 2 multi-site randomized clinical trials, independent samples t-tests and ANOVA were used to distinguish between classes of women on co-occurring symptoms. The severity of 7 symptoms was self-reported daily by women (0-10 scale) during cycles 2 and 3 of chemotherapy, using an automated telephone system. Summative severity scores were calculated for each symptom, including the number of days subjects scored 4 or higher, and then compared to class membership. Results Participants (n=166) had a mean age of 53 years (S.D.±10.8); 52.4% had early stage breast cancer. Membership in the higher severity anxiety class was associated with fatigue (p<.001), disturbed sleep (p<.001), and depressed mood (p<.01). Membership in the higher severity depressed

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mood class was associated with fatigue (p<.01), disturbed sleep (p=.01), anxiety (p<.01), and nausea (p<.01). Conclusions Symptoms co-occur during cancer treatment. This dynamic process of multiple symptoms may be altered by future identification of the gateway symptom. Identification of women at risk for high symptom burden during chemotherapy allows clinicians to target those individuals for intervention, potentially avoiding poor outcomes associated with symptom burden.

eP472 CANCER CAREGIVER PERCEPTION OF SYMPTOM SEVERITY CHANGE M. Whisenant1, G. Donaldson1, A. Wilson1, K. Mooney1 1 University of Utah, College of Nursing, Salt Lake City, USA Introduction Symptom assessment during cancer treatment is challenging because symptoms often escalate between clinic visits. Patients and caregivers must recall the symptom experience over the previous weeks during clinic visits. It is unknown whether perception of change in the severity of symptoms can be accurately recalled. Objectives This purpose of this paper is to describe caregiver-reported perception of change in symptom severity with relation to actual reported symptom severity. Methods Participants were 319 caregivers of patients receiving hospice care for advanced cancer randomly assigned to intervention or usual care. All caregivers placed daily calls to an automated system, Symptom Care at Home (SCH) that assessed severity for 3 patient and 2 caregiver symptoms (0-10 scale). If reported severity differed by 2 or less points from the previous call, caregivers were asked whether the symptom was less, the same, or more severe than the previous call. SCH intervention caregivers received automated care coaching and hospice nurse alerts for poorly controlled symptoms. Correlations between reported change and perceived change were calculated using linear mixed effects models. Results Correlations for patient pain (R = 0.45), anxiety (R = 0.29), and depressed mood (R = 0.36) and for caregiver mood (R = 0.44) and anxiety (R = 0.40) were statistically significant (p < 0.0001). There was a significant interaction between group and change in pain on perceived change in pain (p < 0.0001). Conclusions Caregivers perceive symptom severity change consistent with reported symptom severity. The intervention may enhance caregivers’ ability to perceive change in patient pain.

eP473 INSPECTION OF CERVIX USING ACETIC ACID-A GOOD ALTERNATIVE TO PAP SMEAR IN UNDER DEVELOPED COUNTRIES S.S.A. Zaidi1 1 , Lahore, Pakistan Introduction Cervical cancer is the leading cause of death in Pakistan. Early detection through cervical screening is crucial for prevention and treatment. Objectives To determine the diagnostic accuracy of visual inspection of cervix using 3% acetic acid as a screening test for early detection of cervical cancer taking histopathology as the gold standard.

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Methods The cross-sectional study was conducted at Sir Ganga Ram Hospital, Lahore from January 2014 to December 2014 and comprised all sexually active women aged 19-60 years. During speculum examination 3% acetic acid was applied over the cervix with the help of cotton swab. The observations were noted as positive or negative on visual inspection of the cervix after acetic acid application according to acetowhite changes. Colposcopy-guided cervical biopsy was done in patients with positive or abnormal looking cervix. Colposcopic-directed biopsy was taken as the gold standard to assess visual inspection readings. SPSS 17 was used for statistical analysis. Results There were 500 subjects with a mean age of 35.74±9.64 years. Sensitivity, specifically, positive predicted value, negative predicted value of visual inspection of the cervix after acetic acid application was 93.5%, 95.8%, 76.3%, 99%, and the diagnostic accuracy was 95.6%. Conclusions Visual inspection of the cervix after acetic acid application is an effective method of detecting pre-invasive phase of cervical cancer and a good alternative to cytological screening for cervical cancer in resource-poor setting like Pakistan.

eP474 THE EFFECT OF COMPREHENSIVE TRANSITIONAL CARE MODEL DELIVERED BY ENTEROSTOMAL NURSES AMONG POST-DISCHARGED COLOSTOMY PATIENTS WITH RECTAL CANCER Zhang Jun-e, Lv Lin, Zheng Mei-chun School of Nursing, Sun Yat-sen University, Guangzhou, China Introduction People with a new colostomy encounter many difficulties as they struggle to adjust to their ostomies. There is a urgent need to improve their quality of life and resume normal life among post-discharged colostomy patients. Objective To explore the effect of comprehensive transitional care model among post-discharged colostomy patients with rectal cancer. Methods Totally 112 colostomy patients were recruited from June 2013 to December 2014 from three tertiary Grade A hospitals in Guangzhou and divided into the study group and control group with 56 patients in each group. Both the study and control groups received routine discharge care, whereas the study group received stoma care education manual and 2-3 nurse telephone calls in the follow-up period. The patients were investigated by Stoma Quality of life-Chinese Version,Stoma selfefficacy Scale, Stoma Self-care Scale before discharge, 1 month and 3 month after discharge. Results The scores of stoma self-care(F=5.177, P<0.05), stoma selfefficacy(F=6.402, P<0.05)and daily routines and social interaction dimensions of quality of life(F=4.255/1.178, P<0.05 among colostomy patients in study group were significantly higher that those in the control group. Conclusions Comprehensive transitional care model delivered by enterostomal nurses could improve the stoma self-care ability, stoma self-efficacy but only two dimensions of quality of life among colostomy patients. Enterostomal nurses should pay more attention to the individualized cultivation of observation and learning ability of colostomy patients.

eP475 DIFFERENCE BETWEEN IMMEDIATE EFFECTS OF ACTIVE EXERCISE WITH COMPRESSION THERAPY ON LOWERLIMB LYMPHEDEMA WHILE SEATED AND SUPINE

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K. Abe1, T. Tsuji2, A. Oka2, J. Shoji3, Y. Sano3, M. Kamisako3, H. Hohri3, M. Liu2 1 Keio University Graduate School of Medicine, Rehabilitation Medicine, Tokyo, Japan 2 Keio University School of Medicine, Rehabilitation Medicine, Tokyo, Japan 3 Keio University Hospital, Rehabilitation Medicine, Tokyo, Japan Introduction Although regarded as an important remedy for lymphedema, the therapeutic effects of active exercise with compression therapy (AECT) are supported by little evidence. Objectives We aimed to determine whether the outcomes of seated or supine AECT using a bicycle ergometer differed in patients with lower limb lymphedema (LLL) associated with gynecological cancers. Methods Eighteen women with LLL completed 15 minutes of seated and supine AECT on a bicycle ergometer with elastic bandages and 15 minutes of supine compression therapy (CT) alone in this randomized controlled crossover trial. Lower limb volumes were assessed using a PerometerTM, and symptom severity was assessed before and after each intervention using a visual analog scale (pain, heaviness) and palpation (pitting, stiffness). The effects of the interventions were estimated using linear mixed-effect models. Results The decrease in volume significantly differed among the three interventions (p<0.05) and the rate at which the volume in the lower limbs decreased was significantly lower after supine AECT than after CT (p<0.05). Moreover, the effects of seated AECT and CT did not significantly differ. Therefore, the most effective intervention was supine AECT. Pre-interventional pitting severity and stiffness significantly correlated with a volume decrease after all interventions and after supine AECT, respectively. Conclusions Supine AECT using a bicycle ergometer could decrease fluid volume in the lower extremities. The present findings also suggest that AECT has an obviously positive effect on women with extreme LLL associated with gynecological cancers.

eP476 UNMET NEEDS OF OVARIAN CANCER PATIENTS DURING CHEMOTHERAPY IN THE ASPECTS OF REHABILITATION IN DAILY ACTIVITY FUNCTION AND SUBJECTIVE SYMPTOMS I.Y. Cheong1, J.Y. Cho1, J.S. Yoo2, J.W. Lee3, S.Y. Park4, S.H. Chung2, J.H. Hwang1 1 Samsung Medical Center- Sungkyunkwan University School of Medicine, Department of Physical and Rehabilitation Medicine, Seoul, Republic of Korea 2 Research Institute and Hospital- National Cancer Center, Rehabilitation Medicine, Gyeonggi-do, Republic of Korea 3 Samsung Medical Center- Sungkyunkwan University School of Medicine, Department of Obstetrics and Gynecology, Seoul, Republic of Korea 4 Research Institute and Hospital- National Cancer Center, Center for Uterine Cancer- and Gynecologic Cancer Branch, Gyeonggi-do, Republic of Korea Introduction Cancer survivors considerably experience treatment related symptoms and functional morbidity that are amenable to rehabilitation services during their treatment, but these are often unnoticed and seldom managed.

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Objectives This study aimed to investigate patients’ present symptoms and functional loss focused in activities of daily living (ADL) to identify unmet needs of ovarian cancer patients during chemotherapy. Methods The medical records were retrospectively reviewed of all ovarian cancer patients undergoing chemotherapy that visited or were hospitalized at the department of Gynecology and Obstetrics at Samsung medical center and National cancer center from June to August, 2016. The presence of cancer and cancer treatment related symptoms, the Katz index score and additional available records on the patients’ awareness and recognition of the rehabilitation needs were reviewed from the medical chart. Results The most complained symptoms were paresthesia, fatigue, pain, muscle weakness, memory and concentration dysfunction, lymphedema, breathing discomfort, dysphagia and speech difficulty in descending order. Although only minority patients(19.05%) showed dependence in the functions, the most affected function of activities of daily living was continence, bathing, transfer and dressing in descending order. Total Katz index score and all of each functional domains showed significant correlation with the severity of fatigue, which in turn increased in proportion to total number of chemotherapy cycle. Conclusions As we have determined the situations of unmet needs in symptoms and function of ADL among ovarian cancer patients under chemotherapy, it is expected to contribute in planning for proper rehabilitation intervention for symptom relief and functional restoration in ADL.

eP477 THE EFFECT OF MHEALTH SMART AFTER CARE IN PHYSICAL PERFORMANCE OF COLORECTAL CANCER PATIENTS UNDER CHEMOTHERAPY I.Y. Cheong1, S.Y. Ahn1, W.C. Cha2, D.K. Chang3, J.H. Hwang1 1 Samsung Medical Center- Sungkyunkwan University School of Medicine, Department of Physical and Rehabilitation Medicine, Seoul, Republic of Korea 2 Samsung Medical Center- Sungkyunkwan University School of Medicine, Department of Emergency Medicine, Seoul, Republic of Korea 3 Samsung Medical Center- Sungkyunkwan University School of Medicine, Division of Gastroenterology- Department of Medicine, Seoul, Republic of Korea Introduction Mobile health (mHealth) is defined as the delivery of health care or health-related services using portable devices. mHealth smart after care provides a wide range of management from lifestyle intervention to regular physical exercise. Objectives This study aimed to identify the effect of rehabilitation cancer care exercise protocol using mobile application in physical performance of colorectal cancer patients under chemotherapy. Methods The outpatients diagnosed of colorectal cancer with ongoing chemotherapy were recruited from Samsung medical center. 100 colorectal cancer patients were enrolled for comprehensive smart after care using mobile application. The mHealth application provided proper information and managed surveillance ranging from taking timely proper medication to performing regular rehabilitation exercises. Among various managements, the physical performance of the patients were checked with 6 weeks of interval though total 12 weeks of study by checking the patients’ grip strength, 30 seconds chair stand test and 2 minute walk test along with physical activity and performance scales. The individualized proper level of exercise was prescribed at each follow up according to the test results.

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Results The baseline, 6weeks and 12 weeks follow up data of the patients were compared and analyzed. The grip strength, 30 seconds chair stand test score and 2 minute walk test distance improved with time, although the increase in grip strength was not significant. Performance scale also showed improved scores. Conclusions The provision of rehabilitation exercise protocol and surveillance using mHealth application was effective in promoting improved physical performance of the colorectal cancer patients under active chemotherapy.

eP478 WHAT IS THE USUAL REHABILITATION CARE PATHWAY FOR PEOPLE WITH CANCER? J. Fisher1, L. Vail1, A. Marshall1, G. Furze2, R. Owen3, A. Young1 1 University of Warwick, Medical School, Coventry, United Kingdom 2 Coventry University, Faculty of Health and Life Sciences, Coventry, United Kingdom 3 Wye Valley NHS Trust, Health Psychology Service, Hereford, United Kingdom Introduction Over two million people in the UK are living with and beyond cancer. Whilst advances in treatment have led to improved outcomes in survival, the need for rehabilitation is often over-looked. Current guidance recommends Holistic Needs Assessment, to identify and address any on-going unmet need(s). However, research suggests that the majority of patients are not routinely assessed. Objectives This aim of this research is to explore and describe the usual rehabilitation care pathway for patients across a range of cancer types. Methods Design: semi-structured telephone interviews. Participants: A purposive stratified sample of ten cancer patients and seven cancer specialist nurses. Setting: Cancer centres in the West Midlands of the UK. Methods: A topic guide was developed to ensure all relevant areas were discussed. The recorded interviews were transcribed verbatim and analysed using framework analysis. Results Patients and HCP professionals describe assessments of, and interventions directed at, addressing unmet needs. However, these were mainly directed at clinical rehabilitation and aimed at improving or returning function; little was directed towards addressing or improving well-being, psychological or psycho-sexual unmet need. Formal holistic assessment was not undertaken across the patient journey. Patients did feel their cancer specialist nurse was available and they felt comfortable talking openly. Conclusions Holistic assessment of unmet need is not embedded in usual rehabilitative care for cancer patients and opportunities to intervene early are missed. N.B. This research is part of the PRO-REHAB study: http:// www2.warwick.ac.uk/fac/med/research/hscience/sssh/research/pro-rehab

eP479 “BACK ON TRACK”:- A LONGITUDINAL MIXED METHODS STUDY ON THE REHABILITATION OF YOUNG ADULT CANCER SURVIVORS M. Hauken1 1 Center for Crisis Psychology Bergen, Research, Bergen, Norway

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Introduction Young adult cancer survivors (YACS) are a small and understudied group, reporting sever physical and psychosocial late-effects. Still, there is a huge research gap in rehabilitation interventions for YACS. Objectives To investigate if a complex rehabilitation program would improve YACS’ quality of life (HRQOL) outcomes and how they would described their rehabilitation process over time. Methods Twenty YACS were enrolled in a rehabilitation program structured around three weeks of residential rehabilitation and one-week follow-up visits after three and six months. The program consisted of goal setting, physical activity, psychoeducation, individual follow-ups and peer support. Using mixed methods and a longitudinal convergent parallel design, data was collected simultaneously through questionnaires, physical testing and semi-structured interviews at four points, in addition to questionnaires at a one-year follow-up. Results The results portrayed rehabilitation as a process yielding gradual improvement in QOL, participation and physical capacity, whereby finding a balance between the different aspects of life, novel insights and multidimensional follow-up were presented as important factors. By the end of the program, YACS reported high goal achievement, increased QOL and participation. Both at the end of the program and at the one-year followup, participants scored closer to the normal population compared to the cancer population in all measured aspects, with the exceptions of CF and fatigue, indicating that fatigue continued to be a long-term problem. Conclusions This study represents a promising starting point for cancer rehabilitation research tailored to YACS, and for the use of longitudinal mixed methods in cancer rehabilitation research. Further research is therefore highly warranted

eP480 MOBILE AND WIRELESS TECHNOLOGY IN SUPPORTIVE CARE IN CANCER. V. Krylov1 1 First Moscow State Medical University- Moscow- Russia, Surgery, Moscow, Russia Introduction It’s very important to use online technology to improve the life of our ptients Objectives It’s better to remind patiens about doctors prescribtions than in the future to treat relapses. Methods We used an online system for patient education based on the video lessons, full of humor, pictures, and cartoons to convey the necessary information on good nutrition and necessary to do exercises, vitamins and minerals consumption. Results Watching the short movies, the patients formed the habits of good nutrition during the first month already, which includes a diet with restriction of fat, digestible carbohydrates and daily consumption of dairy products, slow carbohydrates, protein and fiber. Were also presented recommendations for compliance with the physical activity, as well as vitamins and minerals consumption. A patient was in touch with a doctor, if he has any additional questions. We examined data from a survey of 100 patients registered in the online system and 30 patients control group who were given the same recommendations on the appointment. The consumption of fiber, milk and dairy products increased by 2.6 times. Regular physical activity were the main group of 260 minutes per week, in control group 80 minutes per week, consumption of vitamins and

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minerals was regular during first year compared with 4 months, and they received a reminder of the need to visit a doctors regulary. Conclusions Mobile and wireless technology could helps physicians to support patiens after surgery to remind about necessity to fulfill doctors recommendations and could be a part of supportive care in cancer.

eP481 P E R C E I V E D B A R R I E R S A N D FA C I L I TAT O R S T O ADHERENCE TO A COMPUTERIZED COGNITIVE TRAINING PROGRAM AFTER TREATMENT FOR HEMATOLOGICAL CANCER S.J. Mayo1, R. Vitorino1, S.B. Rourke2, J. Kuruvilla3 1 University of Toronto, Lawrence S. Bloomberg Faculty of Nursing, Toronto, Canada 2 St. Michael's Hospital, Centre for Urban Health Solutions- Li Ka Shing Knowledge Institute, Toronto, Canada 3 Princess Margaret Cancer Centre, Division of Medical Oncology and Hematology, Toronto, Canada Introduction Computerized cognitive training programs have been shown to improve neurocognitive functioning and quality of life among cancer survivors, but adherence to such programs can be limited. Objectives To explore patients’ perceived facilitators and barriers to adhering to a computerized cognitive training program. Methods Semi-structured interviews were conducted as part of a feasibility study of a computerized cognitive training program to enhance neurocognitive functioning after treatment for hematological cancers. Participants were provided access to an online training program over a period of 8-weeks, during which they were recommended to complete 40 hours. Follow-up interviews explored participant experiences with the program, including facilitators and barriers. Interviews were transcribed verbatim and analyzed for the identification of themes. Results Of the 19 participants enrolled after completion of either first-line chemotherapy treatment or stem cell transplantation, 15 (9 male, 7 female; aged 22-70 years) completed the follow-up interviews. Total time spent on the training program was a median 2.76 hours (range 0.0 – 32.96). Sustaining a sense of motivation, either through internal beliefs or external feedback, was described as a major facilitator of adherence to the training program. Major barriers to adherence included the time required and physical demands associated with resuming roles and responsibilities soon after treatment. No barriers related to the technical requirements or web-based format of the intervention were identified. Conclusions Approaches that sustain motivation over time and offer strategies for balancing the intervention with competing concerns, including establishing a minimum dose, may be useful for enhancing adherence to computerized cognitive training programs after cancer treatment.

eP482 A NOVEL REHABILITATION PLANNING CONSULT FOR SURVIVORS OF HEAD AND NECK CANCER: PILOT TESTING S. McEwen1,2, C. Dunphy2,3, J. Rios1, A. Davis2,4, J. Jones5,6, R. Martino4,7, J. Ringash5,8 1 Sunnybrook Research Institute, St. John's Rehab Research Program, Toronto, Canada 2 University of Toronto, Physical Therapy, Toronto, Canada

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Introduction A rehabilitation planning consult (RPC) was developed to address rehabilitation access issues for survivors of head and neck cancer (HNC). Based in self-management, the RPC determines survivors’ priority rehabilitation needs, sets individualized goals and plans, and facilitates execution and evaluation of plans through a collaborative consultation and follow-up, facilitated by a rehabilitation professional. Previous work established feasibility. Objectives This study aimed to estimate the effect of the RPC on individualized goal attainment, quality of life (QoL) and function in survivors of HNC, to facilitate planning of a future controlled trial. Methods A single group, pre-post pilot study was conducted. Survivors of HNC who had completed active treatment within 18 months were recruited from HNC clinics in Toronto, Canada. Exclusion criteria were lack of English fluency, cognitive impairment, or concurrent major degenerative condition. Outcome measures included survivors’ goal attainment ratings, SF-36, and FACT H&N. Means, standard deviations (SD), and change scores were calculated; effect sizes were estimated with Cohen’s dz. Results Of 35 recruits, 30 participants started the program, 23 identified individualized rehabilitation goals, and 20 completed post-intervention assessments. At follow-up, mean change scores on a 100-point scale for goal performance and goal satisfaction were 45 (SD=32.5; dz=1.4) and 52.8 (SD=20.3; dz=2.6) respectively, indicating a large effect; a large effect (dz=0.8) was seen on QoL related to physical health (SF-36 physical summary score) and a moderate effect was seen on FACT’s H&N subscale (dz=0.3). Conclusions The RPC may improve individualized goals, QoL, and function in survivors of HNC; a larger randomized controlled trial is warranted.

eP483 RELATIONSHIP BETWEEN PHYSICAL FUNCTION AND BODY COMPOSITION/BONE STATUS IN CANCER SURVIVORS AND HEALTHY SUBJECTS S. Morishita1, A. Tsubaki1, M. Kitajima2, Y. Mitobe2, H. Onishi1, T. Tsuji3 1 Niigata University of Health and Welfare, Institute for Human Movement and Medical Sciences, Niigata, Japan 2 Niigata University of Health and Welfare, Department of Nursing, Niigata, Japan 3 Keio University School of Medicine, Department of Rehabilitation Medicine, Tokyo, Japan Introduction Objectives To compare physical function, body composition, and bone status between long-term cancer survivors and healthy subjects. We also investigated the differences in relationships of physical function and body composition/ bone status between long-term cancer survivors and healthy subjects. Methods Seventeen cancer survivors (breast: 10, gastric: 4, lymphoma: 1, lung: 1, colorectal: 1) and 15 healthy subjects were enrolled in this study. All

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participants were assessed for body composition and bone status at the calcaneus using the osteo sono assessment index (OSI). Physical function was assessed according to hand grip and knee extensor strength, while balance function was evaluated using the Timed Up and Go test (TUG) and the Functional Reach test. Results No significant differences were found in physical function, body composition, and sarcopenia rate between cancer survivors and healthy subjects. However, the OSI values of cancer survivors were significantly lower than those of healthy subjects (p = 0.01). In cancer survivors, grip strength and knee extensor strength were correlated with lean body mass (p < 0.05), skeletal muscle mass (p < 0.05), and OSI (p < 0.05). In cancer survivors, TUG was negatively correlated with OSI (p < 0.05). In healthy subjects, grip strength was correlated with lean body mass (p < 0.05) and skeletal muscle mass (p < 0.05). Conclusions Physical function is related to body composition and bone status in cancer survivors more than in healthy subjects. We suggest the importance of physical exercise to increase physical function. This intervention could dramatically improve body composition and bone status in cancers.

eP484 R E L AT I O N S H I P B E T W E E N M U S C L E O X I D AT I V E METABOLISM AND MUSCLE STRENGTH IN PATIENTS WHO RECEIVE ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION S. Morishita1, T. Wakasugi2, K. Kaida3, Y. Itani2, K. Sota2, K. Ikegame3, H. Ogawa3, K. Domen4 1 Niigata University of Health and Welfare, Institute for Human Movement and Medical Sciences, Niigata City, Japan 2 Hyogo College of Medicine Hospital, Department of Rehabilitation, Nishinomiya, Japan 3 Hyogo College of Medicine, Division of Haematology- Department of Internal Medicine, Nishinomiya, Japan 4 Hyogo College of Medicine, Department of Physical Medicine and Rehabilitation, Nishinomiya, Japan Introduction Patients who receive allogeneic hematopoietic stem cell transplantation (allo-HSCT) are known to develop decreased knee extensor muscle strength. Near-infrared spectroscopy (NIRS) has been widely used to monitor muscle oxidative metabolism. Objectives The purpose of this study was to investigate the relationship between knee extensor muscle strength due to impaired nutrition and muscle oxidative metabolism in patients who receive allo-HSCT. Methods This study included 18 male patients who received allo-HSCT between January 2010 and July 2012 at the Hyogo College of Medicine Hospital in Japan. This study was approved by the Human Research Ethics Committee of Hyogo College of Medicine, and written informed consent was obtained from all participants. Knee extensor muscle strength was assessed with a hand held dynamometer at maximum voluntary contraction. Muscle oxygen saturation (SmO2) levels as a parameter of muscle oxidative metabolism were measured continuously and noninvasively in the tibialis anterior muscle by using NIRS (BOM-L1TRW, Omegawave Inc., Japan). Nutritional status was assessed by albumin levels (Alb). Results Maximum knee extensor muscle strength was associated with maximum amplitude of SmO2 following the contraction phase (ΔSmO2max) and Alb (ΔSmO2max: r = 0.604 P = 0.008, Alb: r = 0.571 P = 0.013, respectively)

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Conclusions Skeletal muscle strength was associated with muscle oxidative metabolism and nutritional status after allo-HSCT. Physiotherapists may need to promote muscle oxidative metabolism through exercise in order to maintain muscle strength.

eP485 PULMONARY FUNCTION AND HEALTH-RELATED QOL IN SURGICALLY-TREATED PATIENTS WITH MALIGNANT PLEURAL MESOTHELIOMA S. Morishita1, T. Tanaka2, M. Hashimoto3, S. Hasegawa3, K. Domen4 1 Niigata University of Health and Welfare, Institute for Human Movement and Medical Sciences, Niigata, Japan 2 Hyogo College of Medicine Hospital, Department of Rehabilitation, Nishinomiya, Japan 3 Hyogo College of Medicine, Department of Thoracic Surgery, Nishinomiya, Japan 4 Hyogo College of Medicine, Department of Physical Medicine and Rehabilitation, Nishinomiya, Japan Introduction Malignant pleural mesothelioma (MPM) is a rare cancer that affects the thin cell wall lining of internal organs and structures. In previous research, pulmonary function and health-related quality of life (HRQOL) in surgically-treated MPM patients have not been evaluated in detail. Objectives The aim of this study was to assess pulmonary function and HRQOL in MPM patients following pleurectomy/decortication (P/D). Methods The subjects were 22 MPM patients (20 men) who underwent P/D between December 2013 and March 2015. Pulmonary function tests included forced expiratory vital capacity (FVC) and forced expiratory volume in one second (FEV1). HRQOL was assessed using the Medical Outcome Study 36-item Short Form Health Survey (SF-36). Results FVC and FEV1 values following P/D decreased significantly compared to baseline. Additionally, scores in 3 of the 8 SF-36 domains were significantly lower following P/D: physical functioning (P<0.001), body pain (P=0.002), and vitality (P=0.005). Significant correlations were also observed between FEV1 and Physical (P<0.05) and Social functioning (P<0.05). Conclusions Patients with MPM who completed P/D have decreased pulmonary function and HRQOL. Physicians, nurses, and rehabilitation staff should note these findings, which may provide insight into the development of customized rehabilitation strategies for patients with MPM who undergo P/D.

eP486 ONCOLOGY CARE PROVIDERS' PERSPECTIVES ON EXERCISE IN PEOPLE WITH CANCER: AN EXAMINATION OF KNOWLEDGE, PRACTICES, BARRIERS, AND FACILITATORS M. Nadler1, D. Bainbridge2, J. Tomasone3, O. Cheifetz4, R.A. Juergens5, J. Sussman6 1 McMaster Michael G DeGroote School of Medicine, General Internal Medicine, Hamilton Ontario, Canada 2 Juravinski Cancer Centre JCC, Oncology, Hamilton, Canada 3 Queen's University, School of Kinesiology and Health Studies, Kingston, Canada 4 Hamilton Health Sciences, Oncology, Hamilton, Canada 5 Juravinski Cancer Centre JCC, Medical Oncology, Hamilton, Canada 6 Juravinski Cancer Centre JCC, Radiation Oncology, Hamilton, Canada

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Introduction Despite the reported benefits of physical activity in alleviating the impact of cancer and its treatments, oncology care providers (OCPs) are not routinely discussing exercise with their patients, suggesting a Knowledge to Action gap. Objectives We sought to determine OCP’s knowledge, beliefs, barriers, and facilitators to exercise discussion. Methods A survey was administered to all OCPs including physicians, nurses, radiation therapists, and allied health practitioners at the comprehensive cancer center in Hamilton, Canada. Questions comprised of demographics, knowledge and beliefs regarding exercise guidelines, and barriers and facilitators to exercise discussion. Analysis of survey responses was descriptive. Pearson's chi-squared tests were used to examine select associations. Results There were 120 respondents (61% response rate) representing a diversity of professions. Approximately 80% of OCPs were not aware of any exercise guidelines in cancer and self-reported poor knowledge on when, how, and which patients to refer to exercise programs. OCPs who reported meeting Canada’s Physical Activity guidelines were significantly more likely to identify correct guidelines (p=0.023) and to report good knowledge on how to provide exercise counseling (p=0.014). Across OCP groups, barriers to exercise discussion included poor knowledge, lack of time, and safety concerns. Most felt that educational sessions and having an exercise specialist on the clinical team would be beneficial. Conclusions OCPs have low knowledge regarding exercise guidelines and counseling, but believe that discussing exercise is a multi-disciplinary task and expressed a desire for further training. Interventions will require a multi-pronged approach including education for OCPs and guidance on assessment for exercise safety.

eP487 INCREASED RESTING HEART RATE MAY INDICATE PHYSICAL DYSFUNCTION, MALNUTRITION, AND POOR PROGNOSIS IN ELDERLY PATIENTS WITH ADVANCED NON-SMALL-CELL LUNG CANCER T. Okayama1, T. Naito2, T. Aoyama3, A. Morikawa4, Y. Masuda1, T. Ishii1, N. Mitsuhashi1, H. Murakami2, K. Omae5, K. Mori5, T. Takahashi2, A. Tanuma1 1 Shizuoka cancer center, Division of Rehabilitation Medicine, Shizuoka, Japan 2 Shizuoka cancer center, Division of Thoracic Oncology, Shizuoka, Japan 3 Shizuoka cancer center, Division of Nutrition, Shizuoka, Japan 4 Shizuoka cancer center, Department of Nursing, Shizuoka, Japan 5 Shizuoka cancer center, Clinical Research Center, Shizuoka, Japan Introduction Patient with advanced cancer may suffer from malnutrition which causes physical dysfunction. Resting heart rate (HR) was reported to reflect physical capacity and was associated with mortality in advanced cancer patients. Objectives The aim of this study is to explore the relationship between resting HR and physical function, nutritional status, and lean body mass in elderly patients with advanced non-small-cell lung cancer (NSCLC). Methods Patients aged >=70 years with advanced NSCLC (stage III-IV) were prospectively enrolled. Hand-grip strength in dominant side (HGS, kg), incremental shuttle walking distance (ISWD, m), lean body mass (LBM, kg), and nutritional status assessed by Mini Nutritional Assessment (MNA, point) were measured before initiation of radiotherapy or

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chemotherapy. LBM was estimated by lumbar computed tomography analysis. Association was analyzed using linear regression. Results Among 60 patients (17 women and 43 men) enrolled from Jan. 2013 to Nov. 2014, median age was 76 (range, 70-89) years. The mean ±SD resting HR was 74±13 bpm. Resting HR was negatively associated with HGS (β = -0.2, p=0.004), ISWD (β = -2.95, p=0.003), LBM (β = -0.2, p=0.0006), and MNA (β = -0.1, p=0.006). Patients with resting HR of <74 bpm had longer median survival time than those with >=74 bpm (22 vs 16 months, log-rank test p =0.0092). Conclusions Resting HR negatively associated with nutritional status, muscle mass, muscle strength, and walking capacity. The resting HR at diagnosis of cancer might be an useful biomarker for predicting physical function, nutrition, and prognosis in elderly patients with advanced NSCLC. (Clini cal Trials Registry No.UMIN000009768)

eP488 THE IMPACT OF PHYSICAL EXERCISE AND NUTRITION I N T E R V E N T I O N S I N PAT I E N T S U N D E R G O I N G RADIOTHERAPY FOR HEAD AND NECK CANCER: A SYSTEMATIC REVIEW J.A. Sandmæl1, A. Bye2, L. Thorsen3 1 LHL-klinikkene, Fou, Røros, Norway 2 Oslo and Akershus University College of Applied Sciences, Nursing and Health Promotion, Oslo, Norway 3 Department of Oncology, Oslo University Hospital, Oslo, Norway Introduction Patients with head and neck cancer (HNC) experience unintentional weight loss, muscle wasting and decreased quality of life throughout the treatment trajectory Objectives The overall aim of the present systematic review was to summarise and evaluate the scientific literature on clinical interventions consisting of physical exercise and/or nutrition during treatment for patients with HNC. Methods In June 2016 a search in MEDLINE (PubMed interface), EMBASE (Ovid interface), CINAHL (EBSCO interface) and Cochrane Library (Wiley interface) was conducted. The searches consisted of combinations of controlled terminology and free-text terms expressing the concepts (a) head and neck cancer and (b) exercise and (c) nutrition, adapted to each specific database. The inclusion criteria were: (1) prospective clinical trial design (randomised controlled trials, quasi-RCTs, cohort studies, pre-post studies and case control studies), (2) patients aged 18 years or more with a confirmed head and neck cancer diagnosis and starting active cancer treatment at trial entry, (3) repetitive physical exercise (> 1 session) consisting of muscle strength exercises or aerobic exercises or a combination of both, (4) nutrition interventions consisting of diet counselling, oral nutrition supplements or enteral nutrition alone or in combinations and (5) published in peer reviewed journals and written in English language Results The database searches retrieved 1681 records, and reduced to 220 records after removal of duplicates and exclusion of irrelevant records by title. After screening of abstracts, 23 records were screened in full-text Conclusions We are currently analysing full-text and will present and submit the results before May 3rd

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eP489 FEASIBILITY OF HOME VS. HOSPITAL BASED RESISTANCE TRAINING FOR ADVANCED CANCER PATIENTS: A PHASE II TRIAL C. Ribeiro1,2, P. Correia3, R. Santos4, B. Gomes2,5 1 Centro Hospitalar de Lisboa Central, Medical Oncology, Lisboa, Portugal 2 King's College of London, Department of Palliative Care- Policy & Rehabilitation Cicely Saunders Institute, London, United Kingdom 3 The Strength Clinic, Performance Specialist, Lisboa, Portugal 4 Centro Hospitalar de Lisboa Central, Physiotherapy and Rehabilitation, Lisboa, Portugal 5 University of Coimbra, Faculty of Medicine, Coimbra, Portugal Introduction Resistance training is an effective way to increase muscle mass but little is known about its role to prevent sarcopenia in advanced cancer. Furthermore, the preferred setting for this training is not known, and considering home is frequently the place of care and death preferred by cancer patients, it is important to find out whether this would also be the best scenario for training as opposed to the most common one, hospitals. Objectives We aimed to test if resistance training at home and in hospital are bothfeasible (primary outcome) and safe, with a view to inform a phase III trial. Methods Phase II randomised controlled trial including adults (≥18) with incurable solid tumours, randomised into one of three arms: 1. Supervised resistance training at home; 2. Supervised resistance training at the hospital; 3. Standard of care with information leaflet. Both training programs were similar, one-to-one with therapists, planned to last 12 weeks (3 sessions/ week). Feasibility included adherence (proportion of completed sessions) and acceptability (proportion of completed exercises within sessions), compared using Fisher’s test. ClinicalTrials.gov Identifier: NCT02930876 Results We included 15 patients (53.3% men, median age 68), 5 per arm. The home intervention had higher adherence (49% vs. 9% in hospital; p<0.001). Acceptability was similar (93% in home and 95% in hospital; p=0.179). No adverse events were recorded. Conclusions Resistance training is a safe intervention, more feasible at home than in hospital in advanced cancer. Ways to increase adherence to the home intervention could further improve its potential benefit.

eP490 REHABILITATION NEEDS FOR PEOPLE WITH ADVANCED LUNG CANCER - THE PATIENT'S PERSPECTIVE J. Roe1,2, C. Sandsund1,3, S. Popat4,5, T. Wiseman6,7, C. Shaw1 1 The Royal Marsden NHS Foundation Trust, Therapies Department, London, United Kingdom 2 Imperial College London, Department of Surgery and Cancer, London, United Kingdom 3 University of Southampton, Faculty of Health Sciences, Southampton, United Kingdom 4 The Royal Marsden NHS Foundation Trust, Lung Unit, London, United Kingdom 5 National Heart and Lung Institute, Molecular Genetics and Genomics Group, London, United Kingdom 6 The Royal Marsden NHS Foundation Trust, Department of Applied Health Research, London, United Kingdom 7 University of Southampton, Department of Health Sciences, Southampton, United Kingdom

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Introduction People with advanced lung cancer often experience significant symptom burden and limited median survival time. There is little evidence to understand the patient’s perspective of their rehabilitation needs. Objectives To explore the rehabilitation needs of people with advanced lung cancer at a tertiary cancer centre. Methods We conducted a qualitative study using a grounded theory approach. Discussions with our Patient and Carer Research Review Panel, rehabilitation specialists and oncologists informed the study design. Following ethical approval, eligible participants were approached and interviews were offered following informed consent. Theoretical sampling was used and data were analysed using a constructivist approach. Interview data were transcribed then coded by the first and second authors, and a third verified the analysis. Results Emotional and psychological concerns were frequently expressed that had not been shared previously with clinical teams. Participants reported limited contact with rehabilitation services despite indicating needs. Participants managed their own decline when they could and had difficulty finding reliable support for their rehabilitation and supportive care needs. The lack of holistic support from providers and inconsistencies in care were perceived as burdensome. Those who had accessed hospice care expressed less uncertainty and fear for the future. Those receiving targeted therapies reported fewer cancer-related symptoms. However, increased treatment burden and uncertainty regarding treatment effectiveness and prognosis was voiced. Conclusions Our study highlights how patients create their own social and information networks in spite of healthcare systems. Flexible, holistic, supportive care and information, in a variety of formats, should be available from diagnosis and implementation should be patient-led.

eP491 R E S I S TA N C E T R A I N I N G A N D N U T R I T I O N A L SUPPLEMENTS DURING RADIOTHERAPY J. Sandmæl1, L. Oldervoll2 1 LHL-klinikkene, Røros, RØROS, Norway 2 LHL-klinikkene, Oslo, RØROS, Norway Introduction Patients with head and neck cancer (HNC) experience involuntary weight loss before, during and after treatment. Severe weight loss has a negative impact on survival, morbidity and physical function, and interventions with physical exercise and nutrition can potentially counteract declines in body weight. Objectives The primary aim of the present study was to evaluate the feasibility of resistance training and ONS during radiotherapy treatment, by tracking recruitment, attendance, adherence and attrition rates. The secondary aim was to assess preliminary intervention effects on skeletal muscle mass, body weight, physical function and quality of life. Methods Patients diagnosed with HNC were included prior to treatment and randomised to an exercise and nutrition intervention during or after radiotherapy. The intervention during radiotherapy was conducted in a training facility at the hospital for six weeks, and the intervention after radiotherapy carried out at a rehabilitation centre for three weeks. The interventions consisted of

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progressive resistance training (PRT) and oral nutritional supplements (ONS). Preliminary efficacy outcomes on muscle mass, body weight and physical function were measured prior to start of radiotherapy (week -4 to 0), at the end of radiotherapy (week 6-7) and at 2 months follow-up (week 14-16). Results Efficacy-outcomes are currently being analysed. Conclusions Efficacy-outcomes are currently being analysed.

eP492 CURRENT STATUS OF CANCER REHABILITATION AT D E S I G N AT E D C A N C E R C E N T E R H O S P I TA L S THROUGHOUT JAPAN T. Tsuji1, R. Sekine2, K. Mori3, E. Nakata4, H. Sato5, A. Tanuma6, J. Kawakami7, H. Kagaya8 1 Keio University School of Medicine, Department of Rehabilitation Medicine, Tokyo, Japan 2 Kameda Medical Center, Department of Pain and Palliative Care, Kamogawa, Japan 3 Shizuoka Cancer Center, Clinical Research Center, Nagaizumi, Japan 4 National Hospital Organization Shikoku Cancer Center, Department of Rehabilitation, Matsuyama, Japan 5 Saitama Medical University International Medical Center, Division of Gastrointestinal Surgery, Hidaka, Japan 6 Shizuoka Cancer Center, Division of Rehabilitation Medicine, Nagaizumi, Japan 7 Shiga Medical Center for Adults, Department of Rehabilitation Medicine, Moriyama, Japan 8 School of Medicine- Fujita Health University, Department of Rehabilitation Medicine, Toyoake, Japan Introduction Cancer patients often develop physical impairments caused either by the cancer itself or its treatment. As a result of these impairments, a decline is seen in activities daily living (ADL) and QOL. Threfore comprehensive rehabilitation services should start when patients are first diagnosed with cancer and continue through treatment and beyond. However, cancer control programs in Japan still lack comprehensive support that covers all aspects of treatment, including QOL. Objectives This study aimed to determine the current status of cancer rehabilitation at designated cancer center hospitals throughout Japan. Methods Rehabilitation group leaders at 427 designated cancer center hospitals were surveyed using a questionnaire between November and December 2016. The main outcomes comprised rates of inpatient and outpatient cancer rehabilitation services. Results We received 188 (44.0%) responses. There were a mean number of 28.6 physical, occupational, and speech therapists at each hospital. Among them, only 37.8% were certified for cancer rehabilitation (mean, 10.8). Inpatient and outpatient cancer rehabilitation services were provided at 88.9% and 24.0% of the cancer centers, respectively. Among the respondents, 71.0% answered that better outpatient cancer rehabilitation is needed. Conclusions The need for outpatient cancer rehabilitation at cancer center hospitals is not being met, perhaps because of the scarcity of highly skilled therapists who specialize in cancer rehabilitation, the lack of outpatient cancer rehabilitation educational program, the limiting charge for outpatient rehabilitation services, and so on.

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eP493 EFFECTS OF PALLIATIVE REHABILITATION ON THE FUNCTIONAL STATE, SYMPTOMS AND QUALITY OF LIFE OF PATIENTS WITH ADVANCED CANCER IN PALLIATIVE CARE: A PILOT STUDY E. VERASTEGUI-AVILES1, S. ALLENDE PEREZ1, A. Roeniger1 1 instituto nacional de cancerologia, cuidados paliativos, mexico city, Mexico Introduction Physical deterioration and symptomatic burden associated with advanced cancer are significant problems for patients because of quality of life impairment. This loss of functionality is one of the most significant symptoms for patients in Palliative Care (PC) because it creates a sense of disability and greater vulnerability. Objectives To evalute the feasibility of palliative rehabilitation (PR) IN PC patients Methods Pilot study implementing two sessions of physical therapy twice weekly. Pre-and post changes in functionality, symptoms and quality of life were measured using the Wilcoxon test. P value of 0.05 or less was used to determine statistical significance. Results Twelve patients were included. Statistically significant changes were observed in functionality (6MWT distance p = 0.005, Karnofsky p = 0.016, ECOG p = 0.031 and FIM p = 0.043); symptoms (fatigue p = 0.007, wellbeing p = 0.041, dyspnea p = 0.042 and pain p = 0.042) and quality of life (perception of health status p = 0.003, mobility p = 0.008, pain / discomfort and self-care p = 0.034). Conclusions Rehabilitation Medicine brings great benefits in functionality, symptoms relief and quality of life in patients with advanced cancer. Integrative medicine of PC groups should include this type of physical therapy and rehabilitation to improve quality of life as it is a feasible and potential intervention in the management of functional decrease and symptomatic burden.

eP494 FACTORS ASSOCIATED WITH MODERATE TO SEVERE DYPSNEA IN PATIENTS WITH ADVANCED CANCER M. Hwang1, S. Chan2, L. Zhang2, M. Tsao2, C. Danjoux2, T. Barnes2, R. McDonald2, L. Rowbottom2, P. Zaki2, A. Wan2, E. Chow2 1 , Toronto, Canada 2 Sunnybrook Health Science Centre, Odette Cancer Centre, Toronto, Canada Introduction Introduction: More than 70% of patients with advanced cancer experience dyspnea. Dyspnea is prognostic of shorter survival and interferes with quality of life. Objectives Objective: To examine the predictors for moderate/severe dyspnea in patients with advanced cancer. Methods Methods: A retrospective review was conducted with Edmonton Symptom Assessment System (ESAS) and patient activity level on the Patient Reported Functional Status (PRFS) survey (scale from 0-4 with 0 being normal activity). Dypsnea was classified as mild (1-3), moderate (4-6) and severe (7-10). Multivariable generalized estimating equations (GEE) were used to assess the association between various patient factors (such as pulse oximetry, smoking history, respiratory problems) with moderate to severe dyspnea over time since first visit.

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Results Results: 182 patients with 263 visits (58% male, 50% smokers, 11% with prior respiratory problems, 25% inpatients) were included in this study. Median age was 70.5 years, median KPS was 70, and median oxygen saturation at room air (O2 Sat) was 96%. 23.3% had moderate to severe dyspnea. Patients with low O2 Sat <90% [OR=6.2, p=0.004], lung metastases [OR=3.5, p=0.0006], and a PRFS score ≥3 [OR=2.4, p=0.01] were associated with moderate to severe dyspnea; and these patients also tended to be more tired [OR=5.1, p=0.003], worse appetite [OR=3.9, p=0.0003], and more drowsy [OR=2.2, p=0.03]. Conclusions Conclusion: Patients with low O2 Sat <90%, lung metastases and a PRFS score≥3 have moderate to severe dyspnea, which in turn are associated with increased tiredness, drowsiness and worse appetite.

eP495 THE EFFICACY OF COMBINATION THERAPY WITH VA R E N I C L I N E A N D B U P R O P I O N F O R S M O K I N G CESSATION D. Johns1 1 DM Wayanad Institute Of Medical Science, Clinical Research, Meppady, India

Introduction Combined pharmacotherapies to treat tobacco dependence may increase smoking abstinence Objectives E v a l u a t e sm o k i n g a b s t i n e n c e b y u s i n g B u p r o p i o n a n d Varenicline Methods 300 smokers were enrolled Group 1 Bupropion (150 mg twice daily) Group 2 Varenicline (1 gm twice daily) Group 3 Varenicline + Bupropion (1 gm twice daily+ 150 mg twice daily) for 12 weeks. The primary outcome was carbon monoxide-confirmed continuous abstinence rates (CAR). Nicotine dependence was with 6-item Fagerstrom Test for Nicotine Dependence scores ≥ 6 indicate high dependence. Minnesota Nicotine Withdrawal Scale was used to assess withdrawal symptoms. Results Subjects in the group 1,2 and 3 (n = 100 each) were comparable in age, smoking history, number of daily cigarettes, and nicotine dependence. After the treatment there was reduced cigarette cravings (17.5 ± 1.1vs 15 ±3 vs 13.1 ± 1) and total nicotine withdrawal symptoms (17.8 ± 4.3 vs 15.4 ± 5.1 vs13.2 ± 2.1) during the treatment period. As compared to B and VR monotherapy ,VR+B produced significant increases in CAR at 6 months (OR, 1.63; CI, 1.10-2.20, OR, 1.52; CI, 1.00-2.30 and OR, 1.72; CI, 1.06-2.67, respectively); results were similar, but somewhat stronger, when 7PP was used at 10 weeks (OR, 1.69; CI, 1.05-2.53,OR, 1.57; CI, 1.03-2.41 and OR, 1.82; CI, 1.09-2.83, respectively) All medications were well tolerated, but participants in the VR groups experienced more fatigue, digestive symptoms (e.g., nausea, diarrhea), sleep-related concerns ( abnormal dreams, insomnia). The frequency of serious adverse events did not differ between groups. Conclusions Dual medication was found to enhance success in early phases of quitting.

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eP496 EFFICACY AND SAFETY OF VISCUM ALBUM TO TREAT MALIGNANT PLEURAL EFFUSION Y.G. Lee1, J. Inha1, D.H. Koo1, S. Oh1, S.S. Lee1 1 Kangbuk Samsung Hospital, Internal Medicine, Seoul, Republic of Korea Introduction Regarding symptomatic malignant pleural effusions (MPE), local therapies including pleurodesis and treatment of primary malignancy are required to alleviate dyspnea and/or pleuritic pain. Helixor-M made from European mistletoe (Viscum album) has been used as adjuvant anticancer treatment by boosting immune system. We have used Helixor-M as sclerosing agent for pleurodesis to control MPE. Objectives To evaluate efficacy and safety of Helixor-M to control MPE Methods Between 2009 and 2015, we consecutively enrolled 52 patients with lung cancer who were treated with Helixor-M for MPE and analyzed retrospectively. For pleurodesis, we instilled 100mg of Helixor-M via pleural catheter at Day 1. After 3-hour of frequent repositioning we drained residual pleural fluid. If prior procedures were not effective, we repeated this procedure up to 5 times every second day with increasing dose by 100mg. Our primary study outcome was reappearance of pleural effusion 1-month after pleurodesis. Results The median age was 63 years and 77% were male. Among 52 patients, 69% were adenocarcinoma, followed by squamous cell (13%), not otherwise specified (10%), and small cell lung cancer (8%). About 85% of MPE were cytogenetically malignant. Among 52 patients, 39 (75%) were evaluable for recurrence of MPE. The 1-month recurrence rate was 49% (19/39). Among 19 patients who experienced recurrent MPE, 6 required recurrent pleural drainage. One fourth of patients experienced significant pain after pleurodesis. Only 15% of patients experienced fever. Conclusions Our results suggest that a pleurodesis with Helixor-M was effective and tolerable procedure to control MPE in lung cancer patients.

eP497 PNEUMONITIS AND OTHER PULMONARY INFILTRATIONS ASSOCIATED WITH NIVOLUMAB TREAT MENT IN PRETREATED PATIENTS WITH NON-SMALL CELL LUNG CANCER B.L. Rapoport1, T. Smit2, R. Van Eeden3 1 The MedicalOncology Centre of Rosebank, Department of Oncology, Johannesburg, South Africa 2 The Medical Oncology Centre of Rosebank, Medical Oncology, Johannesburg, South Africa 3 The Medical Oncology Centre of Rosebank, Department of Oncology, Johannesburg, South Africa Introduction Nivolumab, a fully human IgG4 programmed death 1 (PD-1) immunecheckpoint-inhibitor antibody, disrupts PD-1-mediated signaling and may restore antitumor immunity in NSCLC patients. Pneumonitis is a complication associated with this agent. Objectives Describe pulmonary abnormalities associated with nivolumab treatment in NSCLC patients. Methods Retrospective data review. Results A total of 18 patients (pts) (10 males and 8 females) were included in the analysis. The median age was 66 years (range 46-85). Adenocarcinoma

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was documented in 15 pts and squamous cell carcinoma in 3 pts. All pts failed frontline treatment: 14 pts failed platinum based chemotherapy and 4 pts failed TKI-inhibitors (3 on erlotinib and 1 on crizotinib). Pts received a median of 4 cycles of nivolumab (range 1-16). The median ECOG performance status was 1 (range 0-2). The median number of metastatic sites was 3 (range 1-5). Documented toxicities included pneumonitis in 2 pts (responded to corticosteroids), chest infections in 3 pts, opportunistic infection in 1 pt (documented pulmonary tuberculosis). Other pulmonary abnormalities were primarily due to disease progression. Conclusions Pneumonitis and other pulmonary abnormalities are complications associated with nivolumab treatment. A variety of noninfectious and infectious conditions can lead to pulmonary infiltrates in these patients. Pneumonitis differential diagnosis in these patients includes: lymphangitis carcinomatosa, disease progression, other opportunistic infections, disease pseudo-progression and pleural effusion due to metastatic disease. Diagnostic evaluation of pulmonary infiltrates will require additional noninvasive investigations including high resolution CT Scan and serological studies. Others may require invasive studies such as fiberoptic bronchoscopy and bronchoalveolar lavage, and surgical lung biopsy.

eP498 A CASE OF SEVERE RECURRENT DERMATOMYOSITIS DUE TO TESTICULAR CANCER R. Boparai1 1 North Shore University Hospital/Northwell Health, Hospital Medicine, Manhasset, USA Introduction Dermatomyositis (DM) can present as a paraneoplastic syndrome associated with an underlying malignancy. This has been reported most commonly in ovarian, lung, and colorectal cancers. In most cases, DM improves as the cancer is being treated. Objectives We present a case of severe recurrent DM flares that presented after successful treatment of testicular cancer with orchiectomy and chemotherapy. Methods A 22 year-old-male with recently treated non-seminomatous testicular cancer with right radical orchiectomy and chemotherapy was admitted with worsening facial swelling, erythema, dysphagia and hoarseness. A recent shave biopsy of his rash had shown superficial perivascular infiltrate of lymphocytes consistent with dermatomyositis. The patient received high dose steroids and two doses of IVIG with improvement in his symptoms and was discharged two days later. He returned to the hospital after one month for another dermatomyositis excacerbation characterized by significant myopathy with distal, proximal and bulbar weakness. He was unable to ambulate or swallow and was intubated for hypoxemic respiratory failure due to epistaxis. A PEG tube was placed for severe dysphagia. Results His respiratory status subsequently improved and he was successfully extubated. He was given Rituximab given frequent exacerbations and was scheduled to receive regular IVIG at an outpatient infusion center. No evidence of cancer recurrence was found during admission. Conclusions This case highlights the importance of recognizing various temporal presentations of cancer related dermatomyositis and to remain vigilant for possible dermatomyositis even after successful treatment of the underlying cancer.

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eP499 EFFECTIVENESS OF LAWSONIA INERMIS (HENNA) FOR T H E M A N A G E M E N T O F PA L M A R - P L A N TA R ERYTHRODYSESTHESIA: PRELIMINARY RESULTS FROM A RANDOMISED CONTROLLED TRIAL A. Charalambous1, G. Astras2, M. Stavrinou2, L. Paikousis3 1 Cyprus University of TEchnology, Nursing, Limassol, Cyprus 2 American Medical Centre, Oncology Department, Nicosia, Cyprus 3 Improvast Analytical Services Company, Biostatistics, Nicosia, Cyprus Introduction Palmar-plantar erythrodysesthesia-PPE is a skin toxicity that has a common association with drugs such as liposomal doxorubicin and fluorouracil. PPE is not life threatening but can be very debilitating and impair patients’ quality of life. The management for PPE includes treatment interruption, lengthening the interval between drug administrations, or dose reduction of the cytotoxic agent. Objectives To test the effectiveness of a henna treatment protocol in the management of capecitabine and/or pegylated liposomal doxorubicin induced palmarplantar erythrodysesthesia. Methods This is a randomized double-blind, placebo-controlled study (NCT01751893) with 80 patients assigned either to treatment (n=40) or control group (n=40). Outcome measures include PPE grade, EORTC QLQ-C30, HFS-14 and ECOG at pre (T0) and post (T1-3 weeks, T2weeks, T3-5weeks) intervention. The treatment includes the application of henna (40gr natural henna and 40ml of purified water) to the affected areas (feet or/and hands) twice a week. Results Significant differences of mean were found in the PPE Grade between T0 and T1, T2 and T3 in the two groups (mean PPE was 1.24, 1.25, 1.05, 1.00 in the henna group versus 1.25, 1.30, 2.15, 2.20). The mean HFS-14 score was significantly higher in patients in the control group compared to those in the intervention group. The higher the HFS-14 score, the greater the QoL impairment. In the EORTC QLQ-C30, there was a statistically significant difference between T0 measurement and T3 (p<0.001). Conclusions The preliminary findings showed the henna was more effective to reduce the PPE grade compared to the placebo. eP500 X O N R I D ® A S P R E E M P T I V E T R E AT M E N T F O R RADIATION-INDUCED DERMATITIS IN HEAD AND NECK CANCER PATIENTS RECEIVING CURATIVE TREATMENT: UPDATE N.A. IACOVELLI1, S. NAIMO1, F. BONFANTINI2, A. CAVALLO2, P. BOSSI3, C. FALLAI1, E. PIGNOLI2, S. ALFIERI3, C. BERGAMINI3, E. ORLANDI1 1 Fondazione - IRCCS -Istituto Nazionale Tumori, Radiation Oncology 2, Milano, Italy 2 Fondazione - IRCCS -Istituto Nazionale Tumori, Medical Physics, Milano, Italy 3 Fondazione - IRCCS -Istituto Nazionale Tumori, Medical Oncology 3, Milano, Italy Introduction There is no gold-standard approach in the prevention and management of radiotherapy (RT)-induced dermatitis. Objectives To investigate safety, tolerability and efficacy of Xonrid® as preemptive treatment of radiation-induced dermatitis in head and neck cancer (HNC) radiotherapy. We also assessed late skin toxicity.

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Methods We prospectively enrolled adult consecutive HNC patients who were planned to receive curative RT with or without chemotherapy at our Institution. Xonrid® had to be applied on the irradiated area during treatment continuing until 2 weeks after the completion of RT or the development of severe skin toxicity. Toxicity was assessed with Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 scale as physician assessment and with Skindex-16 questionnaire and patient satisfaction as patient reported outcome measures. Objective evaluation of dermatitis was performed using skin reflectance measurements. Results Forty-one patients were enrolled overall (30 males, 11 females, median age 60 years). No skin adverse events were recorded over the entire period of administration. At the end of RT, 9 patients (22%) presented G1, 31 (76%) G2, and one patient (2%) G3 skin toxicity (after 5 weeks). With Xonrid® use a delay in the development of G2 toxicity was observed compared to historical controls. An increasing trend of median spectrophotometry scores along with skin toxicity grades was observed. We found a correlation between Skindex-16 scores and skin toxicity grade during treatment. No skin fibrosis was detected at 12 months follow up. Conclusions Xonrid® is safe, well tolerated and effective in reducing high grades of RT-induced skin toxicity in HNC patients.

eP501 CUTANEOUS REACTIONS TO CHEMOTHERAPY IN BREAST CANCER: DOLICHOL AS A RISK GROUP MARKER. G. Kuznecova1, S. Kuznecovs1 1 Institute of Preventive Medicine, Supportive Care, Riga, Latvia Introduction The resent results are in favour of the idea that N- glycoprotein synthesis is limited by Dolichyl Phosphate Cycle (DPC), which is a target for chemotherapy and essential in maintaining mucocutaneous resistance and immunity. This dual role is important in prediction and prevention of chemotherapy-induced skin disoders. Objectives With focus on a risk group marker for cutaneous side effects of cancer chemotherapy, the present study was carried out to estimate Dolichol (Dol) metabolism in patients treated with cytostatic agents. Methods The samples obtained from 316 patients with breast cancer before and during treatment with cisplatin, cyclophosphamide, docetaxel, doxorubicin and trastuzumab. Dol in urine was assayed by HPLC. Dolichol phosphate N-acetyl-glucosamine-1 levels. phosphate transferase (GPT) activity was defined in dermal fibroblasts by method with [2-(3)H]-mannose. Results During the period of observation 92 (20,2%) of cancer patients were presented with different skin reactions, including flushing, urticaria, dermatitis, erythema, pruritus and acne. From this group of patients 76 (82,6%) have had elevated urinal Dol excretion (> 20,8 mkg/mmol) 2 weeks before chemotherapy and 87 (94,6%) during and 2 weeks after chemotherapy. GPT activity was reduced to approximately 88,6-99,8% of normal levels. Conclusions There is a reason to suggest that reduced GPT activity, lowered Nglycoprotein synthesis and elevated urinary Dol detected in this group of patients may evidence of the disorders of DPC and possible susceptibility to the development of chemotherapy-induced cutaneous reactions. Elevated urinary Dol is one of the first manifestations of this disorder which could be prevented by breast cancer patients selection and DPC regulation

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eP502 INCREASED INCIDENCE AND SEVERITY OF C A P E C I TA B I N E R E L AT E D S K I N T O X I C I T Y I N METASTATIC BREAST CANCER PATIENTS WITH LIGHT SKIN TYPE R. MATEI1, A. ENIU1, T. TOROK2 1 "ION CHIRICUTA " INSTITUTE OF ONCOLOGY, DAY HOSPITAL UNIT, CLUJ NAPOCA, Romania 2 "ION CHIRICUTA " INSTITUTE OF ONCOLOGY, HEMATOLOGY UNIT, CLUJ NAPOCA, Romania Introduction Skin toxicity is a frequent and disabling side effect of Capecitabine given as palliative chemotherapy for metastatic breast cancer patients. Objectives To demonstrate that skin toxicities are more frequent and more severe in light skin patients receiving Capecitabine for metastatic breast cancer. Methods 41 metastatic breast cancer patients were included in this study. They all received Capecitabine in metastatic setting, between 2013 and 2016. The skin type was assessed using Fitzpatrick scale, which classifies skin types in 6 categories- varying from type 1 (very light skin) to type 6 (dark brown). None of our patients had 4, 5 or 6 skin type. 24 of patients (60%) had light skin ( type 1+2 ), while 17 of them ( 40%) had fair skin (type 3). We assessed any types and any grades of skin toxicity occuring during Capecitabine treatment. Results A total of 15 patients ( 36,58%) developed skin toxicity, varying from grade 1 to grade 4. Incidence was increased in the light skin type group (10 from 17-58,8 %) versus type 3 skin group ( 5 from 24-20,83%). Among those 15 patients with skin toxicity, frequency of grade 3 side effects was increased in light skin patients: 4 from 17-23,5%, versus type 3 patients: 1 from 24-4,1 %. Conclusions Capecitabine related skin toxicity is more frequent in light skin patients. It impaires with patients' quality of life and treatment, implying dose reductions or delays.Those patients need special attention and preventive measures, with early intervention if skin toxicity occurs.

eP503 CANCER PATIENTS' PERCEPTIONS OF CONTINUED SMOKING AND SMOKING CESSATION D. Alton1,2,3,4, L. Eng1,4, L. Lu1,5, D. Farzanfar1, O. Krys1, K. Mattina1,3, C. Harper1,3, S. Liu1,3, T. Yoannidis6, R. Milne1,2, M.C. Brown1, A. Vennettilli1, A.J. Hope2, D. Howell1,4, J.M. Jones1, P. Selby7,8,9, W. Xu1,10, D.P. Goldstein6, G. Liu1,4,10, M.E. Giuliani1,2 1 Ontario Cancer Institute, Toronto, Canada 2 Princess Margaret Cancer Center, Department of Radiation Oncology, Toronto, Canada 3 University of Toronto, Faculty of Medicine, Toronto, Canada 4 Princess Margaret Cancer Center, Division of Medical Oncology and Hematology- Department of Medicine, Toronto, Canada 5 Princess Margaret Cancer Center, Department of Biostatistics, Toronto, Canada 6 Princess Margaret Cancer Center, Department of Otolaryngology-Head and Neck Surgery, Toronto, Canada 7 University of Toronto, Department of Family and Community Medicine, Toronto, Canada 8 University of Toronto, Center for Addiction and Mental Health, Toronto, Canada 9 University of Toronto, Department of Psychiatry, Toronto, Canada 10 University of Toronto, Dalla Lana School of Public Health, Toronto, Canada

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Introduction Continued smoking after a diagnosis of cancer leads to poorer treatment outcomes, survival, and quality-of-life. Objectives Here, we evaluated cancer patients’ perceptions of the effects of continued smoking on quality-of-life, survival, and fatigue after a cancer diagnosis and the effects of these perceptions on smoking cessation. Methods 1121 cancer patients from all disease subsites from Princess Margaret Cancer Centre (Toronto, ON) completed a questionnaire between April 2014-January 2016 assessing for socio-demographic variables, smoking history, and perceptions of continued smoking on quality-of-life, survival, and fatigue. Multivariable regression models evaluated the association between patients’ perceptions and smoking cessation and evaluated factors influencing patients’ perceptions of smoking. Results Among all patients, 261(23%) smoked at diagnosis and 54% subsequently quit; 23% had lung and 27% had head and neck cancers. Most patients felt that continued smoking after a diagnosis of cancer negatively impacted quality-of-life(83%), survival(86%) and fatigue(82%). Current smokers at the time of survey were less likely to perceive that continued smoking was harmful compared to ex-smokers and never smokers (P<0.001). Among current smokers, perceiving that smoking negatively impacted quality-oflife (aOR=2.34;95%CI[1.34-4.08]), survival (aOR=4.23[2.31-7.75]) and fatigue (aOR=3.35[1.89-5.96]) were each strongly associated with smoking cessation. Patients with low income more likely felt that smoking was harmful on quality-of-life (aOR=2.15[1.00-4.62]) and experiences of fatigue (aOR=3.23[1.39-7.51]). Conclusions Cancer patients’ perceptions of continued smoking after a cancer diagnosis are strong ly associ at ed with smokin g cessation . Th e sociodemographic and clinicopathologic factors found to be associated with patient perceptions on smoking should be considered when developing a smoking cessation program.

eP504 EXPLORING DELAYS AND GAPS IN SURVIVORSHIP CARE : EXAMPLES FROM THE RETURN-TO-WORK PATHWAY K. Bilodeau1, D. Tremblay2, M.J. Durand3 1 Université de Sherbrooke - Campus Longueuil, Medicine and Health Sciences, Longueuil, Canada 2 Université de Sherbrooke - Campus Longueuil, School of Nursing, Longueuil, Canada 3 Université de Sherbrooke - Campus Longueuil, School of Rehabilitation, Longueuil, Canada Introduction After cancer treatment, many patients experience delays in survivorship care. The lack of continuity of care, guidance, and resources may affect cancer survivors’ capacity to resume their life and cope with late sideeffects of cancer treatments. Exploring the return-to-work (RTW) pathway after cancer treatments helps identify gaps in accessing survivorship care. Objectives Identify delays and gaps in survivorship care by exploring the RTW pathway for breast cancer (BC) survivors. Methods A qualitative multiple case study was carried out. A case was defined as a BC survivor’s journey to RTW at the end of cancer treatment. Units of analysis were women with BC diagnosis. Nine participants were recruited. Twenty-three semi-structured interviews were conducted. Iterative content analysis was performed. Results One month after treatment, BC survivors worried about their capacity to RTW because they still experienced symptoms. They tried to find resources

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by themselves. Six to eight months’ after treatment, BC survivors felt more confident in their capacity to RTW. They challenged themselves to resume physical, domestic, and social activities. Most participants decided on their own when to RTW. Overall, BC survivors were insufficiently informed by healthcare professionals about long-term side effects, RTW, or resources. Conclusions Our results show gaps in accessing survivorship care during the RTW pathway. They suggest that professionals should intervene at one and six months after cancer treatment. At these moments, BC survivors need support in managing side-effects, making the RTW decision, navigating resources, and returning to daily activities.

eP505 I WOULD HAVE TOLD YOU ABOUT BEING FORGETFUL, BUT I FORGOT:” THE EXPERIENCE OF COGNITIVE CHANGES AND COMMUNICATIVE PARTICIPATION AFTER HEAD AND NECK CANCER S. Bolt1, C. Baylor2, M. Burns1, T. Eadie1 1 University of Washington, Department of Speech and Hearing Sciences, Seattle, USA 2 University of Washington, Department of Rehabilitation Medicine, Seattle, USA Introduction Self-perceived cognitive function has been identified as an important predictor of communication outcomes among survivors of head and neck cancer (HNC). In some cases, difficulties with memory, attention, verbal fluency, and processing speed persist many years after completion of treatment. Objectives The purpose of this study was to explore the lived experience of cognitive changes in survivors of HNC and how these changes affect communication in their daily lives. Methods In the tradition of phenomenology, five adult survivors of nonnasopharyngeal HNC participated in individual semi-structured interviews. All interviews were audio-recorded, transcribed, coded, and summarized by emergent themes. Results Two major themes emerged from the interview data, each with three subthemes (see Table 1): (1) I would have told you about being forgetful, but I forgot; and (2) It’s such a journey that much of it is uncharted. Participants described problems with memory, focus/attention, and task initiation along with slowed processing and language difficulties at least one year after cancer treatment. These cognitive difficulties affected their everyday lives and self-identities at work, socially, and at home. Participants expressed feeling unprepared for the possibility of cognitive changes, not knowing why they were happening, or what to do about them. Conclusions Individuals with HNC may experience difficulties with memory, attention, language, and processing speed. Said difficulties can affect a person's ability to communicate in everyday activities as well as their ability to learn and follow complex medical and rehabilitation treatment regimens. The results of this study can inform future research and promote improved intervention and patient education.

eP506 A 4.5-YEAR FOLLOW-UP STUDY OF ASIAN BREAST CANCER SURVIVORS: RISKS OF DEVELOPING CHRONIC ILLNESSES J.W. Chae1, H.L. Yeo1, T. Ng2, R. Fok2, K. Loh2, M. Farid2, S.Y. Lim3, J. Lee1, A. Chan1 1 National University of Singapore, Department of Pharmacy, Singapore, Singapore

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National Cancer Centre Singapore, Division of Medical Oncology, Singapore, Singapore 3 National Cancer Centre Singapore, Division of Radiation Oncology, Singapore, Singapore Introduction Emerging data suggests that cancer survivors are at high risk of developing diabetes mellitus, hyperlipidemia and cardiovascular diseases after cancer diagnosis. However, little is known whether cancer survivors residing in Asian countries are at risk developing these conditions after cancer treatment. Objectives This study was designed to describe the incidence of diabetes mellitus, hyperlipidemia and cardiovascular diseases after cancer treatment, and to describe the utilization of medications to manage these newly diagnosed chronic diseases. Methods This was a secondary analysis of a prospective cohort study. Cancer survivors enrolled in this analysis were initially diagnosed with early-stage breast cancer in Singapore between 2011 and 2013. Clinical and medication data were followed up for 4.5 years post diagnosis. Results A total of 155 cancer survivors were analyzed. Mean (±SD) age at diagnosis was 51.0 (8.9) years old, with 81.9% Chinese, 9.7% Malays and 5.2% Indians. Eighty patients (51.6%) were postmenopausal. At the point of cancer diagnosis, the prevalences of diabetes mellitus, hyperlipidemia and cardiovascular diseases were 9.0%, 18.7%, and 25.2%, respectively. Over the follow-up period, the cumulative incidences of new onset diabetes mellitus, hyperlipidemia and cardiovascular disease were 6.5%, 7.1%, and 5.2%, respectively. Thirty-three (21.3%) patients received medications to manage at least one of the comorbidities aforementioned, with 7.7% patients requiring more than 3 medications. Conclusions New onset of chronic illnesses appeared to be common and prevalent among Asian breast cancer survivors. Survivorship care plans must emphasize preventive and proactive management of these health conditions to improve the holistic life-span health outcomes in cancer survivors.

eP507 PRACTITIONERS’ PERSPECTIVES ON COMMUNITY-BASED CANCER SURVIVORSHIP CARE IN SINGAPORE: A FOCUS GROUP STUDY A. Chan1, G.W. Ngai1, W.L. Chung2, A. Yeo1, T. Ng1, K. Loh3, M. Farid3, Y.L. Soong4, R. Fok3 1 National University of Singapore, Pharmacy, Singapore, Singapore 2 Watson's Personal Care Stores Pte Ltd- Singapore, Pharmacy, Singapore, Singapore 3 National Cancer Centre Singapore, Medical Oncology, Singapore, Singapore 4 National Cancer Centre Singapore, Radiation Oncology, Singapore, Singapore Introduction Cancer survivorship care is still in its infancy in Asia. Singapore, as one of the most developed nation within Southeast Asia, ongoing efforts are made to improve the services provided to cancer survivors. Objectives With a long-term goal to optimize the delivery of cancer survivorship care in Singapore, we conducted a qualitative study to gather in-depth descriptions from community practitioners, consisted of general practitioners and

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community pharmacists, on their perceptions of community-based cancer survivorship care in Singapore. Methods Sixteen participants (including 11 general practitioners and 5 community pharmacists) participated in four structured focus group discussions between September to December 2016. The focus group discussions were audio recorded, transcribed verbatim and analyzed by thematic analysis. Results Majority of the community practitioners do not encounter cancer survivors in their clinical practices. Perceived barriers to community-based survivorship care include patients’ lack of confidence in primary care, financial constraints and lack of empanelment. Most community practitioners concur that the success of community-based survivorship care greatly depends on the cooperation and participation of survivors. Survivorship management via standardized care pathways are not fully advocated by the practitioners. Survivorship care plans are identified to be useful, but they should also incorporate non-cancer-related medical history and medication list. Conclusions Community practitioners in Singapore are eager to participate in the delivery of cancer survivorship care. Future studies should develop a community-based care model that would highly involve community practitioners, and to evaluate the cost-effectiveness of such a care model.

eP508 BIOMARKERS OF RESPONSE TO RADIATION THERAPY – A REVIEW OF THE LITERATURE 1

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M. Choi , L. Rowbottom , R. McDonald , A. Furfari , S. Chan , P. Zaki , A. Azad1, R. Chow1, A. Wan1, A. Agarwal1, C. DeAngelis1, E. Chow1, G. Charames1 1 Sunnybrook Hospital, Radiation Oncology, Toronto, Canada Introduction Radiation is a mainline treatment modality for both curative and palliative purposes in the context of cancer management. While used widely, radiotherapy is not associated with homogenous patient response, with degree of benefit and post-treatment outcomes varying across patients. Certain inflammatory markers may be associated with increased survival, decreased local recurrence and better quality of life (QoL), while other inflammatory markers may be associated with poor outcomes. Objectives The present review was conducted to summarize the literature regarding biomarkers of response to radiation therapy in terms of patient-important outcomes of benefit and harm. Methods A literature search was conducted using OVID MEDLINE and Embase databases with the following keywords: “inflammation”, “cancer”, “radiation”, “neoplasm”, “cancer”, “pain”, “biological marker”, “allele”, and “genomics”. Results were limited to English-language studies conducted in humans. Title-and-abstract screening, full-text screening and data extraction for studies deemed eligible for inclusion was conducted independently by paired reviewers. Results From a total of 5,480 retrieved hits, 4 studies were deemed eligible for inclusion for the present review. Studies generally supported an increase in inflammatory markers following radiation therapy. However, no clear associations were identified between increases in specific inflammatory markers and significant improvements or declines in survival, recurrence rates, patient-reported QoL and safety events, with conflicting results reported across studies.

Conclusions While it is clear that radiation therapy causes an increase in inflammatory markers, the association between specific markers and outcomes of benefit and harm for patients post-treatment remains unclear and warrants further investigation through more robust investigations.

eP509 GENETIC AND BIOLOGICAL MARKERS OF CANCERRELATED PAIN SENSITIVITY: A LITERATURE REVIEW M. Choi1, R. McDonald1, A. Bobrowski1, A. Furfari1, L. Rowbottom1, H. Lam1, R. Chow1, A. Wan1, A. Agarwal1, G. Charames1, A. Azad1, D. Carlo1 1 Sunnybrook Hospital, Radiation Oncology, Toronto, Canada Introduction Cancer-related pain remains one of the most commonly-reported symptoms, yet one of the least well-managed in many cases. Improper management of pain may lead to reductions in physical and psychological well-being, and quality of life. Cancer-related pain sensitivity and response to pain reduction treatments such as analgesics and radiotherapy may vary widely across oncologic patients, including those with similar cancer types and severities. Objectives To summarize the literature investigating genetic and biological markers associated with cancer-related pain sensitivity and response to treatment in oncologic patients. Methods

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A literature search was conducted using OVID MEDLINE and Embase databases with the following keywords: “neoplasm”, “cancer pain”, “inflammation”, “biological marker”, “allele”, and “genomics”. The search was limited to English-language articles and restricted to human studies only. Title-and-abstract screening, full-text screening and data extraction for studies deemed eligible for inclusion were conducted independently by paired reviewers using a priori criteria. Results Out of a total of 5,480 hits yielded by the search, 26 studies were deemed eligible for inclusion in the present review. A number of genetic and biological markers showed significant associations with cancer-related pain sensitivity, including CRP, IL-1β, IL-6, IL-8, IL-10, LTA, potassium channel genes, PTGS2, and TNF. A number of markers also showed significant associations with response to pain reduction therapeutic strategies, including IL-7, IL-18, MCP1, MIPIβ, OPG, and sTNFR1.

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Objectives Relationship between concentration of HE4 and MMP-2 in the patients with endometrial cancer serum and histopathological type of tumor, FIGO stage, grading, myometrial invasion and the lymph nodes metastases. Methods Serum HE4 concentrations were measured using the Elecsys ECLIA assay from Roche running on the cobas e 601 analyzer. MMP-2 concentrations were quantified in serum by multiplex fluorescent bead-based immunoassays (Luminex Corporation, Austin, TX, USA). Results We demonstrated statistically significant correlation between median MMP-2 and HE4 concentrations among patients with various degrees of histopathological tumor differentiation, p=0.004/p=0,002. Significantly higher statistical mean levels of MMP-2 and HE4 protein were noted among patients with higher clinical staging compared to patients with lower staging p=0,001/ p=0.0027. We noted no statistically significant differences in median MMP-2 concentrations between patients with different depth of the myometrial invasion. Significantly higher statistical mean levels of HE4 protein were noted among patients with > 1/2 depth of the myometrial invasion compared to patients with < 1/2 depth of the myometrial invasion. Significantly higher median of MMP-2 and HE4 concentration levels were found in a subgroup of patients with lymph node metastasis and respectively were 4926 pg/mL, 87pmol/L. Conclusions HE4 protein seems to be a good prognostic factor in endometrial cancer. Serum levels of MMP2 was not good enough.

eP511 SURVIVAL OF BRAZILIAN WOMEN WITH BREAST CANCER TREATED AT A REHABILITATION SERVICE. L.C. Durant1, A.M. Almeida1, M.A.S. Prado1, T. de Oliveira Gozzo1 1 University of São Paulo at Ribeirão Preto College of Nursing, MaternalInfant and Public Health Nursing, Ribeirão Preto, Brazil

Conclusions The findings of our review suggest that a variety of genetic and biological markers have been identified with potential clinical and therapeutic utility in predicting cancer-related pain sensitivity and treatment response.

eP510 THE CLINICAL SIGNIFICANCE OF HE4 AND MMP2 CONCENTRATION IN THE SERUM OF PATIENTS WITH ENDOMETRIAL CANCER A. Cymbaluk-Ploska1, C.G. Anita2, P.S. Ewa3, M. Bogusław3, S.R. Agnieszka4, M. Janusz2 1 Pomeranian Medical University, Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Szczecin, Poland 2 Pomeranian Medical University, Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Szczecin, Poland 3 Pomeranian Medical University, General Pathology Department, Szczecin, Poland 4 West Pomeranian University of Technology, Department of Mathematics Applications in Economy, Szczecin, Poland Introduction Endometrial cancer is the second most common gynecological cancer in European countries. Five-year survival and recurrence prognosis depends on the clinical stage and histological type of tumor.

Introduction Introduction: Breast cancer has a high incidence in the female population and is considered a major cause of cancer death among women in many countries, there fore it is essential more survival studies in oncology to evaluate results, related factors and outline the behavior disease. Objectives To evaluate the survival rate of women treated in a rehabilitation service of mastectomies at the university hospital, located in the Southeast region of Brazil. Methods The cohort was identified from search services performed in the rehabilitation center from 1989 to 2014. The data were collected on secondary data, complemented by search the database of the Mortality Information System (SIM), telephone call and distribution of cards. Survival functions were calculated using the Kaplan-Meier method and to compare the curves we used the log rank test. The level of significance for the study was 0.05. Results The results indicated that overall survival at 60 months of this population was 78.5%, and the specific-survival was 75.8% in 60 months. Regarding the clinical features, the most common histological type was with CDI (82.2%); 49.9% had tumors between 2 and 5 cm and the predominant clinical stage at diagnosis was the IIA (25,7%). Those who did not develop distant metastases had a survival rate of 96.9% in five years compared with those who had metastasis in 5 years (50%). There were significant by log-rank test (p<0,000) in this variable. Conclusions The results reinforce the importance of early diagnosis through screening by clinical breast examination and mammography combined with effective treatment.

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eP512 DO PATIENT-REPORTED OUTCOME STUDIES PAINT A TOO ROSY PICTURE? SYSTEMATIC UNDERREPRESENTATION O F PAT I E N T S W I T H L O W E R S U R V I VA L – T H E POPULATION-BASED PROFILES REGISTRY B.H. de Rooij1,2, N.P.M. Ezendam1,2, F. Mols1, P.A.J. Vissers2, M.S.Y. Thong3, C. Vlooswijk2, S. Oerlemans2, O. Husson4, N.J.E. Horevoorts2, L.V. van de Poll-Franse1,2,5 1 Tilburg University, Medical and Clinical Psychology, Tilburg, The Netherlands 2 The Netherlands Comprehensive Cancer Organisation, Research, Utrecht, The Netherlands 3 Academic Medical Center University of Amsterdam, Medical Psychology, Amsterdam, The Netherlands 4 Radboud University Medical Center, Medical Psychology, Nijmegen, The Netherlands 5 The Netherlands Cancer Institute, Psychosocial Research and Epidemiology, Amsterdam, The Netherlands Introduction PROFILES (‘Patient Reported Outcomes Following Initial treatment and Long term Evaluation of Survivorship’) registry is a large and growing population-based cohort of cancer survivors through which patientreported outcomes (PROs) are collected. Objectives The aim of this study is to assess the generalizability of PRO research among cancer survivors by comparing socio-demographic and clinical characteristics, and survival of participants and non-participants in cancer survivors invited for questionnaire research through the PROFILES registry. Methods Between 2008 and 2015, cancer survivors with different cancer diagnoses (N=14,011) were invited to participate in a study from the PROFILES registry, of whom 69% (N=9,684) participated. Patient characteristics and survival data were collected through the Netherlands Cancer Registry and were associated with participation versus non-participation in multivariable logistic regression analyses and cox proportional hazard regression models respectively. Results Compared to non-participants, participants had a significantly higher survival (HR=0.65, P<0.01) (figure 1), while sensitivity analysis suggest that the health-related quality of life (EORTC QLQ-C30 function scales; range 0-100) of participants might be up to 4.3 points higher compared to non-participants. Other associations with participation compared to non-participation were ages between 50 and 80, a higher socioeconomic status, female sex, receipt of radiotherapy, fewer comorbidities and invitation for participation 2-3 years after diagnosis.

Conclusions Cancer survivors not participating in PROs research significantly differ from participants, with respect to socio-demographic and clinical characteristics, and survival. Therefore, even in PRO studies with relatively high participation rates, observed outcomes may systematically represent the healthier patient with better outcomes.

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eP513 MEASURING A MODEL PROGRAM FOR SYMPTOM REDUCTION AND SURVIVORSHIP IN THE NYC BREAST CANCER POPULATION L. DeAngelis1, J. Isaacs2, H. Greenlee3 1 You Can Thrive! Foundation, Research & Development, New York, USA 2 Yeshiva University, Psychology, New York, USA 3 Columbia University Medical Center, Epidemiology, New York, USA Introduction Accessible comprehensive survivorship tools are essential to ensuring an improvement in long-term outcomes for populations with cancer. Objectives The purpose of this study is to understand and measure the impact of a model program for aftercare on women with breast cancer, and further, to call attention to the pressing need for palliative support tools to be made accessible to women during and after cancer treatment, regardless of staging. Methods Preliminary data has been collected in a population of 28 women. Participants were enrolled in 13-week program for weekly visits to multidisciplinary care center. Modalities were administered weekly. These include weekly patient navigation, peer support, acupuncture, reflexology and massage. Nutritional counseling was bi-weekly. A MYMOP (Measure Yourself Medical Outcome Profile) evaluation tool was used by participants to self-evaluate symptoms over time. Results Ratings from before/after the first and fourth sessions, and after eighth visit, showed self-reported symptom reduction was statistically significant. These preliminary findings suggest a reduction in symptomology, less symptom interference with daily activities, and a better overall sense of wellbeing after participating in the program for 4 consecutive sessions. Women who stayed with the program were measured at 8 and 13 weeks the trend of symptom reduction appears to continue.

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Conclusions This preliminary data indicates that our integrative care survivorship program is an effective supportive tool on several levels. Further studies with larger populations are essential to clinically demonstrating the effectiveness of a comprehensive survivorship program such as this.

eP514 A S YST EMAT IC REV IE W OF T HE RE LATI ONSHI P BETWEEN PERCEIVED SOCIAL SUPPORT AND PATIENTREPORTED COMMUNICATION OUTCOMES ACROSS DISORDERS T. Eadie1, M. Kapsner-Smith1, S. Bolt1, C. Sauder1, K. Yorkston2, C. Baylor2 1 University of Washington, Speech and Hearing Sciences, Seattle, USA 2 University of Washington, Rehabilitation Medicine, Seattle, USA Introduction Patients with head and neck cancer (HNC) often report difficulties in verbal communication in everyday activities. Consequently, patientreported communication measures have emerged as meaningful outcomes. Preliminary research from patients with neurological conditions (e.g., Parkinson’s Disease (PD), multiple sclerosis (MS), stroke) suggests that one important predictor of communication success may include perceived social support: the expectation that others will provide support if needed. Determining how perceived social support affects communication outcomes across diagnoses will offer insight into rehabilitation approaches after HNC. Objectives Identify relationships between measures of perceived social support and patient-reported communication outcomes, across diagnoses in adult populations. Methods Electronic databases were searched up to April 2016 including: PubMed, PsycINFO, and CINHAL. PRISMA guidelines were strictly followed. Included studies were assessed using the Critical Appraisal Skills Program. Given the heterogeneous nature of the studies, data synthesis was narrative. Results Eleven studies met eligibility criteria: 7 quantitative and 4 qualitative. In the quantitative studies, no significant relationships were found between perceived social support and communication outcomes in three studies (2 aphasia, PD), while perceived social support was a weak, but significant predictor in one study (MS). One study (aphasia) showed that relationships were moderate and became significantly stronger over time. Results from 4 qualitative studies (HNC, 2 aphasia, MS) revealed that social support acted as a barrier and a facilitator. Skillful, responsive family members were able to facilitate better quality of communicative interactions. Conclusions While perceived social support may affect communication outcomes, current measures may not sensitively capture these constructs.

eP515 ELIMINATION OF SECOND-HAND SMOKE (SHS) EXPOSURE AFTER A LUNG OR HEAD AND NECK (HN) CANCER DIAGNOSIS AND SUBSEQUENT PATIENT SMOKING CESSATION L. Eng1, D. Alton1, Y. Song2, D. Farzanfar3, O. Krys3, T. Yoannidis4, R. Milne5, S. Habbous3, M.C. Brown3, A. Vennettilli3, F.A. Shepherd1, N.B. Leighl1, A.J. Hope5, D. Howell6, J.M. Jones3, P. Selby7, W. Xu2, D.P. Goldstein4, M.E. Giuliani5, G. Liu1 1 Princess Margaret Cancer Centre, Medical Oncology and Hematology, Toronto, Canada

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Princess Margaret Cancer Centre, Biostatistics, Toronto, Canada Ontario Cancer Institute, Applied Molecular Oncology, Toronto, Canada 4 Princess Margaret Cancer Centre, Otolaryngology-Head and Neck Surgery, Toronto, Canada 5 Princess Margaret Cancer Centre, Radiation Oncology, Toronto, Canada 6 Princess Margaret Cancer Centre, Palliative Care and Psychosocial Oncology, Toronto, Canada 7 Centre for Addiction and Mental Health, Addictions, Toronto, Canada 3

Introduction Exposure to SHS after a cancer diagnosis is associated with continued smoking in lung and HN cancer patients (PMID:24419133,23765604). However, smoking is a social activity. Objectives We evaluated whether elimination of SHS exposure around and after a diagnosis of either cancer is associated with smoking cessation in the cancer patient. Methods Lung and HN cancer patients completed questionnaires at diagnosis and follow-up assessing smoking history and SHS exposures (cohort study). Multivariate logistic regression analysis evaluated the association of elimination of SHS exposure after diagnosis with subsequent smoking cessation, adjusted for significant covariates. A cross-sectional study (20142015) of 183 lung and HN patients assessed consistency in associations. Results For the cohort, 261/731 lung and 145/450 HN patients smoked at diagnosis; subsequent quit-rates: 69% and 50%. Most (91% lung, 94% HN) patients were exposed to SHS at diagnosis; while few (40% lung, 62% HN) were exposed at follow-up. Elimination of SHS exposure was associated with smoking cessation in lung (aOR=4.76, 95%CI[2.56-9.09],P<0.001), HN (aOR=5.00[1.61-14.29],P<0.001), and combined cancers (aOR=5.00[3.038.33],P<0.001). The cross-sectional study has similar cessation and SHS exposure rates and similar association for elimination of SHS with smoking cessation (aOR=3.42[1.16-10.10],P=0.03). However when asked directly, only 26% of patients quit smoking with another individual. Conclusions Elimination of SHS exposure around patients is associated with smoking cessation in lung and HN cancer patients, but few patients quit smoking with others around them despite the ‘teachable moment’ with a cancer diagnosis. Clinicians should encourage patients and their household/ friends to quit smoking together to improve overall cessation rates.

eP516 GASTRO-INTESTINAL SYMPTOMS IN OVARIAN CANCER PATIENTS DURING SURVIVORSHIP: A CROSS-SECTIONAL STUDY FROM THE PROFILES REGISTRY N. Ezendam1, M. Rietveld2, C. Vos3, L. Van de Poll-Franse 1, N. Ottevanger2, O. Husson4 1 Netherlands Comprehensive Cancer Organisation, Research, Utrecht, The Netherlands 2 Radboud UMC, medical oncology, Nijmegen, The Netherlands 3 Elisabeth TweeSteden Hospital, Gynecology, Tilburg, The Netherlands 4 Radboud UMC, Medical Psychology, Nijmegen, The Netherlands Introduction Gastro-intestinal symptoms are acknowledged as presenting symptom of recurrence among ovarian cancer patients, but may also be a persistent side effect. The magnitude among survivors and the impact on healthrelated quality of life (HRQoL) are unknown. Objectives This study aims to assess 1. the proportion of ovarian cancer patients with persistent gastro-intestinal symptoms among patients with and without

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recurrent disease 2-12 years post diagnosis, and 2. the association between gastro-intestinal symptoms and HRQoL among patients without recurrent disease. Methods Women diagnosed with ovarian cancer (n=191; response 55%), registered between 2000 and 2010 in the Netherlands Cancer Registry, completed a questionnaire assessing HRQoL (EORTC QLQ-C30, QLQ-OV28) and distress (HADS) in 2012. Of 131 patients we could obtain recurrence status and these were included in this study. Results In the total sample 33 patients (25%) reported gastro-intestinal symptoms, including abdominal pain, bloated feeling, clothes feeling too tight, change in bowel habit, passing gas, and filling up too quickly. Among patients without recurrence (n=101) this was 20% and among those with recurrence (n=30) this was 43%. Among patients without recurrent disease, patients with gastro-intestinal symptoms (defined as a score >30, n=20) had lower functioning, lower general quality of life and more symptoms, compared to patients without gastro-intestinal symptoms (score <30, n=81). Differences ranged from small to large clinical effect sizes. No difference was observed for sexuality and distress. Conclusions One fifth of long-term ovarian cancer patients without recurrent disease experience gastro-intestinal symptoms besides other symptoms during survivorship, which substantially impacts patients’ functioning and general quality of life.

eP517 R U R A L C A N C E R S U RV I VO R S ' P O S T- T R E AT M E N T S U P P O RT I V E C A R E N E E D S A N D I N T E RV E N I T O N PREFERENCES: A QUALITATIVE STUDY K. Fennell1,2,3, I. Olver1, P. Livingston4, K. Meneses5,6, C. Wilson2,3 1 University of South Australia, Sansom Institute for Health Research, Adelaide, Australia 2 Flinders University, Flinders Centre for Innovation in Cancer- School of Medicine, Adelaide, Australia 3 Cancer Council SA, Behavioural Research and Evaluation Unit, Adelaide, Australia 4 Deakin University, Faculty of Health, Melbourne, Australia 5 The University of Alabama Birmingham, School of Nursing, Birmingham, USA 6 The University of Alabama Birmingham, Comprehensive Cancer Center, Birmingham, Australia Introduction The completion of cancer treatment and transition from urban centres back to rural communities is challenging for many rural cancer survivors. Objectives To a), build deeper understanding of the experiences and unmet needs of rural people who have completed active cancer treatment and returned to their rural communities and b), determine how existing services could be re-orientated and/or new interventions be developed to more appropriately meet their supportive care and tertiary prevention needs. Methods Adult South Australians who lived outside metropolitan Adelaide and had completed active cancer treatment (n=13), the carers of someone who fitted this description (n=3) and people who had been both a rural survivor and a carer (n=6), participated in semi-structured interviews. A broad range of demographic backgrounds and medical histories (50% < 2 years, 50% > 2 post-treatment) were represented in the sample. Data were analysed using Thematic Analysis (Braun and Clarke, 2006). Results Themes included; ‘when it is over, it is not all over’ (problems emerge with fatigue, fear of recurrence etc.)’, ‘lack of faith in local medical care’, ‘frustration with travel for surveillance/ follow-up medical care’ and

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‘openness to new forms of support’, delivered via telephone, face-toface and to a lesser degree, via the internet. A preference for nurse-led interventions, continuity of care and services making direct contact with survivors (rather than self-referral) emerged. Greater use of telehealth facilities to minimize travel would also be valued. Conclusions Findings will inform the development of new interventions that better meet the needs of this unique, isolated and underserved group.

eP518 PROGRAM UTILIZATION AND PARTICIPANT FEEDBACK IN THE PROSTATE CANCER SUPPORTIVE CARE (PCSC) PROGRAM C. Higano1, L. Hedden2, P. Pollock3, M. Sundar3, M. Spillane3, C. Zarowski3, S. Weller3, C. Van Patten4, M. Dayan3, K. Lutz3, D. Kuhl5, S. Elliott5, L. Goldenberg5 1 University of Washington, Medicine & Urology, Seattle, USA 2 University of British Columbia, Centre for Clinical Epidemiology and Evaluation, Vancouver, Canada 3 Vancouver Prostate Centre, Supportive Care, Vancouver, Canada 4 BC Cancer Agency, Oncology Nutrition, Vancouver, Canada 5 University of British Columbia, Urologic Sciences, Vancouver, Canada Introduction The diagnosis and management of prostate cancer (PC) can affect quality of life for patients (pts) and their partners/family. The PCSC Program provides group education sessions, workshops and clinic visits to address the unique physical and emotional needs of this population. Objectives To analyse pt utilization of the PCSC Program and feedback from education session participants. Methods Uptake of each optional module was measured. A feedback tool with Likert-based and Boolean response items, and qualitative commentary was collected from participants regarding timing, structure, and content of each session. Results 1319 pts registered with PCSC, median age 66 (range 36-92 yrs): 167 (2013), 370 (2014), 381 (2015), 344 (2016), and 36 (Jan 2017). 1103 (84%) have participated in ³1 module: 320 (24%) attended information about PC and primary treatment options (TX), 710 (54%) sexual health and intimacy (SH), 337 (26%) lifestyle changes in exercise and diet (LS), 165 (13%) adapting to androgen deprivation therapy (ADT), 438 (33%) pelvic floor physiotherapy for urinary incontinence (PFP), and 115 (9%) psychological support (PS). We collected 1357 surveys between Feb 2013 and Sept 2016. Average satisfaction score was 3.63 (out of 4), ranging from 3.46 to 3.78 across the different sessions. We found no difference in satisfaction between pts and partners except for SH, which partners rated better than pts (p=0.03).

Conclusions SH and PFP are the most heavily attended modules. Feedback from pts and partners demonstrated a high degree of satisfaction with interdisciplinary education sessions provided within the PCSC Program.

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eP519 FACTORS ASSOCIATED WITH ALCOHOL DRINKING BEHAVIOR OF CANCER SURVIVORS: THE KOREAN NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY H. Ko1, Y.M. Song1, J. Shin1 1 Samsung Medical Center, Family Medicine, Seoul, Republic of Korea Introduction High-risk alcohol drinking is often reported to be highly prevalent among cancer survivors. Objectives This study aimed to evaluate the factors associated with drinking behavior of cancer survivors after cancer diagnosis. Methods The study subjects were 906 adult cancer survivors who had reportedly drunk alcohol before cancer diagnosis and participated in the Korean National Health and Nutrition Examination Surveys conducted from 2007 to 2013. Among them, 360 abstained from alcohol drinking after cancer diagnosis. We categorized remaining 546 persistent drinkers into high-risk drinker (consuming ≥ 7 glasses of alcohol for men and ≥ 5 glasses of alcohol for women at one episode at the frequency of at least once a month) or moderate drinker. We used multiple logistic regression analysis to evaluate risk factors associated with drinking behavior. Results The high-risk drinkers occupied 27.1% (148 survivors) of the persistent alcohol drinking survivors. Age increase (OR=0.96; 95% CI 0.93-0.99), female sex (OR =0.15; 95% CI 0.08-0.28), and increase of time lapse (by 1-year) after cancer diagnosis (OR =0.94; 95% CI 0.92-0.97) were associated with a lower risk of high-risk drinking as compared with moderate drinking. Meanwhile, ≤ 9 years of education (OR=1.99; 95% CI 1.103.60), alcohol-related cancer (OR=2.09; 95% CI 1.23-3.56), and current smoking (OR =1.92; 95% CI 1.03-3.59) were associated with increased risk of high-risk drinking of cancer survivors. Conclusions These findings suggest that greater efforts for preventing high-risk drinking should be laid on the cancer survivors, with consideration of individual sociodemographic characteristics, especially when the survivors had been diagnosed with alcohol-related cancer.

eP520 ASSESSMENT OF QUALITY OF BREAST CANCER SURVIVORSHIP USING WIRELESS TOUCH SCREEN TABLET COMPUTER S.J. Koh1, Y. Choi1, C.R. Kim2, J.H. Kim1, J. Kim3 1 Ulsan University College of Medicine- Ulsan University Hospital, Hematology and Oncology, Ulsan, Republic of Korea 2 Ulsan University College of Medicine- Ulsan University Hospital, Physical Medicine and Rehabilitation, Ulsan, Republic of Korea 3 Gachon University, College of Nursing, Incheon, Republic of Korea Introduction Survivorship management demands a systematic approach that is critical to the continuity and improved quality of care as well as for better patient outcomes including quality of life outcomes. Objectives We evaluate whether a tablet PC survey is feasible to screen risks for the recurrence of breast cancer or primary cancer and survivorship issues associated with breast cancer treatment. Methods First, a tablet PC survey was developed for breast cancer survivorship to assess their quality of life, physical function and activity, pain management, fatigue, and psychological distress including anxiety and

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depression. Second, a pilot testing was conducted using a sample of 40 breast cancer survivors at their first visit at the clinic. The tablet PC survey was evaluated by structured questionnaires, which were designed to assess feasibility regarding patient experiences responding to the tablet PCbased surveys and user friendliness of the device itself. Results Patients of older age and lower education were more likely to have difficulty with responses to the tablet PC surveys. Patients rated using the tablet PC survey being user friendly, with scores ranging from 72.1 to 84.6 on a 100-point scale, regarding ease, simplicity, necessity, comfort, satisfactory, and advocate; these aspects of feasibility of the tablet PC survey were not impacted by demographic or clinical characteristics. Conclusions This pilot testing supported the feasibility of a tablet PC survey as a vehicle for breast cancer survivorship management; while, for those who were older age and had lower education who had difficulty with the tablet PC administration require assistance.

eP521 THE MEDIATING EFFECT OF SLEEP QUALITY ON THE EFFECTS OF YOGA ON CANCER-RELATED FATIGUE: A URCC NCORP RCT IN 321 CANCER PATIENTS P.J. Lin1, I. Kleckner1, C. Cole1, A. Peoples1, L. Peppone1, M. Janelsins1, E. Culakova1, C. Heckler1, M. Messino2, J. Atkins2, B. Esparaz3, P. Reddy4, K. Mustian1 1 University of Rochester Medical Center, Surgery-Cancer Control, Rochester, USA 2 Southeast clinical Oncology Research Consortium, National Cancer Institute Community Oncology Research Program, Winston-Salem, USA 3 Heartland Cancer Research, National Cancer Institute Community Oncology Research Program, St. Louis, USA 4 Wichita NCORP, National Cancer Institute Community Oncology Research Program, Wichita, USA Introduction Cancer-related fatigue (CRF) often co-occurs with impaired sleep quality and is one of the most incapacitating adverse effects of cancer and its treatments. Yoga has been shown to significantly lower CRF and improve sleep quality in cancer survivors. However, it is not clear if the effect of yoga on CRF is mediated by improvements in sleep quality. Objectives To assess the mediating effects of changes in sleep quality stemming from YOCAS©® yoga on CRF. Methods A secondary analysis was completed using data collected from a multicenter phase III RCT with 2 arms, standard care alone (SC) and SC + 4week YOCAS©® yoga. Three hundred and twenty one cancer survivors (96% female; mean age 54 years) who were 2-24 months post-primary treatment reported sleep quality using Pittsburgh Sleep Quality Index (PSQI) and CRF via Multidimensional Fatigue Scale Inventory. Causal mediation analyses were used to estimate changes in global and each PSQI subscale scores on the effect of yoga on CRF. Results Yoga significantly improved CRF (p<0.01) and sleep quality (p<0.01), compared to SC, with total 6.5 points reduction in CRF. Twenty-two percent of such CRF reduction was mediated through improving sleep quality (p<0.01). Among the PSQI subscales, daytime dysfunction had the greatest mediating effect, which accounted for 37% of the improvements in CRF (p<0.01). Conclusions Our data suggest that significant portion of the reduction in CRF from yoga is due to improvements in sleep quality and decreases in daytime dysfunction. Clinicians should consider prescribing yoga for survivors experiencing CRF in combination with sleep disorders.

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eP522 PERSPECTIVES OF PRIMARY CARE PROVIDERS ON IMPLEMENTING BREAST CANCER SURVIVORSHIP CARE GUIDELINES: A QUALITATIVE DESCRIPTIVE STUDY M. Luctkar-Flude1, A. Aiken2, M.A. McColl1, J. Tranmer1 1 Queen's University, School of Nursing, Kingston, Canada 2 Queen's University, School of Rehabilitation Therapy, Kingston, Canada Introduction Stable early-stage, post-treatment breast cancer survivors may now be discharged early from oncology follow-up to primary care follow-up within two years of breast cancer diagnosis. Thus, it is important to address known primary care provider knowledge and practice gaps. Enhancing translation of evidence-based guidelines to primary care requires an understanding of the practice context. This qualitative descriptive study examined primary care provider’s perspectives on their practice context and other factors that influence implementation of existing clinical practice guidelines for survivorship care. Objectives The purpose of this study was to determine the challenges, strengths and opportunities related to implementing comprehensive evidence-based breast cancer survivorship care guidelines by primary care providers in southeastern Ontario, Canada. Methods A qualitative descriptive study was undertaken. Semi-structured interviews were conducted with 19 primary care providers: 10 physicians and 9 nurse practitioners. Results Thematic analysis revealed six themes across the broad categories of knowledge, attitudes and resources. Participants highlighted three major challenges related to providing breast cancer survivorship care: inconsistent educational preparation, provider anxieties, and primary care burden. They also described three major strengths or opportunities to facilitate implementation of survivorship care guidelines: tools and technology, empowering survivors, and optimizing nursing roles. Conclusions We identified several important challenges to implementation of comprehensive evidence-based survivorship care for breast cancer survivors, as well as several strengths and opportunities that could be built upon to address these barriers. Findings from this research will inform targeted knowledge translation interventions to provide support and education for primary care providers and breast cancer survivors.

eP523 ALTERATIONS IN GENE EXPRESSION INDUCED BY OXALIPLATIN BASED CHEMOTHERAPY ON PERIPHERAL L E U K O C Y T E S : I M P L I C AT I O N S F O R L O N G T E R M SURVIVORS M. Morales1, R. González-Fernández2, A. Julio2, M.V. Pablo2 1 Hospital Universitario Ns Candelaria, Medical Oncology, Santa Cruz De Tenerife, Spain 2 University of La Laguna, Department of Biochemistry and Molecular Biology, La Laguna, Spain Introduction Anticancer chemotherapy drugs target genetic material of tumours and normal cells. These effects on normal cells can induce genotoxicity and could have implications for long term survivors. Colorectal cancer represents the third most frequently diagnosed malignancy in the world and a considerable number of patients will receive adjuvant oxaliplatin based chemotherapy.

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Objectives We designed the followig study to search the effects of oxaliplatin based chemotherapy on gene expression on peripheral leukocytes with the following aims: 1) to assess the effects of the therapy on gene expression; 2) to determine target genes for the drugs, and 3) to search for molecular markers of toxicity. Methods Peripheral leukocytes from 27 patients previously and after three cycles of oxaliplatin based chemotherapy were isolated with Ficoll-Hypaque gradient. mRNA was extracted from leukocytes and differential transcriptome was analysed. All patients signed informed consent and the study was approved by the Ethical Committee of the hospital. Results We choose the genes that were at least ten times over- or down-expressed. Over-expressed genes: BCAR1; BMPR1B; CBS; CDR2L; ICOL4A2; COL7A1; ELN); KRT8; MAGEC1; PMEL, and PPARG. Downexpressed genes: CH25H; CSF3; GFRA1; GJB; IL1A; CXCL8; INHBA; RASD2; SGCA; SLC1A3; SOD2, and TTLL10. Conclusions Several genes alter their expession afte oxaliplatin based chemotherapy (FOLFOX or CAPEOX). Future work is in progress to determine if these changes are associated with long term toxicity, like neuropathy, liver injury or thrombopenia, and with the aim to establish early markers of toxicity.

eP524 A MULTIMODAL SUPPORTIVE CARE INTERVENTION IN MEN AND THEIR PARTNER/CARERS AFFECTED BY METASTATIC PROSTATE CANCER: A RANDOMISED CONTROLLED FEASIBILITY STUDY C. Paterson1, C. Primeau1, G. Nabi1 1 University of Dundee, Division of Cancer, Dundee, United Kingdom Introduction A metastatic prostate cancer diagnosis and its treatments carry significant morbidity and related unmet supportive care needs. Such unmet needs have a profound decrement on patients and their families quality of life. Objectives We aimed to deliver at multimodal intervention based approach that targeted unmet needs for men and their partner/carers and compared this to current standard care. Methods A two arm RCT compared standard care to a multimodal supportive care intervention that combined an educational seminar on prostate cancer thrivership and individualized care from a designated prostate cancer specialist nurse. This involved in-depth assessment using patient reported outcome measures (PROMs) in routine clinical practice, followed up with a tailored plan of ongoing support to address informational, emotional, social and practical needs. 48 completed standardized self-reported measures at baseline and at 3 months. 32 patients, carers/partners and the members of the multidisciplinary team completed semi-structured interviews. Results Participants in standard care arm identified a range of unmet supportive care needs related to physical, psychological/emotional, intimacy/sexual, practical, health system/informational, existential and patient/clinician communication needs. Intervention group, reported overall high satisfaction with the intervention and acceptance of PROMs in routine clinical practice, with less prevalence of unmet needs compared to standard care over time. Men and carers/partners perceived that they had derived benefit from this model of care. Conclusions This multimodality supportive care intervention contributed towards optimal supportive care. The active components of the intervention have been distinguished and provide the basis for the development of a larger sufficiently powered trial.

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eP525 UNMET INFORMATIONAL AND SUPPORTIVE CARE NEEDS OF PATIENTS WITH MUSCLE INVASIVE BLADDER CANCER: A SYSTEMATIC REVIEW C. Paterson1, B. Jensen-2, J. Jensen2, G. Nabi1 1 University of Dundee, Division of Cancer, Dundee, United Kingdom 2 Aarhus University Hospital, Department of Urology, Aarhus, Denmark Introduction Little is known about the lived experience of patients affected by muscle invasive bladder cancer (MIBC). The identification and management of unmet supportive care needs is an essential component of modern healthcare internationally. Addressing such unmet domains of care is crucial to optimising patient’s quality of life and rehabilitation following treatment, and into survivorship. Objectives To determine the different domains of unmet supportive care needs for patients affected by MIBC. Methods A systematic review was conducted according to the PRISMA Statement Guidelines. A highly sensitive search was performed in electronic databases from the earliest date available to November 2016. Empirical studies employing qualitative and/or quantitative methodology were considered for inclusion if they detailed unmet supportive care needs of patients with MIBC. Methodological evaluation was conducted, and findings were integrated in a narrative synthesis. Results 1405 references were retrieved, 8 studies met the eligibility criteria. Individual unmet needs were classified in ascending order of frequency: patient-clinician communication, daily living needs, health system/ information needs, practical needs, family-related needs, social needs, psychological/emotional needs, physical needs and interpersonal/ intimacy needs. Patients reported high unmet needs at diagnosis, following surgery and into survivorship, with a lack of information to support treatment decisions in relation to the type of urinary diversion. Conclusions Despite the emerging evidence-base, the current within study limitations precludes our understanding about how the needs of patients evolve over time. Future studies should employ a prospective longitudinal design, examine the determinates of psychological adjustment, and the impact of complications using the Clavien-Dindo classification system on unmet needs.

eP526 AN EXPLORATION OF SUPPORTIVE CARE IN LUNG CANCER SURVIVORSHIP T. Perloff1, A. Ciupek1, M. Rigney2, J. King1 1 Lung Cancer Alliance, Science and Research, Washington, USA 2 Lung Cancer Alliance, Support Initiatives, Washington, USA Introduction 1 in 15 people in the US will be diagnosed with lung cancer in their lifetime. People diagnosed with lung cancer experience high levels of distress and greater unmet supportive care needs than those diagnosed with other cancers. Objectives Our study goal was to assess supportive care needs from the perspectives of lung cancer patients and caregivers. Methods A Community Needs Assessment survey was electronically distributed to lung cancer patients and caregivers. The survey assessed the patient’s physical and emotional side-effects experienced during treatment and throughout survivorship. 820 people

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responded, including 471 patients and 349 caregivers. The overall completion rate was 72.6%. Demographic information was collected to determine if patterns of care correlated with geographical or socioeconomic factors. Results 95% of lung cancer patients reported having at least one sideeffect during active treatment and rated physical side-effects as most problematic. Fatigue, anxiety, and shortness of breath were prevalent problems at all time periods. Only 26.9% of active patients discussed palliative care and 20.13% reported receiving it. During survivorship (including long term, >5 years), emotional side effects were rated most problematic by patients and caregivers. Less than 50% of patients reported having a conversation about their values and care goals with their treatment team. Conclusions The majority of lung cancer patients and caregivers perceived a lack of attention to supportive care during active treatment and throughout survivorship. More research and programs are needed to address supportive care needs in health care delivery to positively impact survivorship for lung cancer patients and their families.

eP527 SUPPORTIVE CARE NEEDS IN THAI CANCER SURVIVORS P. Pittayapan1, W. Boonnuch2, Y. Chansilpa3, V. Srimuninnimit4, N. Siritanaratkul5, A. Laocharoenkeat6, S. Hunnangkul7 1 Department of Nursing, Siriraj Hospital, Faculty of Medicine, Mahidol University 2 Department of Surgery, Faculty of Siriraj Medicine, Mahidol University 3 Department of Radiology, Faculty of Siriraj Medicine, Mahidol University 4 Department of Medicine, Division of Medical oncology, Faculty of Siriraj Medicine, Mahidol University 5 Department of Medicine, Division of Hematology, Faculty of Siriraj Medicine, Mahidol 6 Department of Pharmacology, Siriraj Hospital, Faculty of Medicine, Mahidol University 7 The Siriraj Clinical Research Center, Faculty of Siriraj Medicine, Mahidol University Background: A supportive needs assessment is an essential component of any cancer care program. There is no research evidence regarding the supportive care needs of cancer patients in Thailand. Aims: To assess the supportive care needs of Thai cancer patients after the end of first line treatments. Materials and Methods: A cross-sectional survey was carried out in a Cancer center, University Hospital, Bangkok, Thailand. A total of 160 cancer patients completed the validate scales (Cancer Survivors Unmet Needs scale-CaSUN), physical-symptom concerns (Cancer Survivors Survey of Needs-CSSN subscale) and a single-item measure of global quality of life perception (QOL). Descriptive statistics were used for data analysis. Results: One-quarter of the patients reported poor QOL. Unmet needs of moderate/strong level were particularly high in all aspects assessed, particularly in the area of existential survivorship (psychosocial care) and receiving comprehensive cancer care. Conclusions: Thai cancer patients experience many unmet needs and there is an urgent need for establishing additional survival ship care plan for cancer patients after the end of first line treatments.

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eP528 WHAT IS THE ROLE OF PRIMARY CARE PHYSICIANS IN CHILDHOOD CANCER SURVIVORSHIP CARE? A MIXEDMETHODS, MULTI-PERSPECTIVE STUDY C. Signorelli1, C.E. Wakefield1, J.E. Fardell1, J.K. McLoone1, B. McGill1, T. Foreman1, R.J. Cohn1 1 Sydney Children's Hospital, Kids Cancer Centre, Randwick, Australia Introduction Long term follow-up care is recommended to manage late complications for cancer treatment as a child or adolescent. However, many survivors are disengaged from follow-up, mandating alternative models of care to encourage engagement among the growing number of survivors. Objectives This study explores survivors’ preferences, and primary care physicians’ (PCPs) confidence, in delivering survivorship care. Methods Survivors and parents (of survivors <16 years) completed surveys on their follow-up preferences (Stage 1). Survivors nominated their PCP for an interview regarding their role and confidence in providing survivorship care (Stage 2). Results Stage 1: 623 surveys were returned (403 survivors, mean age: 26.8years; and 207 parents, child mean age: 12.4years). Two-thirds of survivors have a regular PCP. One-quarter of survivors reported not attending hospitalbased follow-up, reporting their PCP was best placed to meet their needs (vs 6% of parents, χ2=29.492, p < 0.001). However, oncologists were preferred (60%) compared with PCPs (11%) to lead survivors’ follow-up. Significantly fewer parents nominated PCPs as their first choice for follow-up (2% vs 11% survivors χ2=32.183, p<0.001). Stage 2: Only 12% of PCPs (n=51) recalled receiving their patient’s treatment summary or Survivorship Care Plan, and 67% recalled receiving a letter from the survivors’ clinic. Fifty-percent of PCPs were confident in providing pediatric survivorship care, however 92% had unmet information needs especially understanding survivors’ unique health needs. Conclusions Survivors, parents, and PCPs lack confidence in physician-led survivorship care. Improved communication between tertiary and primary care may increase confidence, and the quality of survivorship care.

eP529 SUPPORTIVE CARE NEEDS OF LOW-INCOME LATINA BREAST CANCER SURVIVORS A. Sleight1 1 University of Southern California, Los Angeles, USA Introduction Low-income Latina breast cancer survivors are disproportionately at risk for poor health outcomes. Supportive care services can reduce health disparities and increase quality of life. However, little is known about the supportive care needs of this population. Objectives To identify the unique supportive care needs of low-income Latina breast cancer survivors. Methods Participants in this descriptive study were Latina breast cancer survivors (n=102) with no metastasis who had completed cancer treatment. Three self-report questionnaires included: 1) The Supportive Care Needs Survey (SCNS-SF34). 2) The Health Behaviors and Logistical Challenges Survey. 3) A standard demographics questionnaire. Results 77% of participants disclosed an annual income of <$15,000. 72% of participants reported having at least one co-morbidity. Respondents

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reported, on average, 16 unmet supportive care needs. They indicated the highest level of unmet need in the domain of “health systems and information.” Items most commonly rated as 5/5 (“high need”) in this domain included “being informed about how to help yourself get well” and "being given information about managing your illness at home.” The most frequently reported health behavior-related need was “help managing another health condition” (45% of respondents). Other commonlyreported health behavior-related challenges included obtaining adequate nighttime sleep and addressing weight loss/maintenance. Conclusions These findings suggest that low-income Latina breast cancer survivors may require more and/or better-tailored health-related information and increased support in self-management of co-morbidities, along with guidance in health behavior change. These findings carry implications for optimizing multidisciplinary supportive care for this population.

eP530 HIGH RATES OF DELAYED GENITAL TRACT HUMAN PAPILLOMAVIRUS (HPV) REACTIVATION IN LONG-TERM FEMALE STEM CELL TRANSPLANT SURVIVORS P. Stratton1, D. Shanis2, P. Anandi3, C. Grant4, A. Bachi5, N. Vyas6, M. Merideth7, P. Pophali3, E. Koklanaris3, S. Ito3, B. Savani8, A.J. Barrett3, M. Battiwalla3 1 NINDS, OCD, Bethesda, USA 2 NICHD, OCD, Bethesda, USA 3 NHLBI, Hematology Branch, Bethesda, USA 4 Howard County Community College, PA, Columbia, USA 5 Newcastle University- UK, Medical School, Newcastle, United Kingdom 6 UCLA, David Geffen School of Medicine, Los Angeles, USA 7 NHGRI, Medical Genetics Branch, Bethesda, USA 8 Vanderbilt University Medical Center, Hematology/Oncology, Nashville, USA Introduction Cervical Human Papillomavirus (HPV) disease is reported in 30-40% of women after allogeneic hematopoietic cell transplantation (HCT). Objectives Determine the risk factors and course of any genital HPV disease in women after HCT. Methods In a long-term study after HCT, gynecologic history and examination, cervical cytology and HPV testing were performed followed by colposcopy and surgery as indicated. Demographic, disease-related factors, history of HPV infection, chronic graft-versus-host disease (cGVHD), and use of immunosuppression were assessed for their association with multifocal, persistent and severe genital HPV disease. Results One hundred nine women underwent HCT between 1994 and 2014. Eightytwo females (median: 5.2 years, range 0.3-17.4) surviving transplant for >1 year were studied. The cumulative rate estimates of any genital HPV infection at 1, 3, 5, 10 and 20 years were 4.8, 14.9, 28.1, 36.7 and 40.9%, respectively. Fifteen (18%) women reported abnormal cytology, genital warts or dysplasia pre-transplant; this history was associated with any post-transplant HPV (OR=6.5, 95%CI=1.65-25.85, p=0.008), and persistent HPV (OR=23.2, 95%CI=4.98-108.43, p<0.001). Having either extensive cGVHD or genital cGVHD was associated with increased risk of any HPV disease (OR=5.7, 95%CI=1.90-17.16, p=0.002) and a higher risk for severe cervical or vulvar dysplasia (OR=13.1, 95%CI=1.59-108.26, p=0.017). Conclusions High HPV rates and its association with extensive cGVHD or genital cGVHD in transplant survivors likely reflects HPV reactivation and suggests a role for immune dysregulation. The kinetics of reactivation offers a wide window for HPV vaccination, which may reduce this risk. As persistent HPV disease can progress, women benefit from regular gynecologic follow-up.

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eP531 CHRONIC FATIGUE IN TESTICULAR CANCER SURVIVORS DURING LONG-TERM FOLLOW-UP A.H. Torstveit1, A.A. Dahl1, S.D. Fosså1, I. Utne2 1 Oslo University Hospital, Clinical Cancer Research Unit, Oslo, Norway 2 Oslo and Akershus University College of Applied Sciences, Department of Nursing and Health Promotion, Oslo, Norway Introduction Testicular cancer survivors are at risk of chronic fatigue as a result from cancer and cancer treatment. Chronic fatigue (CF) is described as one of the most troublesome and common long-term symptom, and is often reported to have a negative effect on quality of life among cancer survivors. Objectives The aims of this study in a sample of long-term testicular cancer survivors (TCSs) treated in Norway between 1980 and 1994, was to to describe their level of CF in 1998-2002 (T1) and in 2007-2008 (T2). In addition, to investigate changes in the level of CF from T1 to T2. Methods A total of 934 TCSs completed the Fatigue Questionnaire at both time points. Data were analysed using descriptive statistics and chi-square analyses. Results At T1, the mean age of the men was 42,7 years (SD=7,8), 76% were married or in a paired relationship, and 93% were employed. The prevalence of CF was 16% (n=149) (95% CI 13,6%-18,3%) at T1, and increased to 28% (n=265) (95% CI 25,5%-31,3%) at T2 (p<0,001). Eleven per cent of the TCSs reported CF at both T1 and T2, 5% (n=44) only at T1, and 17% (n=160) only at T2. Conclusions A significant number of TCSs report CF many years after treatment. Although most of the testicular cancer survivors are not developing CF, the incidence of CF in this group is rising over time. This should be taken in to consideration during follow-up of TCSs.

eP532 TRANSLATION AND CROSS-CULTURAL ADAPTATION OF THE CANCER SURVIVOR PROFILE AND PRETEST FOR CANADIAN FRE NCH-SPE AKING BREAST CANCE R SURVIVORS D. Tremblay1, K. Bilodeau2, M.F. L’Italien3, L. Levesque4 1 Centre de recherche − Hôpital Charles-LeMoyne- Université de Sherbrooke - Campus Longueuil, École des sciences infirmièresFaculté de médecine et des sciences de la santé, Longueuil, Canada 2 Centre de recherche − Hôpital Charles-Le Moyne- Université de Sherbrooke - Campus de Longueuil, École des sciences infirmièresFaculté de médecine et des sciences de la santé, Longueuil, Canada 3 Université de Sherbrooke - Campus de Longueuil, Faculté de médecine et des sciences de la santé, Longueuil, Canada 4 Centre de recherche − Hôpital Charles-Le Moyne- Université de Sherbrooke - Campus de Longueuil, Faculté de médecine et des sciences de la santé, Longueuil, Canada Introduction After treatment, breast cancer (BC) survivors face high symptom burdens that are inadequately addressed by clinicians and researchers. Validated instruments such as the Cancer Survivors Profile (CSPro) developed by Todd et al. (2015) might be useful for assessing symptoms and monitoring outcomes for these patients. The original CSPro is in AmericanEnglish, and there is no French-Canadian version. Objectives To produce a cross-cultural adaptation of the CSPro and test its cultural relevance for French-Canadian BC survivors.

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Methods The CSPro was translated and cross-culturally adapted using a rigorous method (Fig.1). A study was conducted to ensure the adapted questionnaire was understandable and acceptable. BC survivors were asked to rate each question using a numeric clarity scale (1=very unclear; 7=very clear), following Vallerand (1989), and undergo a cognitive interview.

Results Of twenty-two BC survivors aged 40–69 who participated in the study, 45% had received surgery, radio- and chemotherapy, and 23% reported a high symptom burden. The mean score for clarity of questions was 5.9; only one question scored <4.0. Participants were unclear on response choices for 10 of the questions. One question concerning physical appearance caused discomfort. Conclusions Linguistic and cultural differences were identified between the FrenchCanadian and original versions of the CSPro. Following a rigorous translation process and expert committee reviews, cognitive interviews showed that certain questions and response choices in the FrenchCanadian version remained unclear. After the expert committee reworded items based on interview feedback, the French-Canadian version of the CSPro is culturally appropriate. Further studies are needed to assess its psychometric properties.

eP533 PRELIMINARY EVALUATION OF A SMOKING CESSATION PROGRAM IN ONTARIO'S REGIONAL CANCER CENTRES R. Truscott1, E. Cameron1, M. Bassier-Paltoo1, M. Haque1, A. Peter1, W.K. Evans1 1 Cancer Care Ontario, Prevention & Cancer Control, Toronto, Canada Introduction Evidence suggests that the risk of dying from cancer could be lowered by 30-40% by quitting smoking at the time of diagnosis. Ontario’s 14 Regional Cancer Centres (RCCs) have implemented a provincial program to screen new ambulatory cancer patients for tobacco use, advise on the benefits of quitting, and refer to smoking cessation (SC) services for support. Objectives The purpose of the preliminary evaluation was to understand the unique processes at each RCC, assess program strengths and barriers and provide recommendations for improvement. Methods The evaluation consisted of: (1) Process flow review meetings; (2) an online survey; and (3) key informant interviews.

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Results Program strengths included having strong leadership support; staff training to improve confidence in discussing SC; communications to increase awareness; access to a dedicated quit specialist; an electronic data capture system; and strong external partnerships. Barriers included the absence of a hospital-wide smoking cessation strategy; increased staff workload and change fatigue; low physician buy-in due to perceptions that smoking cessation is not important following a diagnosis of cancer; insufficient funding; and a lack of nicotine replacement therapy (NRT) provision. Conclusions Recommendations to improve effectiveness included the creation of a cancer-specific best practice guideline for SC; a tailored action plan for each RCC; enhanced training; and provision of free NRT. Cancer Care Ontario will work on program refinements, and is encouraged by the growing recognition of smoking cessation as an important component of quality cancer care.

eP534 BIOLOGICAL BIOMARKERS OF CANCER PROGNOSIS A. Wan1, M. Lam1, A. Furfari1, R. McDonald1, L. Rowbottom1, S. Chan1, P. Zaki1, C. DeAngelis1, R. Chow1, G. Charames2, H. Lam1, E. Chow1, A. Azad2 1 Odette Cancer Centre - Sunnybrook Health Sciences Centre - University of Toronto, Radiation Oncology, Toronto, Canada 2 Mount Sinai Hospital, Pathology and Laboratory Medicine, Toronto, Canada Introduction Antibody-based detection methods have allowed the evaluation of many biological compounds for clinical importance in cancer prognosis. These include proteins in bodily fluids, tumor tissue, or lymph nodes, and cell types identifiable by protein expression. Objectives To systematically summarize the literature on uncommon molecular biomarkers associated with cancer outcome. Methods A literature search was conducted on Medline and Embase utilizing keywords such as “cancer,” “inflammation,” “prognosis,” “inflammation,” and “biomarkers.” Articles that reported on uncommon biological biomarkers of prognosis were included and extracted for information such as cancer type and prognosis. Results 28 studies comprising of 5234 patients found associations between 45 uncommon molecular biomarkers and prognosis in more than 15 types of primary malignancies. Serum hemoglobin, carcinoembryonic antigen, pentraxin 3, and interleukin 6 (IL6), were found to be significantly associated with poor cancerspecific survival, disease-free survival, or overall survival in multiple univariate analyses, and were also found to be significant in multivariate analysis in at least one study. IL1, IL10 and IL8, vascular endothelial growth factor, and prostate-specific antigen were also found to be independent predictors of survival. In multivariate analysis, elevated serum CEA was associated with the greatest risk of death (OR 12.5, p<0.001), and elevated serum IL1 was associated with the greatest risk of recurrence (HR=11.84, p=0.01).

Conclusions Many molecular biomarkers associated with prognosis are part of the inflammation pathway. Identification of prognostic biomarkers has the potential to highlight aspects of physiology that lead to poor prognosis and assist in the identification of therapeutic targets.

eP535 CLINICAL OUTCOMES OF CONTEMPORARY NON-SMALL CELL LUNG CANCER PATIENTS RECEIVING WHOLE BRAIN RADIOTHERAPY: CRYSTALLIZING THE QUARTZ OUTCOMES M.H. Wang1, M. Hwang1, D. Severin1, A. Fairchild1 1 Cross Cancer Institute, Radiation Oncology, Edmonton, Canada Introduction Whole brain radiotherapy (WBRT) in combination with corticosteroids as the standard of care for patients with brain metastases (BM) was established by trials demonstrating improved symptoms and survival in multiple primary tumor sites. However, the recent Quality of Life after Treatment for Brain Metastases (QUARTZ) trial showed no difference in overall survival (OS) or quality of life with adding WBRT (20Gy/5) to optimal supportive care (OSC) in non-small cell lung cancer (NSCLC) patients. Objectives To investigate clinical outcomes in a comparable cohort treated at our tertiary cancer centre.

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Methods Demographic, symptom, disease and treatment-related data were abstracted for adult NSCLC patients receiving palliative WBRT for BM (01-12/2015). Prophylactic cranial irradiation, stereotactic and partial brain radiotherapy were excluded. Descriptive statistics were calculated, and a two-proportion z-test was used for comparisons to QUARTZ. Results For the 75 eligible patients, median age was 65 years (66 in QUARTZ), 48% were male (58% in QUARTZ, p=0.123), 53% had adenocarcinoma (55% in QUARTZ, p=0.757), and 16% had squamous cell carcinoma (20% in QUARTZ, p=0.435). 60% had KPS<70 (38% in QUARTZ, p<0.001), and primary disease was controlled in 23% (33% in QUARTZ, p=0.097). Median time between BM diagnosis and WBRT start was 17 days (23 in QUARTZ). Excluding 12 surviving patients, median OS was 9.9 weeks (95% CI 6.6-13.2), compared to 9.2 weeks (95% CI 7.2-11.1) in QUARTZ. Conclusions Compared to QUARTZ, our cohort of NSCLC patients had poorer functional status, and more uncontrolled primary disease, but a shorter interval between BM diagnosis and treatment, and comparable median OS.

eP536 WELLNESS BEYOND CANCER PROGRAM: PROGRAM EVALUATION AND QUALITY ASSURANCE REVIEW M. Warwick1, R. Morash2, G. Larocque2, C. Liska2, K.A. Baines2, D. Fergusson3, R. Segal4 1 The Ottawa Hospital, Internal Medicine, Ottawa, Canada 2 The Ottawa Hospital, Regional Cancer Program, Ottawa, Canada 3 Ottawa Research Institute, Epidemiology, Ottawa, Canada 4 The Ottawa Hospital, Medical Oncology, Ottawa, Canada Introduction The Wellness Beyond Cancer Program (WBCP) is a multidisciplinary survivorship program whose mandate is to ensure that breast (BC) and colorectal cancer (CRC) patients at The Ottawa Hospital Cancer Program (TOHCP) have access to optimal resources once active treatment is complete. As of August 2016, three thousand eight hundred and eighty-seven (n=3887) patients have been referred. We therefore undertook a quality assurance evaluation of the program Objectives Assess reasons for re-entry including (1) medical complications; (2) disease specific data; and (3) treatment intent/undertaken. Methods Charts for patients discharged to the WBCP, requiring re-entry to TOHCP were reviewed. Disease specific data and treatment intent will be presented. Results One thousand and thirty CRC patients (n=1030) were discharged with eighty-six (n= 86) requiring re-entry. Of those, 6.1% (n=63) were disease recurrences, 0.4% (n=4) were new primaries, and 1 had benign disease. All patients were eligible for therapy; 6 declined. Of patients receiving treatment, 12 were surgical candidates 8 underwent metastatectomies with curative intent. Two thousand seven hundred and ninety-four (n=2794) BC patients were discharged, seventy-three (n=73) required re-entry. Fifteen patients (n=15) relapsed prior to first program visit. Of the remaining 58 patients, 1.5% (n=43) had systemic recurrences, 0.3% (n=9) presented with contralateral BC, and 0.2% (n=6) developed a new primary. All patients were eligible and received systemic therapy; except for 1 patient who declined therapy. Conclusions Preliminary data supports favorable outcomes for patients requiring reentry into TOHCP when discharged through a formalized program. A comparative case matching study is underway.

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eP537 BODY IMAGE, SEXUALITY, AND SEXUAL FUNCTION IN WOMEN WITH CERVICAL AND UTERINE CANCER: A REVIEW OF THE STATE OF THE SCIENCE C.M. Wilson1, D.B. McGuire1, B. Rodgers1, R.K. Elswick1, W. Chafe2 1 Virginia Commonwealth University, School of Nursing, Richmond, USA 2 Virginia Commonwealth University Health System, Department of Obstetrics and Gynecology, Richmond, USA Introduction Over 63,000 women will be diagnosed annually with either cervical cancer or cancer of the uterine body. The multimodal treatments these women face have numerous adverse effects including issues with body image, sexuality, and sexual function, but there are few studies examining these issues or their impact Objectives The purpose of this review of the literature was to describe and appraise the state of the science in regard to body image, sexuality, and sexual function in women with cervical and uterine cancer. Methods A systematic review of the literature was undertaken using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to guide the review. PubMed, CINAHL, and PsychInfo databases were searched using predetermined subject headings, keywords, and exploded topics. Over 1000 articles were retrieved, then reduced to 278 after review of the title and abstract using inclusion and exclusion criteria. After checking for duplicates, 193 articles were included in the review. Citations from these articles were analyzed for additional appropriate articles to be included, resulting in some additions. Results Articles consisted of case reports, quantitative and qualitative research reports, non-research descriptive articles, and commentaries. A majority of the articles were qualitative and quantitative descriptive research, with few intervention studies identified. In qualitative studies, women described body image, sexuality, and sexual function together but in most quantitative studies only one or two of these problems were studied. Conclusions This review demonstrated the need for further descriptive and intervention work in this population.

eP538 LONG-TERM IMPACT OF HEAD AND NECK CANCER (HNC) AND TREATMENT ON FINANCIAL DISTRESS AND EMPLOYMENT OF HNC SURVIVORS E. Wulff-Burchfield1, K. Bonnet2, D. Schlundt2, M.S. Dietrich3, E. Castellanos4, B.A. Murphy4 1 Vanderbilt University Hospital, Medicine, Nashville, USA 2 Vanderbilt University, Psychology, Nashville, USA 3 Vanderbilt University Schools of Medicine and Nursing, Medicine, Nashville, USA 4 Vanderbilt University Hospital, Medicine- division of hematology/oncology, Nashville, USA Introduction Increasing HNC survival highlights the importance of understanding late biopsychosocial outcomes. Financial and occupational topics in HNC survivors represent a knowledge gap. Objectives Perform qualitative analysis to identify financial and occupational themes/impacts of HNC/treatment on survivors’ financial health.

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Methods Eligibility: Locally-advanced HNC, prior participation in R0-1, NED, > 1 year post treatment. Ten of 12 eligible patients were interviewed. Topics queried: financial issues related to HNC/treatment, financial/insurance matters affecting treatment, impact of HNC/treatment on fiscal responsibilities/work, financial counseling. Used frequency distributions to summarize demographics. Interviews were transcribed verbatim, double-coded, and organized into themes. Results 50% male, 100% Caucasian, 60% married, median age 64 years, median time since treatment 64 months. Most denied financial strain from HNC/ treatment; mitigating factors included preparedness (e.g. preexisting savings), health/disability insurance, and marriage. None reported financially-related delays in care. However, 2 patients used free healthcare. Most denied impacts on financial obligations, but a minority reported delays in dental care, paying credit card bills, and travel. Four patients used financial counseling, reporting benefits of decreased stress, access to financial programs, and education. Healthcare providers were considered an important source of financial counseling. Late effects (fatigue, cognitive changes) impaired work capacity for those who resumed/ continued working. The study population may have been skewed by loss to follow-up of patients with financial toxicity that precluded ongoing medical follow-up. Conclusions Long-term financial distress was limited in this HNC survivor cohort. Preparedness, insurance, marital status, and financial counseling attenuated financial impacts of HNC. Late effects may affect the capacity of those returning to work.

eP539 COLORECTAL CANCER AND ITS AWARENESS S.S.A. Zaidi1, A. Fatima2 1 , Lahore, Pakistan 2 SGRH, Oncology, Lahore, Pakistan Introduction Colorectal cancer (CRC) is the leading cause of cancer mortality in Pakistan. Younger people are more affected by this deadly cancer. Many, if not most, cases arise from premalignant lesions (adenomas) which may be identified and removed prior to becoming frankly malignant Objectives To promote awareness regarding increased occurrence of colorectal cancer in younger population and its clinical and pathological features compared to older patients. Methods The cross-sectional study was conducted from February 2014 to January 2016 on patients with diagnosis of colorectal carcinoma admitted through emergency or outpatients in Sir Ganga Ram Hospital Lahore. Data regarding age, gender, presentation, site of tumor, surgery performed and Dukes staging was collected and analyzed Results A total of 23 patients were operated during the study period: 13 (56.52%) males and 10 (43.47%) females. Of them 12 (52.17%) were below the age of 40 years, while 3 (13.04%) patients were in the 11-20 age group. In 7 (30.4%) patients, tumor was irresectable at the time of presentation so a palliative procedure (diversion colostomy or ileostomy) was performed. There was a higher proportion of younger patients with metastatic disease at the time of presentation (n=9; 75%) while 10 out of 12 patients in the younger age group (83.3%) had a tumour of left colon, particularly rectum. Conclusions Although colorectal cancer is usually a disease of older patients, it is increasingly becoming more common in younger population.

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Data suggests a leftward distribution for colorectal carcinoma and that younger patients present with more advanced disease and poorer prognosis.

eP540 ASSESSMENT OF DEEP VEIN THROMBOSIS (DVT) CASES IN A M B U L AT O RY C A N C E R PAT I E N T S I N Q ATA R . A RETROSPECTIVE CASE CONTROL STUDY R. Abd el wahab1, S. EL AZZAZY2, R. Negm3, N. AL TARAWNEH4 1 , doha, Qatar 2 National Center for Cancer Care and Research NCCCR, Pharmacy Department- NCCCR, doha, Qatar 3 National Center for Cancer Care and Research NCCCR, Oncology Hematology Department- NCCCR, doha, Qatar 4 National Center for Cancer Care and Research NCCCR, Quality Management and Patient Safety Department- NCCCR, doha, Qatar Introduction Primary Venous Thromboembolism (VTE) prophylaxis is recommended mainly in surgical and hospitalized cancer patients without contraindications to anticoagulants. Current international guidelines provide recommendations for thromboprophylaxis in selected ambulatory-cancer patients. Some of these guidelines suggest using the Khorana-risk score for DVT risk assessment. Objectives Primary Objective:Incidence Assessment of Deep Vein Thrombosis (DVT) and related cancer types. Secondary objective: assessment of correlation of DVT in ambulatorycancer patients on chemotherapy with Khorana-risk assessment scoring model Methods Observational retrospective case control study, conducted by reviewing Doppler-ultrasound US reports from 1st of January 2014 - 31st of December 2014. Initially identify patients with oncology/hematology malignancies starting chemotherapy, followed by selecting patients with positive impression-DVT, then screening for relevant biomarkers in Khorana-risk score and any additional risk factors. Furthermore, comparison between ambulatory-patients who developed DVT with those who didn't was carried on to determine the Khorana-risk score associated with highest incidence. Non-malignant patients, adults < 18 years and pregnant-women were excluded Results DVT incidence in ambulatory-cancer patients compared to in the inpatient-setting was (22.82% vs. 7.69%). Breast-cancer was the most common malignancy associated with DVT (28.57%) followed by colon-cancer (14.29%) in both settings. Ambulatory-cancer patients on chemotherapy showed higher incidence of DVT (29.33%). Ambulatorycancer patients on chemotherapy with Khorana-risk score of ≥ 2 were more likely to develop DVT (37.5%, OR=1.62, CI 95% [0.58 - 4.55]). Conclusions Results highlight importance for DVT risk assessment for ambulatorycancer patients starting chemotherapy. Also highlights the need to evaluate Khorana risk-score and consider additional risk factors: type of treatment, previous DVT history & admissions

eP541 THROMBOPROPHYLAXIS ON INPATIENT PALLIATIVE CARE UNITS: A NARRATIVE REVIEW B. Hannon1, M. Krzyzanowska2, C. Zimmermann1 1 Princess Margaret Hospital, Supportive Care, Toronto, Canada 2 Princess Margaret Hospital, Medical Oncology, Toronto, Canada

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Introduction Guidelines suggest that most inpatients with cancer should receive thromboprophylaxis (TP) during their hospitalisation, but use of these guidelines on palliative care units (PCUs) is poor and their relevance in this setting is unclear. Objectives To review the literature around TP on PCUs and to better understand practices, attitudes and barriers to its provision. Methods Medline and Embase were searched from 1946-2016 using keywords including TP, anticoagulant, thrombosis, palliative, hospice, cancer and neoplasm. Original, English-language studies were included if they reported on TP use or practices on PCUs for adult patients; exclusion criteria were specific cancer sites, or non-PCU settings. Results Of 204 papers identified, 11 met eligibility criteria; 8 were quantitative (one randomised controlled trial [RCT], 3 retrospective, 2 surveys and 1 quality improvement project) and 3 qualitative studies. These variously aimed to explore: TP practices on PCUs; patients’ attitudes towards TP; the association between risk assessment and the development of symptoms; or outcomes associated with the routine use or omission of TP. The one RCT compared the use of TP or no treatment in terms of both thromboembolic and adverse bleeding events but recruitment was challenging and the results were substantially underpowered. Quantitative papers were analysed using STROBE criteria and were found to be of moderate-high quality. Conclusions There is insufficient high-quality data to support or reject the routine use of TP on PCUs. With growing numbers of patients admitted to acute PCUs for brief, focussed symptom control admissions, further research in this area is warranted.

eP542 FACTORS INFLUENCING T HE USE OF THROMBOPROPHYLAXIS IN CANCER OUTPATIENTS: CAT AXIS, A CASE-VIGNETTE STUDY ON CLINICAL PRACTICE. F. scotte1, I. Elalamy2, D. Mayeur3, G. Meyer4 1 Georges Pompidou European Hospital, Medical Oncology and Supportive Care Unit, Paris, France 2 Tenon University Hospital, Biological Hematology, paris, France 3 Hôpital Mignot, Haematology-Oncology and Supportive Care Unit, Le Chesnay, France 4 Hôpital Européen Georges Pompidou, Department of respiratory diseases, Paris, France Introduction Data on long-term venous thromboembolism (VTE) prophylaxis in cancer outpatients remain scarce. Objectives In the absence of consistent treatment guidelines, our objective was to describe clinical practice and to identify factors influencing the use of thromboprophylaxis. Methods CAT AXIS was a multicenter cross-sectional study based on the completion of physician-profile questionnaires and the assessment of 10 e-mailed credible clinical scenarios of lung, colon and breast cancer by each of participants using the case-vignettes validated method. Results A total of 224 physicians participated allowing the completion and the analysis of 2,085 reviewed case vignettes corresponding to 765, 703 and 617 fictive clinical scenarios on lung, colon and b r e a s t c a n c e r s , r e s p e c t i v e l y. T h e o v e r a l l r a t e o f

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thromboprophylaxis was 680/2085 (32.6%) among participants with a comparable proportion for the three types of cancer. Based on patient’s characteristics, multivariate analyses revealed that ECOG index, metastatic malignancy, chemotherapy and history of thrombosis were significantly associated with the therapeutic decision in most situations excepted chemotherapy and history of VTE in breast cancer and metastatic malignancy in lung cancer. After adjustment to physician’s profile, the multivariate analysis revealed similar results except history of VTE in breast cancer and metastatic lung cancer, both significantly associated with the use of thromboprophylaxis Conclusions In the absence of clear guidance, the use of thromboprophylaxis remains low and rather empiric even though the selection of LMWH by the majority of participants and treatment duration seems appropriate based on available data to date. Specific guidelines with corresponding awareness are required.

eP543 ORAL RIVAROXABAN VERSUS SUBCUTANEOUS LOW MOLECULAR WEIGHT HEPARIN TREATMENT FOR VENOUS THROMBOEMBOLISM IN PATIENTS WITH UPPER GASTROINTESTINAL, HEPATOBILIARY AND PANCREATIC CANCER S. Seyoung1, L. Dae Ho1, R. Min-Hee1, K. Yoon-Koo1, K. Kyu-Pyo1, C. Heung-Moon1, R. Baek-Yeol1, K. Sung-Bae1, L. Jae-Lyun1, P. Sook Ryun1 1 Asan medican center, Department of Oncology, Seoul, Republic of Korea Introduction Although low molecular weight heparin (LMWH) is preferred treatment of cancer-related venous thromboembolism (VTE), rivaroxaban is increasingly used owing to its convenience. Objectives We aimed to compare the LMWH and rivaroxaban maintenance therapy for VTE in patients with upper gastrointestinal (GI), hepatobiliary and pancreatic (HBP) cancer. Methods With exclusion of patients who had resectable disease, received treatment less than 14 days unless discontinued due to bleeding and took anticoagulation not for therapeutic purpose, 107 and 69 patients were analyzed, respectively. Results Most baseline characteristics were similar between the two groups (rivaroxaban vs. LMWH), except age ≥65 and ECOG ≥2. The recurrent or aggravated VTEs were observed at 4 (5.8%) in the rivaroxaban group and 1 (0.9%) in the LMWH group (HR 4.95, 95% CI 0.55-44.90, p=0.156). Regarding the safety, the rivaroxaban group had significantly higher incidences of total events of bleeding (40.6% vs. 19.0%, p=0.002)and clinical relevant bleeding (31.9% vs. 14.3, p=0.006) Major bleeding events also occured more frequently in the rivaroxaban group (17.4% vs. 7.6, p=0.048). In multivariate analysis, the treatment of rivaroxaban was significantly associated with major bleeding (HR 2.94, 95% CI 1.058.21, p=0.040) and clinical relevant bleeding (HR 2.45, 95% CI 1.26-4.76, p=0.008) after adjusting for age ≥65, sex, presence of GI mucosa lesions, poor performance status, lower BMI (<18.5) and azotemia. Conclusions Rivaroxaban had similar efficacy to LMWH for the treatment of cancerassociated VTE, but was associated with a higher rate of bleeding in patients with upper GI and HBP cancer. Further studies are needed to validate our findings.

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eP544 F U L M I N A N T L I V E R FA I L U R E C A U S E D B Y D U A L IMMUNOTHERAPY FOR MALIGNANT MELANOMA R. Boparai1 1 North Shore University Hospital/Northwell Health, Hospital Medicine, Manhasset, USA Introduction Immunotherapy is a new and emerging treatment for solid tumors. Randomized controlled trials resulting in significant increases in survival and disease free periods have been reported. Nivolumab and ipilimumab have been recently determined to be an effective combination to increase progression-free survival time in metastatic melanoma. Increasing toxicity has been reported secondary to immunotherapy including immune colitis, kidney failure and hepatotoxicity. Objectives We report a case of fulminant hepatic failure secondary to dual immunotherapy which did not respond to steroids. Methods A 70 year old male with malignant melanoma on immunotherapy with Nivolumab and Ipilimumab was sent in for admission by his oncologist for abnormal Liver function tests. Found to have and ALT 1138 of, AST of 275. Started on high dose iv steroids for immunotherapy induced hepatitis. Liver function slowly improved. Discharged to rehab on high dose oral prednisone. Patient readmitted 1 week later with fever and confusion. Found to be in acute fulminant liver failure. Continued to worsen despite high dose iv steroids, treatment of presumed sepsis and supportive care. Results Family requested a palliative consult with comfort measures. Patient expired in the hospital. Conclusions It is important to look for immune mediated organ damage in patients undergoing immunotherapy for solid tumors. Early intervention with high dose steroids may reverse immune mediate damage in some cases. Other therapeutic options include TNF inhibitors. Larger studies will be necessary to investigate if patients may benefit from evaluation for pre-existing liver disease prior to initiating therapy or routine liver enzyme monitoring while undergoing therapy.

eP545 MULTICENTRIC PROSPECTIVE OBSERVATIONAL STUDY EVALUATING SUBCUTANEOUS TRASTUZUMAB TOXICITY IN NON-METASTATIC BREAST CANCER PATIENTS F. Estevinho1, A.M. Silva2, M. Salgado1, F. Braga1, A. Mesquita1, C. Gavina3, P. Peixoto4, C. Sottomayor1 1 Hospital Pedro Hispano- Unidade Local de Saúde de Matosinhos ULSM, Medical Oncology, Matosinhos, Portugal 2 Fauldade de Medicina da Universidade do Porto, Unidade de Farmacovigilância do Norte, Porto, Portugal 3 Hospital Pedro Hispano- Unidade Local de Saúde de Matosinhos ULSM, Cardiology, Matosinhos, Portugal 4 Hospital Pedro Hispano- Unidade Local de Saúde de Matosinhos ULSM, Hospital de Dia, Matosinhos, Portugal Introduction Trastuzumab is an anti-HER2 humanized monoclonal antibody (IgG1) which is part of the standard of care of breast cancer patients who express this receptor. Until 2012 its administration was exclusively intravenous. However, a subcutaneous formulation with a fixed dose is now used in most hospitals in Portugal.

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Objectives We aim to evaluate the toxicity profile of subcutaneous trastuzumab in our daily practise; Secondary endpoints are the characterization of the population of breast cancer patients with HER-2 amplification and evaluate progression free survival of these patients. Methods This is a prospective observational study; selected patients are women 18 years old or more, with positive HER-2 breast cancer who have been assigned treatment with trastuzumab in neoadjuvant or adjuvant settings. Evaluation of toxicities will be performed every 3 months, and will include cardiotoxicity evaluation (using echocardiogram, electrocardiogram and myocardial necrosis markers), or less if indicated by ESMO guidelines, during the first year. Afterwards this evaluation will be done every 6 months, until the 4th year after diagnosis. Results We are now in the implementation phase in the first hospital, and plan to expand the study to the other three hospitals in Porto. The inclusion of patients will occur for a whole year in every center. Conclusions Subcutaneous trastuzumab has been described as a safe, cost-effective drug, as compared with intravenous formulation; however no phase IV studies have yet been published. We aim to describe the toxicity profile of this drug in “everyday practise”.

eP546 MANAGING TREATMENT AND SIDE EFFECTS: EXPLORING THE EXPERIENCE OF PEOPLE UNDERGOING IMMUNOTHERAPIES FOR ADVANCED MELANOMA AND FOR THOSE CARING FOR THEM D. Milne1, A. Billett1, K. Gough1, M. Krishnasamy2,3 1 Peter MacCallum Cancer Centre, Cancer Experiences Research, Melbourne, Australia 2 University of Melbourne, Centre for Cancer Research, Melbourne, Australia 3 Victorian Comprehensive Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia Introduction Introduction: Melanoma, the fourth most common cancer in Australia, is among the leading causes of cancer-related death in people under age 50 years. Recent advancements in targeted- and immunotherapies have improved survival in people with advanced disease; anecdotally, however, associated toxicity and side effects often seriously affect life quality. Objectives Objective: To better understand the experiences, needs and supportive care requirements of people with stage IV melanoma receiving systemic treatment, and their carers, to inform the development of interventions that promote or improve patient-centred care. Methods Method: Semi-structured interviews with 22 patients with stage IV melanoma who had received immunotherapy at an Australian public cancer hospital and nine carers. Results Results: Patients described side effects such as fatigue, pruritus, rash and diarrhoea that adversely affected their quality of life, but most felt the benefits of treatment outweighed the side effects. Carers described witnessing the same side effects; however, they described a heightened sense of responsibility for identifying, reporting, and then managing side effects effectively. Fatigue had the most striking impact on quality of life according to patients and carers. Notably, both groups identified side effects as contributing to their sense of an uncertain future.

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Conclusions Conclusions: Side effects from immune-therapies impact physically on patients, and can cause distress for carers. Resources to better prepare patients and carers on what to expect and to plan for the future are required.

eP547 A SUPPORTIVE CARE INTERVENTION FOR PEOPLE WITH MELANOMA BEING TREATED WITH IMMUNOTHERAPY: A PILOT STUDY ASSESSING FEASIBILITY, PERCEIVED BENEFIT, AND ACCEPTABILITY J. Lacey1, A.J. Lomax2, M. Marthick1,3, H. Dhillon4, D.C. Levy1,5, S. Kao2,6, C. McNeil2,6 1 Chris O'Brien Lifehouse, Supportive Care, Camperdown, Australia 2 Chris O'Brien Lifehouse, Medical Oncology, Camperdown, Australia 3 University of Sydney, Faculty of Health Sciences, Camperdown, Australia 4 University of Sydney, CeMPED, University of Sydney, Australia 5 University of Sydney, Faculty of Nursing, Camperdown, Australia 6 University of Sydney, Sydney Medical School, Camperdown, Australia Introduction Metastatic Melanoma (MM) patients receiving pembrolizumab are a growing population. Its impact on their psychosocial and physical wellbeing is underexplored. Supportive care interventions for people living long-term on immunotherapy are needed. Objectives The primary objective was to assess the feasibility of providing a multimodal supportive care program to people with MM patients being treated with pembrolizumab. Methods This pre-post-test feasibility cohort study recruited participants treated with pembrolizumab for MM into two cohorts: i) supportive care intervention; and, ii) usual care. The intervention comprised comprehensive medical assessment by supportive care physician, exercise physiologist, and dietitian after which a tailored supportive care program was devised. Programs included: exercise intervention, dietary advice, meditation, massage, acupuncture, and psychologist consultation. Outcome measures included: adherence to individualized plan, patient reported outcomes (symptoms, anxiety and depression, toxicity) were collected at 3 weekly intervals. Participants completed qualitative interviews (reported elsewhere). Descriptive data regarding symptoms are reported. Results In total 28 participants were recruited, 13 intervention, 15 control; three did not complete the study due to complications or death. Those in the intervention cohort were mostly female (7/13) and aged 42-84 years. Symptoms most troubling at baseline were: memory, sleep, fatigue, appetite. Adherence was excellent, all participants attended appointments with supportive care physician, exercise physiologist, dietitian. Attendance at exercise classes was 91%. Complementary therapies used were: acupuncture, massage, mediation, and reflexology. Conclusions A wholistic supportive care intervention that tailors a program to an individual’s needs is feasible and warrants further investigation to determine impacts on outcomes.

eP548 T H E E X P E R I E N C E O F PAT I E N T S R E C E I V I N G P E M B R O L I Z U M A B T H E R A P Y F O R M E TA S TAT I C MELANOMA D.C. Levy1,2, H. Dhillon3, A.J. Lomax4, M. Marthick1,5, C. McNeil4,6, S. Kao4,6, J. Lacey1 1 Chris O'Brien Lifehouse, Supportive Care, Camperdown, Australia

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University of Sydney, Faculty of Nursing, Camperdown, Australia University of Sydney, CeMPED, University of Sydney, Australia 4 Chris O'Brien Lifehouse, Medical Oncology, Camperdown, Australia 5 University of Sydney, Faculty of Health Sciences, Camperdown, Australia 6 University of Sydney, Sydney Medical School, Camperdown, Australia 3

Introduction The landscape of metastatic melanoma (MM) treatment has shifted with the use of immune checkpoint inhibitors, anti PD-1 and anti-CTLA-4 agents. Patients experience improved overall survival on treatment at the expense of undesirable side effects. A comprehensive supportive care assessment and tailored support program including exercise, diet, psychosocial support, and complementary therapies was explored in a feasibility study with patient experience. Objectives was to explore the experience of patients with stage IV melanoma who were receiving systemic treatment with pembrolizumab. Methods A pre-post-test feasibility study was conducted over 9 weeks. Qualitative interviews were conducted using semi-structured interviews. Interviews were audio-recorded and transcribed then managed in NVivo. Transcripts were analysed using a grounded theory approach with themes developed inductively. Results A total of 28 participants were recruited, 26 completed the qualitative interview. Participants described the experience of pembrolrolizumab treatment as innocuous, particularly when compared to their experience with other therapies. Patients reported fatigue, pain, dry mouth, but these were not troubling or interfering with their daily activities. The supportive care intervention was experienced as professional, friendly, and genuine interest in participant wellbeing. Personalised wholistic advice was valued by participants, particularly in explanations of symptoms and management strategies. Conclusions Side effects from pembrolizumab are present but reported to be minimal and manageable by this population. A supportive care intervention was valued and may add to participant wellbeing and ability to manage those side effects they do experience.

eP549 TOXICITY PROFILE OF L-ASPARAGINASE IN CHILDREN WITH ACUTE LYMPHOBLASTIC LEUKAEMIA - SINGLE CENTRE EXPERIENCE N. Kumaresa Pandian1, A. Shriram1, J. Xavier Scott1, L. Sneha M1, R. Shankar1 1 SRI RAMACHANDRA UNIVERSITY, Paediatrics, Chennai, India Introduction L-asparaginase is an integral component of treatment for patients with ALL. The effects of L-asparaginase on hemostasis and hyperlipidemia are less defined in children. Objectives To demonstrate the toxicity profile of L- Asparaginase specifically to evaluate hyperlipidemia and changes in coagulation and thrombotic risk. To study the differences in toxicities of L-Asparaginase between the two types of L-Asparaginase(E coli and Pegylated). Methods Children after the diagnosis with acute lymphoblastic leukemia underwent baseline investigations with Liver function tests, Lipase,PT,PTT,INR,Random blood sugar and Lipid profile prior to the onset of treatment and thereafter weekly during induction and re induction periods. Antithrombin III and fibrinogen were done twice during induction (day 15 and 29) and once during reinduction therapy (on day 22).

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Demographic data, clinical details, details of diagnosis, Laboratory values were recorded in a proforma. Analyzed data were analysed using SPSS 16.The study was approved by our institution ethics committee. Results 80 cases were included in this study. Type of L- Asparagine used were E coli Asparaginase (n-50) and Pegylated L Asparaginase (n- 30). Complications seen were elevated lipase level without any evidence of clinical pancreatitis 12.5%, Hyperglycemia 12.5%, hyperlipidemia 10%, Thrombosis 2.5%, Allergies 5.6%, e l e v a t e d P T / P T T 1 0 % ; L o w AT 3 ( 1 5 . 5 % ) a n d l o w fibrinogen(16.5%). There is no Statistical difference between the two groups of LAsparginase studied, however increase side effects were noted in Ecoli Asparaginase group. Conclusions Asparaginase is a critical component of ALL protocols, and hence it is important that data be available of all potential treatment-related toxicities.

eP550 RADIATION THERAPY ONCOLOGIC: WOMEN PROFILE WITH BREAST CANCER AND INFLUENCE OF VARIABLE SOCIODEMOGRAPHIC S. KAMEO1, P. MARINHO2, L.E. MACÊDO3, N. SAWADA4 1 UNIVERSITY FEDERAL OF SERGIPE, DEPARTAMENT OF HEALTH EDUCATION, LAGARTO, Brazil 2 HOSPITAL UNIVERSITY OF SERGIPE, SERVICE RELATED INFECTION CONTROL CARE, ARACAJU, Brazil 3 COMPLEX HOSPITAL MANOEL ANDRE CHAMA, RADIOTHERAPY, ARAPIRACA, Brazil 4 UNIVERSITY OF SÃO PAULO, FUNDAMENTAL NURSING DEPARTMENT, RIBEIRÃO PRETO, Brazil Introduction In Brazil, cancer is a disease with high incidence. Therefore, health professionals should know it. Objectives To describe the sociodemographic profile, clinical and therapeutic for people with breast cancer who underwent treatment with radiotherapy and to examine the association between sociodemographic variables with tumor staging, met in UNACON San Francisco in Arapiraca – Alagoas. Methods This was a retrospective study, quantitative, descriptive and exploratory, with secondary data on patients treated in 2015. Results There was a predominance of the age group 41-60 years (58.8%), brown (90.5%), married (53.9%), living in the state of Alagoas (92.1%), the interior state (92.1%), farmers (46%), with incomplete primary education (28%), with referral of the Unified Health System (78.6%), hypertension (37%), smokers (30.8 %), stage III (40.4%), all have received radiotherapy, and more chemotherapy (82%), surgery (79.7%). Conclusions Our results corroborate the literature on the influence of variables such as age, level of education, origin and diseases associated with advanced stage. Show the need for new strategies in the implementation of health policies on the primary and secondary prevention, in view of the large number of people diagnosed with advanced disease and expansion of treatment by the National Health System outside the national capital. Moreover, effective action to minimize the various disabilities to educational and behavioral level. More investments needed in order to a change in disease morbidity and mortality profile.

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eP551 ADVERSE EVENTS AFTER RADIOTHERAPY IN ONCOLOGY PATIENTS IN UNACON SAN FRANCISCO - ARAPIRACA / ALAGOAS S. KAMEO1, P. MARINHO2, L.E. MACÊDO3, N. SAWADA4 1 UNIVERSITY FEDERAL OF SERGIPE, DEPARTAMENT OF HEALTH EDUCATION, LAGARTO, Brazil 2 HOSPITAL UNIVERSITY OF SERGIPE, SERVICE RELATED INFECTION CONTROL CARE, ARACAJU, Brazil 3 COMPLEX HOSPITAL MANOEL ANDRE, RADIOTHERAPY, ARAPIRACA, Brazil 4 UNIVERSITY OF SÃO PAULO, NURSING FUNDAMENTAL, RIBEIRÃO PRETO, Brazil Introduction The health care must be specific to cancer patients and to know the incidence rates have great relevance. Objectives To describe the clinical and therapeutic characteristics, and adverse events related to treatment with radiation therapy, people with cancer treated at UNACON San Francisco in Arapiraca – Alagoas. Methods Retrospective study, quantitative, descriptive and exploratory, with secondary data on patients treated in 2015. Results The total are 373 patients, 200 women and 173 men who had compromised by cancer in the systems: genitourinary (63%), gastrointestinal (13%), head and neck (7%), cutaneous (6%), respiratory (4 %), skeletal muscle (3%) lymph (1%), neurological (1%). The most prevalent types of cancer were breast (24%), prostate (22%), cervix (11%), skin (6%), larynx, endometrium (3%) and pharynx, esophagus and rectum (2%). The treatment implemented, only 32% conducted radiotherapy, 23% associated with chemotherapy and radiotherapy and 45% had radiotherapy, chemotherapy and surgery. The adverse events reported (1356) including localized pain (14%), radio dermatitis (9%) and lack of appetite (8%) were the most prevalent. During the treatment week highest incidence second and third were both 19%. Of the patients who underwent RTX associated with QT, the most prevalent effect was loss of appetite (26%) and were more incidents 3rd week (40%) of treatment. Conclusions Adverse events caused by radiation oncology affect many patients, causing deficits in many organ systems, leaving the nurses take heed as the importance of developing and implementing nursing care focused on adverse reactions in order to perform adequate management for each patient

eP552 CHANGES IN THE MICROCIRCULATION OF THE ORAL MUCOSA ASSOCIATED WITH LATE IRRADIATION INJURY IN HEAD AND NECK CANCER PATIENTS IS MEASURED AT THE CHAIRSIDE R. Helmers1, D. Milstein1, J. Raber-Durlacher1, J. de Lange1 1 Academic Medical Center, Oral & Maxillofacial Surgery, Amsterdam, The Netherlands Introduction Radiotherapy compromises tissue vascularization and can produce late adverse effects such as osteoradionecrosis and mucosal ulcerations in the head and neck (HN) region. The novel CytoCam microscope system, incident dark-field illumination imaging, enables measurements of the oral microcirculation at the patient chairside. Objectives To determine the clinical feasibility of examining and measuring the oral microcirculation with the CytoCam in HN cancer patients with late irradiation injury.

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Methods In a case-control observational study, microcirculation recordings were obtained bilaterally from the mandibular gingiva and buccal mucosa in 20 HN cancer patients and 20 healthy age-matched controls. Tissue diffusion-related (oxygen/nutrient distribution capacity) and blood flow parameters (functional capillary density (FCD), blood vessel diameter (Øbv) and microvascular flow index (MFI) respectively) were analyzed. Results Mean buccal and gingival FCD in age-matched controls was 20±6 cpll/mm2 and 67±20 cpll/mm2 respectively. The mean Øbv of buccal microcirculation in healthy controls was 14±1 μm. A statistically significant larger mean Øbv (17±3 μm; p<0.001) in irradiated buccal mucosa and a decrease in mean FCD (31±14 cpll/mm2; p<0.001) in irradiated mandibular gingiva was found. There were no significant differences in mean buccal FCD or MFI. Conclusions Noninvasive chairside measurements of oral microcirculation in HN cancer patients, using CytoCam microscopy, was feasible for detecting marked pathophysiological alterations in microvascular densities and diameters between late irradiated and healthy tissues.

eP553 RETROSPECTIVE ANALYSIS OF CARDIOTOXICITY OF HER-2 TARGETED THERAPIES IN METASTATIC BREAST CANCER S. Ouhadj1, G. Binas2, J. Kamdar2, A. Jones3, R. Sheth4, A. GrahamDouglas4 1 Leaders in Oncology Care, Head of Pharmacy, London, United Kingdom 2 Leaders in Oncology Care, Oncology Medical Officer, London, United Kingdom 3 Leaders in Oncology Care, Breast Oncologist, London, United Kingdom 4 Leaders in Oncology Care, Senior Specialist Oncology Pharmacist, London, United Kingdom Introduction Trastuzumab, trastuzumab emtansine (TDM1) and pertuzumab are targeted therapies used routinely in 15-20% of breast cancer patients whose tumours overexpress HER-2. They are associated with cardiotoxicity, by causing direct cardiac dysfunction or inducing repolarisation abnormalities which can be measured as a left ventricular ejection fraction (LVEF) of <50% or a drop of >10%. Objectives The aim of this study is to analyse the variation in cardiotoxicity of these agents in the metastatic breast cancer setting to identify patients at risk of trastuzumab induced cardiotoxicity (TIC). Methods This retrospective analysis was conducted in 119 patients with HER-2 positive metastatic breast cancer, who received either trastuzumab (alone or in combination with pertuzumab) or TDM1 over a 2 year period. Collected data evaluated full medical history including prior exposure to anthracyclines, radiotherapy and ER and PR receptor status. Cardiotoxic occurrences including hypertension, pericarditis, thrombosis, LVEF pre- and post treatment were also recorded. Results

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Conclusions These results suggest a strong correlation between previous exposure to anthracyclines and a statistically significant correlation between exposure to radiotherapy and subsequent development of HER-2 receptor associated cardiotoxicity. There was no significant association in development of pericarditis or thrombosis. There was not enough data to suggest increased cardiotoxicity in patients receiving both pertuzumab and trastuzumab as a combination therapy as compared to trastuzumab alone and no cardiotoxicity was reported in patients receiving TDM1. However the results do point towards an increased number of patients developing hypertension during therapy with HER-2 agents requiring a closer evaluation and monitoring to prevent risks of cardiomyopathy.

eP554 POST MARKETING SURVEILLANCE OF NIMOTUZUMAB A NOVEL MONOCLONAL ANTIBODY IN INDIAN POPULATION D. Pawar1, S. Chaudhari2, B. PMS Study Group3 1 Biocon Limited, Medical Affairs and Clinical Development, Bangalore, India 2 Biocon Limited, Medical affairs, Bangalore, India 3 Biocon, Medical affairs, Bangalore, India Introduction Nimotuzumab is approved for head and neck cancer in India and has few incidences of toxicityl. Anti EGFR are known to produce severe toxicities including grade III / IV rashes. Objectives Present study is aimed to evaluate safety and tolerability of nimotuzumab in the real life clinical conditions. Methods Patients with head and neck cancer or any other tumour who were suitable for nimotuzumab therapy were included. All patients received 200mg nimotuzumab IV infusion weekly for six weeks along with SOC. All Patients who received the treatment were considered for the analysis. Results 75 AE were recorded for (24%) patients. The most common event was mucosal inflammation (44%).The adverse events were mild to moderate and 4 events were life threatening. One patient who died as a result of AE, had diarrhea and leucopenia (both grade 3,) probably had immunosuppression followed by infection due to chemotherapy. Six (8%) events were reported to related to nimotuzumab alone whereas 4 (5.33%) events were reported to be related to nimotuzumab, CT and RT. Among the events reported to be related to nimotuzumab alone, there were 2 events of mild hypotension, one event of pyrexia (grade 3, recovered completely), one event each of pruritis (grade 2, recovered completely), vesicular rash (grade 3, recovered completely) and rash (grade 4). Rash due to nimotuzumab were seen in only 2(1.3%) patients who developed 2 events of rash in them Conclusions Nimotuzumab is found to be safe with no major safety issues and the lower incidences of rash compared to other EGFR Inhibitors

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eP555 F I R S T- L I N E R I B O C I C L I B + L E T R O Z O L E I N P O S T M E N O PA U S A L W O M E N W I T H H O R M O N E RECEPTOR–POSITIVE (HR+), HER2− ADVANCED BREAST CANCER (ABC): MONALEESA-2 SAFETY RESULTS W. Janni1, H. Burris2, L. Hart3, A. Chan4, A. Nusch5, O. Burdaeva6, D. Yardley7, T. Bachelot8, M. Gil-Gil9, D. Richards10, J. Sparano11, J. Kattan12, F. Karak13, S. Sutradhar14, M. Miller14, P. Conte15 1 Universitätsklinikum Ulm, Ulm, Germany 2 Sarah Cannon Research Institute, Nashville, TN 3 Florida Cancer Specialists & Research Institute/Sarah Cannon Research Institute, Fort Myers, FL 4 Breast Cancer Research Centre WA & Curtin University, Perth, Australia 5 Onkologische Praxis, Velbert, Germany 6 Arkhangelsk Regional Clinical Oncology Dispensary, Arkhangelsk, Russia 7 Sarah Cannon Research Institute, Tennessee Oncology, Nashville, TN 8 Centre Léon Bérard, Lyon, France 9 Institut Català d’Oncologia, L’Hospitalet de Llobregat, Barcelona, Spain 10 Texas Oncology, Tyler, TX 11 Montefiore Medical Center, Bronx, NY, USA 12 Hotel Dieu de France Hospital, Beirut, Lebanon 13 Bellevue Medical Center, Mansourieh, Lebanon 14 Novartis Pharmaceuticals Corporation, East Hanover, NJ 15 University of Padova and Istituto Oncologico Veneto, IRCCS, Padova, Italy Introduction In the randomized Phase 3 MONALEESA-2 study (NCT01958021), first-line ribociclib (600 mg/d; 3-weeks-on/1-week-off regimen) +

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letrozole (2.5 mg/d) in postmenopausal women with HR+, HER2− ABC significantly prolonged progression-free survival vs placebo + letrozole (hazard ratio, 0.556; P=0.00000329). Objectives To present safety analyses from MONALEESA-2. Methods Analyses of adverse events (AEs) included time to first event, duration, and frequency of associated dose interruptions or reductions. Results The safety analysis included 664 patients (ribociclib + letrozole, n=334; placebo + letrozole, n=330; Table). Neutropenia was the most common grade 3/4 AE, but febrile neutropenia was infrequent (ribociclib arm, 1.5%) with no associated deaths. Other Grade 3/4 AEs with ≥5% increase in the ribociclib arm included leukopenia (21%), elevated alanine aminotransferase (ALT; 9%), lymphopenia (7%), and elevated aspartate aminotransferase (AST; 6%); each AE occurred in 1% in the placebo arm. Grade 3/4 neutropenia led to dose interruptions in 48% vs <1% and reductions in 30% vs 0% in the ribociclib vs placebo arms. Median time to first event for Grade ≥2 neutropenia in the ribociclib arm (based on neutrophil counts) was 16 days. Discontinuations due to AEs occurred in 7.5% vs 2.1% in the ribociclib vs placebo arms, most commonly (>1%) elevated ALT (5% vs <1%), elevated AST (3% vs 1%), and vomiting (2% vs 0%).

Conclusions First-line ribociclib + letrozole had a manageable safety profile in postmenopausal women with HR+, HER2− ABC. Transient neutropenia was the most common AE in the ribociclib arm and was easily reversible with dose modifications.